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Eczema and subsequent suicide: a matched case–control study
  1. Aaron Mark Drucker1,2,3,
  2. Deva Thiruchelvam4,
  3. Donald A Redelmeier4,5,6,7
  1. 1 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2 Division of Dermatology, Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada
  3. 3 Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
  4. 4 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  5. 5 Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  6. 6 Evaluative Clinical Science Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
  7. 7 Center for Leading Injury Prevention Practice Education & Research, Toronto, Ontario, Canada
  1. Correspondence to Dr Aaron Mark Drucker; aaron.drucker{at}wchospital.ca

Abstract

Objective To assess the association of eczema with a patient’s subsequent risk of death from suicide. We hypothesised that persistent eczema would be associated with an increased risk for death from suicide.

Design Double matched case–control study.

Setting General population of Ontario, Canada.

Participants Patients 15–55 years old. We identified cases of suicide from coroners’ reports between 1 January 1994 and 31 December 2014 and matched 1:2 with alive controls based on age, sex and socioeconomic status.

Exposure The primary predictor was a history of persistent eczema, defined as five or more physician visits for the diagnosis over the preceding 5 years.

Main outcome and measure Logistic regression to estimate the association between eczema and death from suicide.

Results We identified 18 441 cases of suicide matched to 36 882 controls over the 21-year accrual period. Persistent eczema occurred in 174 (0.94%) suicide cases and 285 (0.77%) controls yielding a 22% increased risk of suicide associated with persistent eczema (OR 1.22, 95% CI 1.01 to 1.48, p=0.037). In mediation analyses, this association was largely explained through major suicide risk factors. Two-thirds of patients with eczema who died from suicide had visited a physician in the month before their death and one in eight had visited for eczema in the month before their death. Among patients who died by suicide, jumping and poisoning were relatively more frequent mechanisms among patients with eczema.

Conclusions Patients with persistent eczema have a modestly increased subsequent risk of death from suicide, but this is not independent of overall mental health and the absolute risk is low. Physicians caring for these patients have opportunities to intervene for suicide prevention.

  • dermatological epidemiology
  • eczema
  • epidemiology

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Footnotes

  • Contributors AMD and DAR designed and obtained funding for the study. DT performed data analysis. AMD drafted the manuscript and all authors contributed to critical revision of the manuscript. DAR accepts full responsibility for the work, the conduct of the study, had access to the data, and the decision to publish. AMD attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding This study was supported in part by research grants from the National Eczema Association and Eczema Society of Canada. DAR receives funding from the Government of Canada through a Canada Research Chair in Medical Decision Sciences. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

  • Disclaimer The funders had no role in the design, conduct or decision to publish this study. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources.

  • Competing interests AMD served as an investigator and has received research funding from Sanofi and Regeneron and has been a consultant for Sanofi, RTI Health Solutions, Eczema Society of Canada and the Canadian Agency for Drugs and Technologies in Health. He has received honoraria from Astellas Canada, Prime, Spire Learning, CME Outfitters and Eczema Society of Canada.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Institute for Clinical Evaluative Sciences (ICES) and the Women’s College Hospital Research Ethics Board deemed the work exempt from supplementary ethics review.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There is no plan to share raw data from this study.

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