@article{ref1,
title="Rheumatological conditions as risk factors for self-harm: a retrospective cohort study",
journal="Arthritis care and research (2010)",
year="2020",
author="Prior, James A. and Paskins, Zoe and Whittle, Rebecca and Abdul-Sultan, Alyshah and Chew-Graham, Carolyn A. and Muller, Sara and Bajpai, Ram and Shepherd, Tom A. and Sumathipala, Athula and Mallen, Christian D.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVE: To examine the risk of self-harm in rheumatological conditions   METHODS: Retrospective cohort study using data from the Clinical Practice Research Datalink. Patients with ankylosing spondylitis, fibromyalgia, osteoarthritis or rheumatoid arthritis were identified between 1990-2016 and matched to patients without these conditions. Incident self-harm was defined by medical record codes following a rheumatological diagnosis. Incidence rates (per 10,000 person-years(PY)) were reported for each condition, both overall and year-on-year(2000-2016). Cox regression analysis determined risk (hazard ratios(HR), 95% confidence interval(CI)) of self-harm for each rheumatological cohort compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by age and gender. Due to non-proportionality over time, osteoarthritis was also stratified by disease duration(<1 year, ≥1-<5 years, ≥5-<10 years, ≥10 years).   RESULTS: Incidence of self-harm was highest in patients with fibromyalgia (25.12 (95%CI 22.45,28.11) per 10,000 PY) and lowest for osteoarthritis (6.48 (6.20, 6.76)). There was a crude association with each rheumatological condition and self-harm, except for ankylosing spondylitis. Though attenuated, these associations remained after adjustment for fibromyalgia (HR 2.06(95%CI 1.60,2.65)), rheumatoid arthritis (1.59(1.20,2.11)) and osteoarthritis (1-<5years: 1.12 (1.01,1.24); ≥5-<10 years: 1.35 (1.18,1.54)). Age and gender were weak effect modifiers for these associations.   CONCLUSIONS: Primary care patients with fibromyalgia, osteoarthritis or rheumatoid arthritis (but not ankylosing spondylitis) are at increased risk of self-harm compared to people without these rheumatological conditions. Clinicians need to be aware of the potential for self-harm in patients with rheumatological conditions (particularly fibromyalgia), explore mood and risk with them, and offer appropriate support and management.<p /> <p>Language: en</p>",
language="en",
issn="2151-464X",
doi="10.1002/acr.24345",
url="http://dx.doi.org/10.1002/acr.24345"
}