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Comment
. 2019 Oct;181(4):717-721.
doi: 10.1111/bjd.18108. Epub 2019 Aug 1.

Suicidality and risk of suicidality in psoriasis: a critical appraisal of two systematic reviews and meta-analyses

U Matterne  1 , S E Baumeister  2   3 , C J Apfelbacher  1
Affiliations
Comment

Suicidality and risk of suicidality in psoriasis: a critical appraisal of two systematic reviews and meta-analyses

U Matterne et al. Br J Dermatol. 2019 Oct.

Abstract

Aim: Chi et al.1 and Singh et al.2 each conducted a systematic review and meta-analysis of observational studies examining the relationship between suicidality and psoriasis.

Setting and design: Chi et al. included only cohort studies while Singh et al. included cohort, cross-sectional and case-control studies.

Primary exposure and outcome: The primary outcome, suicidality, was assessed in people with psoriasis (exposure) and people without psoriasis. Analyses were separated for suicidal ideation and behaviour.

Results: Chi et al. included five population-based cohort studies that were considered to be of high quality according to the Newcastle-Ottawa Scale (NOS). They found no significant increase in the risk of suicide [risk ratio (RR) 1·13, 95% confidence interval (CI) 0·87-1·46], suicide attempt (RR 1·25, 95% CI 0·89-1·75) or suicidality (RR 1·26, 95% CI 0·97-1·64) among people with psoriasis. Singh et al. included 18 studies that were rated to be of medium quality to high quality according to the NOS. They found a pooled odds ratio (OR) of 2·05 (95% CI 1·54-2·74) for suicidal ideation among patients with psoriasis. For suicidal behaviours (combined attempted and completed suicides) a pooled OR of 1·26 (95% CI 1·13-1·40) was obtained, suggesting a higher risk of these behaviours in people with psoriasis. Subgroup analysis showed that patients with psoriasis were more likely to attempt suicide (OR 1·32, 95% CI 1·14-1·54) and complete suicide (OR 1·20, 95% CI 1·04-1·39) than those without psoriasis.

Conclusions: Singh et al. concluded that patients with psoriasis have a significantly higher risk of suicidal ideation, suicide attempts and completed suicides, while Chi et al. concluded that the available, limited, very low-quality evidence does not support the notion of an association between psoriasis on the one hand, and suicide, suicidal ideation and suicide attempts on the other.

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References

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