Completed suicide in patients with skin disease: A systematic review and meta-analysis

Abstract

Background: Several skin diseases have been associated with suicidality. However, the term ‘suicidality’ encompasses ideation, which weakens the conclusions. In contrast, the much stronger endpoint of completed suicide and skin disease remains ambiguous. Objectives: To determine the risk of completed suicide in adult patients with skin diseases. Methods: The Pubmed, Embase and PsycINFO databases were performed from inception up to June 2023. All original studies in English with a minimum of 10 adult patients that assessed the relationship between a skin disease and death by suicide, were eligible for inclusion. Results: Thirty-seven met the inclusion criteria. Owing to expected interstudy variations, a random effects model was used. A total of 13 skin diseases were identified: 17 population-based high-quality studies, 3,800,748 patients with skin disease, and 33,722,675+ controls were included in the meta-analysis (MA). Each skin disease was analysed separately. Psoriasis: six studies were included in the MA (odds ratio (OR): 1.42, 95% confidence interval (CI) (0.76; 2.68) and found no association. Dermatitis: five studies were included in the MA OR: 1.54, 95% CI (0.57; 4.17) and found no association. Melanoma: four studies were included in the MA, which found an association between melanoma and suicide Standardized mortality rate (SMR): 2.89, 95% CI (1.97; 3.81). Non-melanoma skin cancer: two studies were included in the MA; female patients showed an increased risk of completed suicide compared to the control group SMR: 1.30, 95% CI (1.12; 1.49). In patients with hidradenitis suppurativa, two studies were included in the MA OR: 2.86, 95% CI (1.56; 5.24) and showed a positive association between HS and completed suicide. Conclusions: Suicidality should be considered by physicians when treating dermatological disease, especially when treating patients with hidradenitis suppurativa and melanoma. The association between other skin diseases and completed suicide remains unclear, and further research is indicated.