Rheumatoid Arthritis, Depression, and Suicide Prevention
Today, September 10, is World Suicide Prevention Day which ends Suicide Prevention Week. Here on MyRACentral, we often discuss the pain which comes with RA, but we don’t often discuss depression which is a common comorbidity.
In preparation for this post, I read lots of websites and articles regarding suicide. There is much information available, but all of that doesn’t do any good if the right people don’t get that information at the right time. Each person in our society needs to become aware of the subtle signals and learn how to best help the person who might be having suicidal thoughts.
Fortunately, some of our writers here at HealthCentral have already tackled the subject from different approaches. So rather than repeat what they’ve said, I’d like for us to talk more personally on the subject. Are you up for it?
Vicki Bridges - Suicide and Multiple Sclerosis
Merely Me - How to Prevent Suicide
Nancy Harris Bonk - Migraine and Suicide Prevention
Before we begin, let’s review what the warning signs of suicide are. The American Association of Suicidology, sponsors of Suicide Prevention Week, have reduced the most common symptoms of suicide into an easy-to-remember mnemonic. IS PATH WARM?
(I) Ideation, (S) Substance Abuse
(P) Purposelessness, (A) Anxiety, (T) Trapped, (H) Hopelessness
(W) Withdrawal, (A) Anger, (R) Recklessness, (M) Mood Changes
Here’s another way of thinking of these signs and symptoms.
• Increased substance (alcohol or drug) use
• No reason for living; no sense of purpose in life
• Anxiety, agitation, unable to sleep or sleeping all the time
• Feeling trapped - like there’s no way out
• Withdrawal from friends, family and society
• Rage, uncontrolled anger, seeking revenge
• Acting reckless or engaging in risky activities, seemingly without thinking
• Dramatic mood changes.
Suicide.org lists additional warning signs of suicide. If you experience any of the thoughts or behaviors listed above, please seek help. Reach out. Call someone. Do not act upon an impulse which cannot be retracted.
Call a hotline at 1-800-273-TALK (1-800-273-8255) or 1-800-SUICIDE (1-800-784-2433) in the US; 08457 90 90 90 in the United Kingdom; 1850 60 90 90 in Ireland; or find your local helpline anywhere in the world at befrienders.org.
So how does suicide relate to living with rheumatoid arthritis?
We experience chronic pain at a higher rate than the general public. We experience depression at a higher rate than the general public. When the disease is active and chips away at our quality of life, we can begin to feel hopeless or anxious about the future. Living with a chronic progressive, painful, and debilitating disease is not easy.
But it’s more than just saying that RA and depression go hand-in-hand. In a 2000 study, researchers found that depression associated with progressive physical (neurological) illness may lead to suicidal ideation and rheumatoid arthritis is the most prevalent chronic inflammatory musculoskeletal disease.
Their studies indicated that overall almost 11 percent of RA patients experience suicidal ideation. However, of those patients reporting depression, 30 percent experience suicidal ideation. See “Suicidal ideation in patients with rheumatoid arthritis: Research may help identify patients at high risk.”
In another study, researchers found that comorbid depressive disorders preceded suicides in 90 percent of the female RA patients. Before their suicide, 50 percent of the female RA patients (vs 11 percent of the male RA patients) had experienced at least one suicide attempt and the method of suicide was violent in 90 percent of the RA females. See “Suicides in persons suffering from rheumatoid arthritis.”
The Johns Hopkins Arthritis Center shares that:
Depression is not simply a comorbid condition but interacts with chronic pain to increase morbidity and mortality.
Depressed chronic pain patients report greater pain intensity, less life control, and more use of passive-avoidant coping strategies. They also describe greater interference from pain and exhibit more pain behaviors than chronic pain patients without depression. In patients with rheumatoid arthritis, depressive symptoms were significantly associated with negative health and functional outcomes as well as increased health services utilization. (see webpage for references)
The consequences of unrecognized and untreated major depression are substantial. The most severe consequence of major depression is suicide. For example, patients suffering from chronic pain syndromes including migraine, chronic abdominal pain, and orthopaedic pain syndromes report increased rates of suicidal ideation, suicide attempts, and suicide completion.
Questions for Discussion:
As a person living with rheumatoid arthritis, do you also experience depression? Have you ever felt hopeless or that life is out of your control? Have you ever thought about suicide? If so, what have you done to overcome those thoughts?
I will share that I’ve experienced depression for many more years than I’ve had MS or RA. Over those years, I would not have thought myself suicidal. However after working with a therapist, I realize that some of my thoughts and behaviors were subtle warning signs. Signs of severe depression that I did not recognize as potentially suicidal warning signs.
Fortunately for me, I sought medical help from mental health professionals. I’ve been on two different antidepressant medications for almost 15 years now without which I could not function. It is important to care for all aspects of your physical, mental, and emotional well-being. Seek help, no matter the cause of disease or discomfort.
Also, reach out. Share your stories. You just might say the one thing which helps yourself and another human being. It is worth it.