Suicide and Suicidality in Children and Adolescents with Chronic Skin Disorders: A Systematic Review
DOI:
https://doi.org/10.2340/actadv.v102.1502Keywords:
adolescence, chronic skin disease, childhood, paediatric, suicide, systematic reviewAbstract
Suicide in young children is rare; the incidence increases towards the end of adolescence. Skin disorders confer a high prevalence of psychiatric and psychological comorbidities. However, published research on suicidal behaviour in adolescents and children with skin disorders is sparse. The aim of this study was to identify the prevalence of suicidal behaviour in children and adolescents under 18 years of age with chronic skin disorders and associated contributing risk factors. MEDLINE, PsycINFO, EMBASE, CINAHL and Cochrane databases were searched from inception to October 2020 for suicide or suicide attempts in patients under 18 years old with chronic skin disorders. The study protocol was logged on PROSPERO (CRD42020083528). Returned texts were reviewed independently by 2 authors. Bias was assessed according to Joanna Briggs Institute criteria. Five studies met the inclusion criteria; 4 cross-sectional surveys and 1 retrospective matched-cohort study. A total of 31,641 patients with acne, atopic dermatitis, body dysmorphic disorder or psoriasis were identified. Prevalence of suicidal ideation was 0.45% (psoriasis) to 67% (body dysmorphic disorder). The prevalence of suicidal attempts ranged from 0.08% (psoriasis) to 21.9% (acne). Patients with acne or atopic dermatitis had significantly increased odds ratio for suicidal attempts. Meta-analysis could not be performed owing to the heterogeneity and sparsity of data. Suicidal risk in skin disorders amongst adolescents and children under the age of 18 years old is broad and complex. The suicidal risk remained after adjusting for depression, suggestive of an alternative mechanism.
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References
Gray D, Coon H, McGlade E, Callor WB, Byrd J, Viskochil J, et al. Comparative analysis of suicide, accidental, and undetermined cause of death classification. Suicide Life Threat Behav 2014; 44: 304-316.
https://doi.org/10.1111/sltb.12079 DOI: https://doi.org/10.1111/sltb.12079
Appleby L, Kapur N, Shaw J, Hunt IM, Flynn S, Ibrahim S, et al. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Making Mental Health Care Safer: Annual Report and 20-year Review. University of Manchester; 2016 [Cited 2022 March 12]. Available from: https://documents.manchester.ac.uk/display.aspx?DocID=37580.
Odd D, Williams T, Appleby L, Gunnell D, Luyt K. Child suicide rates during the COVID-19 pandemic in England. J Affect Disord Rep 2021; 6: 1-6.
https://doi.org/10.1016/j.jadr.2021.100273 DOI: https://doi.org/10.1016/j.jadr.2021.100273
Miron O, Yu KH, Wilf-Miron R, Kohane IS. Suicide Rates Among Adolescents and Young Adults in the United States, 2000-2017. JAMA 2019; 321: 2362-2364.
https://doi.org/10.1001/jama.2019.5054 DOI: https://doi.org/10.1001/jama.2019.5054
Suicide in the world: global health estimates [Internet]. World Health Organisation; 2019 [Cited 2022 March 12]. Available from: https://apps.who.int/iris/handle/10665/326948.
Kyu HH, Stein CE, Pinto CB, Rakovac I, Weber MW, Purnat TD, et al. Causes of death among children aged 5-14 years in the WHO European Region: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Child Adolesc Health 2018; 2: 321-337.
https://doi.org/10.1016/S2352-4642(18)30095-6 DOI: https://doi.org/10.1016/S2352-4642(18)30095-6
Geulayov G, Casey D, McDonald KC, Foster P, Pritchard K, Wells C, et al. Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study. Lancet Psychiatry 2018; 5: 167-174.
https://doi.org/10.1016/S2215-0366(17)30478-9 DOI: https://doi.org/10.1016/S2215-0366(17)30478-9
Jafferany M, Pastolero P. Psychiatric and Psychological Impact of Chronic Skin Disease. Prim Care Companion CNS Disord 2018; 26: 17nr02247.
https://doi.org/10.4088/PCC.17nr02247 DOI: https://doi.org/10.4088/PCC.17nr02247
Gupta MA, Gupta AK, Ellis CN, Koblenzer CS. Psychiatric evaluation of the dermatology patient. Dermatol Clin 2005; 23: 591-599.
https://doi.org/10.1016/j.det.2005.05.005 DOI: https://doi.org/10.1016/j.det.2005.05.005
Fergusson DM, Woodward LJ, Horwood LJ. Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychol Med 2000; 30: 23-39.
https://doi.org/10.1017/S003329179900135X DOI: https://doi.org/10.1017/S003329179900135X
Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Chapter 7: Systematic reviews of etiology and risk. JBI Manual for Evidence Synthesis. 2020. Available from https://synthesismanual.jbi.global.
https://doi.org/10.46658/JBIRM-17-06 DOI: https://doi.org/10.46658/JBIRM-17-06
Purvis D, Robinson E, Merry S, Watson P. Acne, anxiety, depression and suicide in teenagers: A cross-sectional survey of New Zealand secondary school students. J Paediatr Child Health 2006; 42: 793-796.
https://doi.org/10.1111/j.1440-1754.2006.00979.x DOI: https://doi.org/10.1111/j.1440-1754.2006.00979.x
Bachmann C, Grabarkiewicz J, Theisen FM, Remschmidt H. Isotretinoin, depression and suicide ideation in an adolescent boy. Pharmacopsychiatry 2007; 40: 128.
https://doi.org/10.1055/s-2007-972575 DOI: https://doi.org/10.1055/s-2007-972575
Schaffer LC, Schaffer CB, Hunter S, Miller A. Psychiatric reactions to isotretinoin in patients with bipolar disorder. J Affect Disord 2010; 122: 306-308.
https://doi.org/10.1016/j.jad.2009.09.005 DOI: https://doi.org/10.1016/j.jad.2009.09.005
Jick SS, Kremers HM, Vasilakis-Scaramozza C. Isotretinion use and risk of depression, psychotic symptoms, suicide, and attempted suicide. Arch Dermatol 2000; 136: 1231-1236.
https://doi.org/10.1001/archderm.136.10.1231 DOI: https://doi.org/10.1001/archderm.136.10.1231
Nevoralová Z, Dvořáková D. Mood changes, depression and suicide risk during isotretinoin treatment: A prospective study. Int J Dermatol 2013; 52: 163-168.
https://doi.org/10.1111/j.1365-4632.2011.05334.x DOI: https://doi.org/10.1111/j.1365-4632.2011.05334.x
Droitcourt C, Nowak E, Rault C, Happe A, Nautout BL, Kerbrat S, et al. Risk of suicide attempt associated with isotretinoin: a nationwide cohort and nested case-time-control study. Int J Epidemiol 2019; 48: 1623-1635.
https://doi.org/10.1093/ije/dyz093 DOI: https://doi.org/10.1093/ije/dyz093
Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol 1998; 139: 846-850.
https://doi.org/10.1046/j.1365-2133.1998.02511.x DOI: https://doi.org/10.1046/j.1365-2133.1998.02511.x
Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol 2006; 54: 420-426.
https://doi.org/10.1016/j.jaad.2005.11.1103 DOI: https://doi.org/10.1016/j.jaad.2005.11.1103
Rehn LMH, Meririnne E, Höök-Nikanne J, Isometsä E, Henriksson M. Depressive symptoms, suicidal ideation and acne: a study of male Finnish conscripts. J Eur Acad Dermatol Venereol 2008; 22: 561-567.
https://doi.org/10.1111/j.1468-3083.2007.02514.x DOI: https://doi.org/10.1111/j.1468-3083.2007.02514.x
Noh HM, Cho JJ, Park YS, Kim JH. The relationship between suicidal behaviors and atopic dermatitis in Korean adolescents. J Health Psychol 2016; 21: 2183-2194.
https://doi.org/10.1177/1359105315572453 DOI: https://doi.org/10.1177/1359105315572453
Lee S, Shin A. Association of atopic dermatitis with depressive symptoms and suicidal behaviors among adolescents in Korea: The 2013 Korean Youth Risk Behavior Survey. BMC Psychiatry 2017; 17: 3.
https://doi.org/10.1186/s12888-016-1160-7 DOI: https://doi.org/10.1186/s12888-016-1160-7
Kimata H. Prevalence of suicidal ideation in patients with atopic dermatitis. Suicide Life Threat Behav 2006; 36: 120-124.
https://doi.org/10.1521/suli.2006.36.1.120 DOI: https://doi.org/10.1521/suli.2006.36.1.120
Khandaker GM, Zammit S, Lewis G, Jones PB. A population-based study of atopic disorders and inflammatory markers in childhood before psychotic experiences in adolescence. Schizophr Res 2014; 152: 139-145.
https://doi.org/10.1016/j.schres.2013.09.021 DOI: https://doi.org/10.1016/j.schres.2013.09.021
Wamboldt MZ, Hewitt JK, Schmitz S, Wamboldt FS, Räsänen M, Koskenvuo M, et al. Familial association between allergic disorders and depression in adult Finnish twins. Am J Med Genet 2000; 96: 146-153.
https://doi.org/10.1002/(SICI)1096-8628(20000403)96:2<146::AID-AJMG4>3.0.CO;2-J DOI: https://doi.org/10.1002/(SICI)1096-8628(20000403)96:2<146::AID-AJMG4>3.0.CO;2-J
Gupta MA, Pur DR, Vujcic B, Gupta AK. Suicidal behaviors in the dermatology patient. Clin Dermatol 2017; 35: 302-311.
https://doi.org/10.1016/j.clindermatol.2017.01.006 DOI: https://doi.org/10.1016/j.clindermatol.2017.01.006
Milch W, Wildt BT, Dieris B, et al. Suicidal ideation in adult patients with atopic dermatitis: a German cross-sectional study. Acta Derm Venereol 2017; 97: 1189-1195.
https://doi.org/10.2340/00015555-2741 DOI: https://doi.org/10.2340/00015555-2741
Sandhu JK, Wu KK, Bui TL, Armstrong AW. Association between atopic dermatitis and suicidality: a systematic review and meta-analysis. JAMA Dermatology 2019; 155: 178-187.
https://doi.org/10.1001/jamadermatol.2018.4566 DOI: https://doi.org/10.1001/jamadermatol.2018.4566
Albertini RS, Phillips KA. Thirty-three cases of body dysmorphic disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry 1999; 38: 453-459.
https://doi.org/10.1097/00004583-199904000-00019 DOI: https://doi.org/10.1097/00004583-199904000-00019
Phillips KA, Didie ER, Menard W, Pagano ME, Fay C, Weisberg RB. Clinical features of body dysmorphic disorder in adolescents and adults. Psychiatry Res 2006; 141: 305-314.
https://doi.org/10.1016/j.psychres.2005.09.014 DOI: https://doi.org/10.1016/j.psychres.2005.09.014
Pellegrini L, Maietti E, Rucci P, Burato S, Menchetti M, Berardi D, et al. Suicidality in patients with obsessive-compulsive and related disorders (OCRDs): A meta-analysis. Compr Psychiatry 2021; 108: 152246.
https://doi.org/10.1016/j.comppsych.2021.152246 DOI: https://doi.org/10.1016/j.comppsych.2021.152246
Kimball AB, Wu EQ, Guérin A, Yu AP, Tsaneva M, Gupta SR, et al. Risks of developing psychiatric disorders in pediatric patients with psoriasis. J Am Acad Dermatol 2012; 67: 651-657.
https://doi.org/10.1016/j.jaad.2011.11.948 DOI: https://doi.org/10.1016/j.jaad.2011.11.948
Egeberg A, Hansen PR, Gislason GH, Skov L, Mallbris L. Risk of self-harm and nonfatal suicide attempts, and completed suicide in patients with psoriasis: a population-based cohort study. Br J Dermatol 2016; 175: 493-500.
https://doi.org/10.1111/bjd.14633 DOI: https://doi.org/10.1111/bjd.14633
Sinclair RD. Alopecia areata and suicide of children. Med J Aust 2014; 200: 145.
https://doi.org/10.5694/mja13.10895 DOI: https://doi.org/10.5694/mja13.10895
Halvorsen JA, Dalgard F, Thoresen M, Bjertness E, Lien L. Itch and pain in adolescents are associated with suicidal ideation: A population-based cross-sectional study. Acta Derm Venereol 2012; 92: 543-546.
https://doi.org/10.2340/00015555-1251 DOI: https://doi.org/10.2340/00015555-1251
Tariq MM, Streeten EA, Smith HA, Sleemi A, Khabazghazvini B, Vaswani D, et al.Vitamin D: a potential role in reducing suicide risk? Int J Adolesc Med Health 2011; 23: 157-165.
https://doi.org/10.1515/ijamh.2011.038 DOI: https://doi.org/10.1515/ijamh.2011.038
Carroll ST, Riffenburgh RH, Roberts TA, Myhre EB. Tattoos and body piercings as indicators of adolescent risk-taking behaviors. Pediatrics 2002; 109: 1021-1027.
https://doi.org/10.1542/peds.109.6.1021 DOI: https://doi.org/10.1542/peds.109.6.1021
Guy GP, Berkowitz Z, Tai E, Holman DM, Jones SE, Richardson LC. Indoor tanning among high school students in the United States, 2009 and 2011. JAMA Dermatology 2014; 150: 501-511.
https://doi.org/10.1001/jamadermatol.2013.7124 DOI: https://doi.org/10.1001/jamadermatol.2013.7124
Yan W-J, Jiang C-L, Su W-J. Life in the flame: Inflammation sounds the alarm for suicide risk. Brain Behav Immun Health 2021; 31: 100250.
https://doi.org/10.1016/j.bbih.2021.100250 DOI: https://doi.org/10.1016/j.bbih.2021.100250
Batty GD, Bell S, Stamatakis E, Kivimäki M. Association of systemic inflammation with risk of completed suicide in the general population. JAMA Psychiatry 2016; 73: 993-995.
https://doi.org/10.1001/jamapsychiatry.2016.1805 DOI: https://doi.org/10.1001/jamapsychiatry.2016.1805
Debnath M, Berk M, Maes M. Changing dynamics of psychoneuroimmunology during the COVID-19 pandemic. Brain Behav Immun Health 2020; 5: 100096.
https://doi.org/10.1016/j.bbih.2020.100096 DOI: https://doi.org/10.1016/j.bbih.2020.100096
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