Increased Risk of Suicide Attempts in Alopecia Areata Patients

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Patients with alopecia areata (AA) have an increased risk for suicide attempts regardless of concurrent psychiatric disorders, according to a new study published in Dermatology.

Researchers used data from the National Health Insurance Research Database in Taiwan to conduct a nationwide, population-based, cohort study to evaluate the association between AA and suicidality.

Eligible participants were aged 10 years and older and received an AA diagnosis between January 1, 1997 and December 31, 2013. For each participant with AA, 10 matched control participants were randomly selected and included.

The primary outcome was the first suicide attempt, which was based on the codes for suicide attempts and nonaccidental poisoning by medical and nonmedical substances. Cox proportional hazard regression analysis was used to determine the independent association between covariates and suicide attempts.

The cohort included 10,515 patients with AA and 105,150 control individuals matched for age, sex, monthly insurance premium, residence, and comorbidities. Participants’ median age was 33 (IQR, 24.0-44.0) years, and 51.2% were women.

Participants in the AA group had a higher Charlson comorbidity index, a longer duration of systemic corticosteroid use, and more annual outpatient visits (P <.0001) compared with the control group. The total follow-up duration was 73,573 person-years for the AA group and 739,408 person-years for the control group.

Among participants in the AA group, the overall incidence rate of suicide attempts was 82.91 cases per 100,000 person-years, compared with 10.95 cases per 100,000 person-years among those in the control group. After controlling for age, sex, monthly insurance premium cost, residence, comorbidities, steroid prescriptions, and annual outpatient clinic visits, patients with AA still had an increased risk for suicide attempts vs control individuals (adjusted hazard ratio [aHR], 6.28; 95% CI, 4.47-8.81).

Other risk factors for suicide attempts were associated with age, monthly insurance premium cost (≥$801 vs $0-$500), urbanization of residence, major depressive disorder, substance use disorder, alcohol use disorder, and annual outpatient visits (≥10 times vs <5 times).

Limitations of the study include the lack of detailed diagnostic classifications regarding the characteristics of patients with AA, including severity, disease subtype, and presence of nail changes, and the omission of some potential confounders from the database. Study authors recommend further studies to explore the pathophysiology of the association between AA and suicidality.

Another recent study found that certain biomarkers such as vitamin D and serum brain-derived neurotrophic factors (BDNF) play a role in the development of depression in patients with alopecia areata. In 2022, the House of Representatives passed an amendment introduced by Congresswoman Ayanna Pressley (MA-07) to require the Department of Health and Human Services to study the suicide crisis among children living with chronic illnesses and conditions, including auto-immune diseases like alopecia.

Reference:

Wang LH, Ma S-H, Tai Y-H, et al. Increased risk of suicide attempt in patients with alopecia areata: a nationwide population-based cohort study. Dermatology. Published online March 15, 2023. Accessed April 24, 2023. doi:10.1159/000530076