Suicide attempts in patients with systemic lupus erythematosus

Background: Suicide and suicide attempts, although well recognised in patients with systemic lupus erythematosus (SLE), have been commented on relatively little. Objective: To obtain a better understanding of the reasons for suicidal behaviour in patients with SLE. Methods: The records of 300 patients with SLE were reviewed to identify completed or attempted suicides. Results: Five patients made seven attempts at suicide over a 20 year follow up period, one of them was fatal. All of those attempting suicide had a history of neuropsychiatric SLE (NPSLE) presenting with depression and they made the attempts soon after the onset of NPSLE (median time 12.5 months). Two patients had appreciable disease activity at the time of the suicide attempt. Lymphopenia was present in five suicide attempts. Anti-SSA/Ro antibodies were detected in three patients, none of whom had anti-SSb/La. All patients apart from one responded to treatment for depression, the remaining female patient made two subsequent suicide attempts, with a fatal outcome despite intensive treatment. Conclusion: Greater awareness of the risk of suicide in patients with psychiatric manifestations of SLE may help to reduce the incidence of this potentially fatal phenomenon.