| BackgroundSystemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by a diverse array of autoantibody production that affects multiple systems and organs. The prevalence of SLE in China far outclasses that of western countries. Until now, SLE cannot be cured. The course of SLE generally involves periods of intense flares and periods of remission. Most of patients have to live with the disease in a long time and have different level of negative emotion and low life expectation. Some studies indica- ted that SLE patients were prone to have mood disorder, especially anxiety and depression. Depression was proved to be an independent risk factor for suicide. Meanwhile, the level of social support in SLE was lower than that in the healthy people, which was considered as a buffering factor of suicide. Many years ago, some studies reported that the frequency of suicidal behavior in SLE patients was higher than that in other patients. SLE had a higher risk of suicide.Suicidal ideation is the most intensive predict factor of suicide and also an important index for assessment of suicide risk. One study suggested that suicidal ideation in SLE was significantly correlated with human relations among family members and high daily steroid dosage, but was not correlated with disease activity. Another study reported that suicidal ideation in SLE was correlated with disease duration, but not with steroid dosage. The studies on suicidal ideation in foreigner SLE patients were limited. There was not any existing research related to suicidal ideation in Chinese SLE patients.Mann and his colleagues (1998) have suggested a comprehensive stress- vulnerability model for suicide. According to proponents of this theory, suicide is a result of interaction of three aspects, namely, stress (such as acute psychiatric or somatic illness, pressing social problems or family crises, etc.), protective factors (such as family, social and culture, etc.) and susceptibility (biological and psychological domains). Biological susceptibility means the level of 5-hydroxytryptamine (5-HT) in cerebrospinal fluid, and its metabolic product called 5-hydroxyindoleacetic acid (5-HTAA). Considering the relationship between the serum cholesterol level and the receptor of 5-HTAA, serum cholesterol level has been considered as a biological susceptibility in many studies on suicidal ideation. Psychological susceptibility of suicide include personality and cognition, while coping is seen as a direct pattern of manifestation for cognition.Combining with the stress-vulnerability model and the results of previous researches, we raised the hypotheses as following: the influencing facors of suicidal ideation in SLE include biological susceptibility (serum cholesterol level), psychological susceptibility (personality and coping style), risk factors (disease duration, frequence of recurrence, disease activity, dosage of glucocorticoids, depression, load of treatment, etc.) and protective factors (social support, family function, perception of SLE, confidence in treatment, religious belief, etc. ). Suicidal ideation in SLE is due to the interactions of the factors mentioned above.Objective(1) To investigate the prevalence of suicidal ideation, the severity and persistence of suicidal ideation in SLE patients.(2) To assess the biological and psychological susceptibility of suicidal ideation in SLE patients.(3) To identify the influencing factors of suicidal ideation in SLE patients. Methods324 SLE patients were interviewed with questionnaires in respect of suicidal ideation, social-demographic characteristics, Beck Depression Inventory (BDI), Family APGAR, Social Support Rate Scale (SSRS), Eysenck Personality Questionnaire (EPQ), Trait Coping Style Questionnaire (TCSQ). The other medical information was collected from the patients’physicians and medical records. Disease activity was assessed with SLE Disease Activity Index. And the current dose of steroid medication was based on a conversion of the various medications into the same dosage for prednisolone.Based on the patients’current suicidal ideation, we investigated the correlation through univariate and multivariate logistic regression between suicidal ideation and social–demographic characteristics, the patients’perceptions of disease, the disease related factors, mental heatlh, family function, social support, personality, trait coping style and serum total cholesterol level. Then we set a dependent variable according to the persistence of suicidal ideation, and continued to investigate the correlation between the persistence of suicidal ideation and the above factors. In addition, we carried a path analysis to explore the role model of personality, trait coping style and depression to suicidal ideation in SLE patients. The data were analyzed by Statistical Package for Social Sciences version 10.5 software (SPSS, Chicago, IL, USA).Results(1) Current suicidal ideation was present in 33.3% of 324 SLE patients, and suicidal ideation was divided into three levels: mild(5.8%), moderate(20.7%), serious (6.8%). Premorbid suicidal ideation as an independent factor was present in 21.6% of SLE patients, whereas lifetime suicidal ideation was present in 38.0% of SLE patients.(2) The susceptibility of suicidal ideation in SLE patients: neurotic personality, low level of active coping and high level of negative coping were psychological suscepti- bility of suicidal ideation, and neurotic personality was an independent factor (the standard score of N scale: OR=1.099, P=0.000); but as a biological susceptibility, serum total cholesterol level was not significantly correlated with suicidal ideation(OR=1.045, P=0.624).(3) The risk factors of suicidal ideation in SLE patients: without job or be a famer, unstable marriage, religious belief, premorbid suicidal ideation, and depression were significantly related to the current suicidal ideation. Among these factors, religious belief(OR=2.654, P=0.024), premorbid suicidal ideation(OR=5.016, P=0.001), depr- session(OR=1.737, P=0.002) were independent influencing factors and predictive factors of suicidal ideation.(4) The protective factors of suicidal ideation in SLE patients: patients’confidence in treatment, family function (including adaptability, partnership, growth, affection and resolve), social support (including subjective support, objective support, availability of support) were significantly related to current suicidal ideation. Among them, resolve (OR=0.392, P=0.027), objective support(OR=0.768, P=0.002) were independent influencing factors. In the SLE patients with the disease durarion more than 1 year, having children(OR=0.394, P=0.039) became an independent protective factor of current suicidal ideation. In addition, resolve(OR=0.544, P=0.047)and subjective support(OR=0.930, P=0.037) could directly influence the change of suicidal ideation from“no”in the period before SLE to“yes”after SLE.(5) The role model of personality, trait coping style and depression to suicidal ideation in SLE: neurotic personality could influence the current suicidal ideation directly(β=0.208), and indirectly by depression(β=0.492),and indirectly by both coping style and depression. Coping style could only indirectly influence the current suicidal ideation by means of depression(β=0.164). Depression was the most direct influencing factor to the current suicidal ideation(β=0.354). ConclusionsIn conclusion, this is the first study to investigate suicidal ideation and its correlations in Chinese SLE patients. The study suggested that SLE patients in China might have a relatively higher risk of suicide. First, neurotic personality was the psychological susceptibility of suicidal ideation in SLE patients, so much attention should be given to the patients with this kind of personality to prevent and intervene in their suicidal ideation. Second, premorbid suicidal ideation and depression were independent risk and predict facors of suicidal ideation in SLE patients. Professional assessment and interventions for these two factors should be attached great importance to the clinical health personnel. Meanwhile, preventing and intervening in SLE patients’suicidal ideation, providing material and spiritual support from family and social forces should not be ignored as well. |
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