Risk of suicide and suicidality in patients with moderate to severe psoriasis: results from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR).

Background: Psoriasis is associated with poor mental health and reduced quality of life. Although the high risk for depression in patients with psoriasis is well established, the suicidality risk among these patients is uncertain. Previous studies provide contrasting results and have not included patients with clinically confirmed severe disease.

Objectives: To determine the risk of suicide among patients with moderate to severe psoriasis and to compare it with that of the general population, and to investigate if psychiatric comorbidity or history of suicidality increases future suicidality risk in psoriasis. We further estimated the incidence of suicidal and self-injurious behaviours in patients.

Methods: Analysis was performed using the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). General population mortality and suicide data were used as controls.

Results: There were nine suicides in BADBIR. The incidence rate of suicide was 12.5 per 100 000 person-years [95% confidence interval (CI) 6.53-24.11] in BADBIR vs. 11.0 per 100 000 person-years (95% CI 10.7-11.3) in the general population in England and Wales. Among patients, psychiatric comorbidity or past suicidality was associated with a higher risk for suicidal ideation, suicide attempts and self-injurious behaviours.

Conclusions: The suicide rate among patients with moderate to severe psoriasis was not significantly higher when compared with the general population. Suicide is a rare event and our results are limited by uncertainty about the reliability of the estimate. However, considering the high depression prevalence in psoriasis, our findings support the need for prompt assessment of patients for psychiatric comorbidities and suicidality history. Further research is required on suicidal behaviours and the role of psoriasis severity.