Patients with alopecia areata (AA) have an increased risk for suicide attempts regardless of concurrent psychiatric disorders, according to study findings published in Dermatology.
Researchers conducted a nationwide, population-based, cohort study to evaluate the association between AA and suicidality with data from the National Health Insurance Research Database in Taiwan.
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).
For the AA group, the median (IQR) age of the first suicide attempt was younger (37.9; 29.1-48.9 years) compared with 60.2 (36.1-73.8) years in the control group (P < .0001).
The risk for suicide attempts was also 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).
After stratification according to age, sex, duration of systemic corticosteroid receipt, and comorbidities, the risk for suicide among participants with AA was still significantly increased for both sexes as well as for patients with or without major depressive disorder, substance use disorder, or alcohol use disorder. After stratification by age, a significantly increased risk for suicide in the AA group was found in younger age groups, including participants aged younger than 20 years, those aged 20 to 39 years, and those aged 40 to 59 years. No significant difference was observed between the AA and control groups for participants aged 60 years and older. The AA group had an increased risk for suicide when corticosteroid use was less than 30 days.
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.
“An increased incidence of suicide attempts in patients with AA was identified, regardless of the underlying psychiatric disorder, including major depressive disorder, substance use disorder, or alcohol use disorder,” conclude the study authors.
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. doi:10.1159/000530076