Chronic Fatigue Syndrome Linked to Suicide Deaths

By Shannon Aymes

NEW YORK - Individuals with chronic fatigue syndrome (CFS) may be at increased risk of committing suicide compared with the general population, according to a population-based study in England and Wales.

"This is the first study to demonstrate that there might be an increased risk of suicide in people diagnosed with chronic fatigue syndrome," Dr. Emmert Roberts of King's College London told Reuters Health by email.

"The results suggest that people with CFS are up to six times more likely to die by suicide compared to the general population, although because the numbers involved are small -- fewer than 1% of our study population of more than 2,000 died by suicide -- this will need to be confirmed by larger studies," Dr. Roberts said.

"Although the risk of a person with CFS dying by suicide is small, it is still greater than we see in the general population, and so patients, their families, and their physicians need to be aware of this. It's important that patients are offered the correct assessment and treatment for their condition," Dr. Roberts advised.

The research team calculated standardized mortality ratios (SMR) in a cohort of patients with CFS using data from a national register with deidentified patient information.

In total, they identified 2,147 patients (1,533 women) with a diagnosis of CFS with 17 deaths (11 women, six men). Deaths were attributed to malignant neoplasm in eight patients, suicide in five patients, and other causes in four patients.

The researchers found no significant difference for sex-standardized or age-standardized mortality ratios for cancer mortality (SMR 1.39, p=0.45) or all-cause mortality (SMR 1.14, p=0.67).

In contrast, they found a higher suicide-specific mortality (SMR 6.85, p=0.002) in this cohort of patients based on the five suicides. The authors point out that with two fewer suicides the effect would not be significant.

Depression was recorded in 216 patients with four total deaths including two deaths attributed to suicide. Both univariate and multivariate analysis demonstrated a higher risk of suicide death in patients with CFS and depression (subhazard ratio 9.57 and 9.61, respectively, both p=0.02). 

The study was published online February 9 in the Lancet.

In an accompanying editorial, Dr. Nav Kapur and Dr. Roger Webb, of the Centre for Suicide Prevention at the University of Manchester, UK, noted that the results should be "interpreted with caution." 

The small sample lacked statistical power and the suicide mortality was calculated on a few deaths and subsequently had wide confidence intervals. Further, the cohort was identified from a national specialist center and may have had more complex or severe CFS.

Although the cause of the possible increased risk for suicide in patients with CFS is unknown, the editorial writers highlight that depression is a risk factor for suicide in the general population and those with CFS.

"Anybody having suicidal thoughts should see their physician or seek medical advice as soon as possible," Dr. Roberts told Reuters Health. "It's important that physicians treating people with CFS are vigilant to the increased risk of suicide in their patients, so that they can ensure anybody at risk receives appropriate support and treatment."

Dr. Leonard Jason, of DePaul University in Chicago, who was not involved in the study, told Reuters Health by email, "CFS is a debilitating illness and we need more research and services for those affected. Certainly, we need to provide comprehensive help to patients with this illness, particularly as it has been stigmatized by many health care personnel in the past."

Dr. Jason continued, "The diagnosis of this illness is very complicated, and what case definition is used is critical. Using a broad case definition might not identify patients who truly have this illness, and that might be one of the problems with this research."

The study had no commercial funding.


Lancet 2016.

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