Asthma and Suicide

Having a chronic disease such as asthma can lead to depression and suicide. The US figures for suicides in the U.S. are alarming: 36,035 in 2008, with about 666,000 persons being treated for nonfatal, self-inflicted injuries. A full 1% of American adults(2.2 million) reported making suicide plans in the past year, and an estimated 1 million (0.5% of the U.S. adult population) made a suicide attempt in that same time span. Of these numbers, more young adults between the ages of 18 and 29 thought, planned or attempted suicide.

In a study, Clarke and colleagues found a link between chronic respiratory diseases, suicide ideation and suicide attempts. A multivariate logistic regression analysis of data from 5692 adults found that while 4.2% attempted suicide, the ratio for adults with asthma was 12%.  The difference between non-asthma and asthma patients remained significant even after adjustment for confounders such as smoking, nicotine dependence, age, sex, and race/ethnicity, depression, panic disorder, and alcohol abuse. 

Factors that were associated with an increased likelihood of suicide attempts included:

  • being female 
  • current smoker
  • dependent on nicotine 
  • suffering from depression
  • suffering from anxiety, and
  • being an alcohol abuser

 
There is a link between respiratory disease, suicide ideation and suicide attempts. Cigarette smoking and  coexisting mental conditions may have an impact on the association between asthma and attempted suicide.

Goodwin and colleagues found an association between asthma, an increased level of suicide ideation and suicide attempts in adults with asthma. Their study of youth hospitalized for asthma found higher than expected levels of suicide ideation. The same result was found in older children and adolescents in Puerto Rico. An analysis of 6584 adults whose data was drawn from the Third National Health and Nutrition Examination Survey (NHANES III)  found an association between current asthma and suicide ideation (Odds Ratio 1.77) and suicide attempt (OR 3.26), after adjusting for confounders such as mood disorder, poverty, smoking and demographics. 

Hence any treatment modality for asthma, in order to minimize the possibility of suicide in patients with asthma, must incorporate:

  • asthma treatment
  • smoking cessation measures
  • alcohol surcease
  • behaviour modification, and
  • treatment for depressive disorders

More research is required in the field of mental health and asthma, but the indicators are clear that there is a significant association between asthma and suicide. Patients with asthma must be assessed not only for physical health but also for psychological morbidity.


References

Crosby AE, Han B, et al.  Suicidal thoughts and behaviors among adults aged >18 years--United States, 2008-2009. MMWR Surveill Summ. 2011 Oct 21;60(13):1-22.

Clarke DE, Goodwin RD, Messias EL, Eaton WW. Asthma and suicidal ideation with and without suicide attempts among adults in the United States: what is the role of cigarette smoking and mental disorders? Ann Allergy Asthma Immunol. 2008;100(5):439-46.

Goodwin RD, Eaton WW. Asthma, suicidal ideation, and suicide attempts: findings from the Baltimore epidemiologic catchment area follow-up. Am J Public Health. 2005;95:717–722.

Goodwin RD, Marusic A. Asthma and suicidal ideation among youth in the community. Crisis. 2004;25:99–102

Bandiera FC, Ramirez R, et al. Asthma and suicidal ideation and behavior among Puerto Rican older children and adolescents. J Nerv Ment Dis. 2013 Jul;201(7):587-91. doi: 10.1097/NMD.0b013e3182982ba4.

Goodwin RD1, Demmer RT et al. Asthma and suicide behaviors: results from the Third National Health and Nutrition Examination Survey (NHANES III). J Psychiatr Res. 2012 Aug;46(8):1002-7. doi: 10.1016/j.jpsychires.2012.04.024.