title: Suicidal drug overdose in patients with systemic lupus erythematosus, a nationwide population-based case-control study.
abstract: OBJECTIVE
  A four-fold increase of suicide mortality has been demonstrated in systemic lupus erythematosus (SLE) patients. Prior studies showed that the most common method of suicide attempts in SLE patients involves drug overdose. Therefore, we conducted a nationwide population-based case-control study to elucidate factors associated with drug overdose as suicide attempt in SLE patients.
  
  
  METHODS
  This study was based on the National Health Insurance Research Database in Taiwan. We identified all SLE patients from January 1, 2000 to December 31, 2010. Patients who had suicidal drug overdose (SDO) were selected as cases while age- and gender-matched patients who did not have SDO were selected as controls.
  
  
  RESULTS
  The incidence rate of SDO in SLE patients was 291 cases per 100,000 person-years, higher than that in the general population (160 cases per 100,000 person-years). In a multivariate logistic regression analysis, we observed that SDO was associated with psychiatric disorders such as depressive disorders (odds ratio: 8.36, 95% confidence interval (CI): 5.60-12.48) and insomnia (odds ratio: 2.71, 95% CI: 1.73-4.25), and lower monthly income (odds ratios: 2.74 to 3.50) in SLE patients.
  
  
  CONCLUSIONS
  SDO is associated with psychiatric disorders such as depressive disorders and insomnia, and lower monthly income in SLE patients.
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
authors.forename: K T
authors.initials: KT
authors.lastname: Tang
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: C H
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taiwan.
authors.forename: H H
authors.initials: HH
authors.lastname: Chen
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Y H
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan dychen@vghtc.gov.tw.
authors.forename: D Y
authors.initials: DY
authors.lastname: Chen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D062787:Drug Overdose / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000523:psychology; D018570:Risk Assessment; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology
keywords: Epidemiology; overdose; poisoning; suicide; systematic lupus erythematosus