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TOPLINE:

Individuals diagnosed with endometriosis showed a 42% higher risk for self-harm, overdose, or suicide than matched control individuals, with risk particularly elevated among those with minimal prior psychiatric care. The study of 56,053 endometriosis patients and 112,106 control participants revealed that those with no or minimal previous mental health services had nearly double the risk.

METHODOLOGY:

• Researchers conducted a population-based, retrospective, matched cohort study using administrative health data from Ontario, Canada, spanning January 2010 to July 2022.
• Analysis included 56,053 women aged 18-50 years with first-time endometriosis diagnosis, matched 1:2 with 112,106 control individuals based on age, sex, census subdivision, psychiatric utilization gradient, and self-harm history.
• Primary outcome measures encompassed a composite of intentional self-harm, poisoning or overdose of accidental or unknown intent, and suicide, with data for suicide outcomes available until December 31, 2018.
• Psychiatric utilization in the 2 years before diagnosis was quantified using a gradient: no psychiatric utilization, outpatient care, emergency department visits, or hospital admission.

TAKEAWAY:

• Endometriosis was associated with an increased risk for the composite outcome (adjusted hazard ratio [AHR], 1.42; 95% CI, 1.27-1.59), showing particularly strong association in individuals with no prior psychiatric care (AHR, 1.88; 95% CI, 1.54-2.30).
• Patients with endometriosis showed elevated risks for both intentional self-harm (AHR, 1.37; 95% CI, 1.22-1.54) and poisoning or overdose (AHR, 1.42; 95% CI, 1.29-1.56).
• The cumulative incidence of the primary composite outcome reached 2.5% in endometriosis patients compared with 1.8% in unexposed individuals.
• According to the researchers, no statistically significant elevation in risk was detected in individuals with higher baseline psychiatric utilization, though absolute incidence of all outcomes increased with the psychiatric utilization gradient.

IN PRACTICE:

“These findings highlight the importance of considering mental health needs for patients newly diagnosed with endometriosis,” the authors of the study wrote.

SOURCE:

The study was led by Peter Thiel, MD, MPH, Department of Obstetrics and Gynecology, University of Saskatchewan in Saskatoon, Saskatchewan, Canada. It was published online in Obstetrics & Gynecology.

LIMITATIONS:

The administrative data used may be misclassified and lacks clinical information such as endometriosis severity, treatment responses, and lag between symptom onset and diagnosis. These gaps limit a more nuanced understanding of the relationship between endometriosis and self-harm outcomes.

DISCLOSURES:

The study was supported by ICES, which receives annual funding from the Ontario Ministry of Health and the Ministry of Long-Term Care. Ally Murji disclosed serving on the advisory board and speaker bureau for AbbVie, Bayer, and Pfizer. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.