TOPLINE: 

Patients with endometriosis showed a 42% higher risk for self-harm, overdose, or suicide compared to matched controls, with the risk being particularly pronounced among those with minimal or no previous mental health services utilization.

METHODOLOGY: 

• Researchers conducted a population-based, retrospective, matched cohort study using administrative health data from Ontario, Canada, spanning from 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 controls 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: 

• Patients with endometriosis demonstrated an increased risk for the composite outcome (adjusted hazard ratio [aHR], 1.42; 95% CI, 1.27-1.59) compared to matched controls.
• Analysis revealed elevated risks specifically for 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) among endometriosis patients.
• Individuals with no prior psychiatric care or only outpatient care showed the highest risk elevation (aHR, 1.88; 95% CI, 1.54-2.30) and (aHR, 1.30; 95% CI, 1.11-1.51), respectively.
• The absolute incidence of self-injurious behavior increased with psychiatric utilization gradient, suggesting psychiatric history had more influence than endometriosis diagnosis in individuals with greater utilization.

IN PRACTICE: 

"These findings highlight the importance of considering mental health needs for patients newly diagnosed with endometriosis," wrote the authors of the study. They added, “Our findings align with data showing that the increased risk of suicide after cancer diagnosis occurs predominantly in patients with minimal prediagnosis psychiatric utilization.”

SOURCE:

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

LIMITATIONS: 

The administrative data used in the study may be subject to misclassification and lacks clinical information such as endometriosis severity, treatment responses, and the time 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 received support from the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. 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.