Fibromyalgia patients are 10 times more vulnerable to suicide. New research points to risk factors and effective interventions.

Fibromyalgia (FM) patients are 10 times more likely to die by suicide than the general population.  In a new study published in Arthritis Care & Research, investigators at Vanderbilt University Medical Center have applied machine learning to analyze documented cases of suicidal ideation and attempts in individuals with FM. The study brings clinically meaningful insights into interpretable risk and protective factors for suicidality in FM patients.

This effort is the first successful application of machine learning to externally validate published models predicting suicidal ideation and attempts in individuals with FM. The researchers included over 18 years of large-scale electronic health record (EHR) data – identifying FM cases with validated Phenotype KnowledgeBase (PheKB) Criteria and factors that increase or decrease risk of suicide in this population.1 Cases included 8,879 individuals with FM, with 34 known suicide attempts and 96 documented cases of suicidal thoughts.

Provider Contact a Crucial Factor

According to senior author Colin Walsh, M.D., M.A., assistant professor of Biomedical Informatics, Medicine, and Psychiatry at Vanderbilt, patients who presented at some point with suicidal thoughts spent on average 1.7 hours in clinic per person per year while those not presenting with suicidal thoughts were in clinic on average 5.9 hours per person per year. The difference was even more substantial for those who presented with suicide attempts: less than one hour per year in clinic for attempters and over 50 hours per year on average for non-attempters.

“Fifty hours versus one hour – that’s a staggering difference,” said lead author Lindsey McKernan, Ph.D., assistant professor of Psychiatry & Behavioral Sciences, Physical Medicine & Rehabilitation at Vanderbilt. McKernan noted that successfully living with and managing FM includes engaging in physical therapy, exercising and self-management, seeing a primary care provider and rheumatologist regularly, and working with a psychologist or mental health provider.

“Not one who received mental health services of some kind went on to attempt suicide”

“Fibromyalgia takes a lot of time to manage. It takes a lot of engagement… We looked at thousands of people in this study and not one who received mental health services of some kind went on to attempt suicide,” McKernan said. The findings highlight the importance of mental health services in patients with FM.

Physical Risks and Protective Factors

In addition to provider face time, the team identified risk factors specific to suicidal ideation including polysomatic complaints such as fatigue, dizziness, and weakness. Factors related to suicide attempt included obesity and drug dependence. While these factors are critical in disease management, the study suggests their contribution to suicide in FM patients can be mitigated by regular physician contact.

“It’s not just about risk factors, it is about what keeps people from hurting themselves, protective factors,” McKernan said. “If you really break it down, the people who were having suicidal thoughts weren’t going in to the doctor as much. I think about the people who might be falling through the cracks. Chronic pain in and of itself is very isolating over time.”

“Often, when you are hurting, your body tells you to stay in bed,” McKernan said. “Moving is the last thing that you want to do. And when you are tired, when your mood is low, when your body aches, you don’t want to see anybody; but that is exactly what you need to do – contact your doctors, stay in touch with them, and move. It really can make a difference.”

The study was funded the Vanderbilt Patient-Centered Outcomes Research Education and Training (VPOCKET) Initiative, funded by the Agency for Healthcare Research and Quality, and the BioVU Synthetic Derivative, funded by the National Center for Advancing Translational Sciences.

About the Expert

Lindsey McKernan, Ph.D.

Lindsey McKernan, Ph.D., M.P.H., is assistant professor of Psychiatry and Behavioral Sciences and Physical Medicine and Rehabilitation at Vanderbilt University Medical Center. She is a licensed clinical psychologist and practices in the Osher Center for Integrative Medicine at Vanderbilt. Her research and clinical work involves the treatment of co-occurring chronic health conditions and understanding psychological factors influencing chronic pain.

Colin Walsh, M.D.

Colin Walsh, M.D., is associate professor of biomedical informatics, medicine and psychiatry and behavioral sciences at Vanderbilt University Medical Center. His research and operational work focus on machine learning/data science applied to mental health, utilization optimization and quality improvement and an analytics approach to value-based healthcare.


Model performance was measured through discrimination – including area under the receiver operating characteristic (AUC), sensitivity, and specificity – and calibration. Risk factors were selected by regression, with bootstrapping for both outcomes. Secondary utilization analyses converted time-based-billing codes to equivalent minutes to estimate face-to-face provider contact.