Physiatric and rheumatological aspects of suicidality

The psychological dimension of rheumatic diseases and conditions is a complex issue that involves the unity of mind and body. Rheumatology and physiatry deal with all aspects of diseases of the musculoskeletal system, including degenerative, metabolic, inflammatory, infectious, developmental, congenital, neurogenic, psychogenic and post-traumatic diseases and conditions. These are often chronic and devastating diseases that affect every aspect of human functioning.

The biopsychosocial model provides a good conceptual link between the functioning of the individual and that of society. Impaired activities of daily living and reduced vocational and avocational abilities prevent a person from taking part in family and social interactions. So does having to face the progressive nature of the disease and to depend on help from other people and from society. The wider social framework includes an interest in pensions or compensation and the benefits that arise from these diseases and conditions. Recognising mental disorders – whether they arose as a consequence of the disease or preceded it – and the influence of the premorbid personality structure must become an integral part of treating patients whose musculoskeletal system is affected. Depression, anxiety and suicidality significantly impair quality of life and treatment outcomes. Prevention and treatment are possible and available. Intervention by everyone involved in care, including doctors, nurses, families and society, with an emphasis on education and prevention, significantly improves treatment outcomes. I will present a programme of psychological prevention and rehabilitation for patients from a physiatric and rheumatological perspective, within the concept of person-centred medicine. The paper will present an analysis of the life activities of people with spinal cord injuries sustained in wartime and in peacetime.