Neurological disorders confer increased suicide risk

  • Erlangsen A & al.
  • JAMA
  • 04/02/2020

  • Susan London
  • Clinical Essentials
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Takeaway

  • Patients with neurological disorders have an 80% higher suicide rate compared with unaffected individuals.

Why this matters

Key results

  • Suicide rate per 100,000 person-years:
    • 44.0 with a neurological disorder diagnosis vs
    • 20.1 without a neurological disorder diagnosis.
  • Adjusted incidence rate ratio for individuals with vs without neurological disorder diagnosis: 1.8 (95% CI, 1.7-1.8).
  • Ratio (95% CI) by disorder:
    • 4.9 (3.5-6.9) for amyotrophic lateral sclerosis,
    • 4.9 (3.1-7.7) for Huntington’s disease,
    • 2.2 (1.9-2.6) for multiple sclerosis,
    • 1.7 (1.6-1.7) for head injury,
    • 1.7 (1.5-1.9) for Parkinson’s disease,
    • 1.7 (1.6-1.8) for epilepsy, and
    • 1.3 (1.2-1.3) for stroke.
  • Ratio (95% CI) decreased over time from diagnosis:
    • 3.1 (2.7-3.6) at 1-3 months and
    • 1.5 (1.4-1.6) at ≥10 years.
  • Ratio (95% CI) for individuals with dementia:
    • 3.0 (1.9-4.6) in first month postdiagnosis and
    • 0.8 (0.7-0.9) overall.
  • Among individuals with Huntington’s disease, absolute risk for suicide: 1.62% (95% CI, 1.04%-2.52%).

Study design

  • Danish nationwide retrospective cohort study: 7,300,395 individuals age 15 years or older, 1980-2016.
  • Main outcome: death by suicide during median 23.6-year follow-up.
  • Funding: Psychiatric Research Foundation, Region of Southern Denmark.

Limitations

  • Included only diagnoses made since 1977 by specialists.
  • Suicides potentially underreported.
  • Possibility of higher depression detection in people with neurological disorders because of greater health care contact.