Advertisement

Increased suicide risk and clinical correlates of suicide among patients with Parkinson's disease

Published:September 06, 2016DOI:https://doi.org/10.1016/j.parkreldis.2016.09.006

      Highlights

      • We explored 4362 Parkinson's disease patients enrolled in a clinical registry.
      • Standardized mortality ratio for suicide was 1.99, out of 29 suicide observed.
      • Retrospective case-control study was conducted to identify correlates of suicide.
      • Depression, delusion and higher L-dopa dosage were associated with suicide.
      • We suggest that suicide risk in PD is higher than that of the general population.

      Abstract

      Introduction

      Parkinson's disease (PD) is a debilitating, neurodegenerative condition frequently complicated by psychiatric symptoms. Patients with PD may be at higher risk for suicide than the general population, but previous estimates are limited and conflicting. The aim of this study is to estimate the suicide rate based on the clinical case registry and to identify risk factors for suicide among patients diagnosed with PD.

      Methods

      The target sample consisted of 4362 patients diagnosed with PD who were evaluated at a general hospital in Seoul, South Korea, from 1996 to 2012. The standardized mortality ratio for suicide among PD patients was estimated. In order to identify the clinical correlates of suicide, case-control study was conducted based on retrospective chart review. The 29 suicide cases (age: 62.3 ± 13.7 years; females: 34.5%) were matched with 116 non-suicide controls (age: 63.5 ± 9.2 years; females 56.9%) by the year of initial PD evaluation.

      Results

      The SMR for suicide in PD patients was 1.99 (95% CI 1.33–2.85). Mean duration from time of initial diagnosis to suicide among cases was 6.1 ± 3.5 years. Case-control analysis revealed that male, initial extremity of motor symptom onset, history of depressive disorder, delusion, any psychiatric disorder, and higher L-dopa dosage were significantly associated with suicide among PD patients. Other PD-related variables such as UPDRS motor score were not significantly associated with death by suicide.

      Conclusion

      Suicide risk in PD patients is approximately 2 times higher than that in the general population. Psychiatric disorders, and also L-dopa medication need further attention with respect to suicide.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Parkinsonism & Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nussbaum R.L.
        • Ellis C.E.
        Alzheimer's disease and Parkinson's disease.
        N. Engl. J. Med. 2003; 348: 1356-1364
        • Elbaz A.
        • Bower J.H.
        • Peterson B.J.
        • Maraganore D.M.
        • McDonnell S.K.
        • Ahlskog J.E.
        • et al.
        Survival study of Parkinson disease in olmsted county, Minnesota.
        Arch. Neurol. 2003; 60: 91-96
        • Hely M.A.
        • Morris J.G.
        • Traficante R.
        • Reid W.G.
        • O'Sullivan D.J.
        • Williamson P.M.
        The sydney multicentre study of Parkinson's disease: progression and mortality at 10 years.
        J. Neurol. Neurosurg. Psychiatry. 1999; 67: 300-307
        • Menza M.A.
        • Robertson-Hoffman D.E.
        • Bonapace A.S.
        Parkinson's disease and anxiety: comorbidity with depression.
        Biol. Psychiatry. 1993; 34: 465-470
        • Slaughter J.R.
        • Slaughter K.A.
        • Nichols D.
        • Holmes S.E.
        • Martens M.P.
        Prevalence, clinical manifestations, etiology, and treatment of depression in Parkinson's disease.
        J. Neuropsychiatry Clin. Neurosci. 2001; 13: 187-196
        • Aarsland D.
        • Larsen J.P.
        • Lim N.G.
        • Janvin C.
        • Karlsen K.
        • Tandberg E.
        • et al.
        Range of neuropsychiatric disturbances in patients with Parkinson's disease.
        J. Neurol. Neurosurg. Psychiatry. 1999; 67: 492-496
        • Weintraub D.
        • Moberg P.J.
        • Duda J.E.
        • Katz I.R.
        • Stern M.B.
        Effect of psychiatric and other nonmotor symptoms on disability in Parkinson's disease.
        J. Am. Geriatr. Soc. 2004; 52: 784-788
        • Juurlink D.N.
        • Herrmann N.
        • Szalai J.P.
        • Kopp A.
        • Redelmeier D.A.
        Medical illness and the risk of suicide in the elderly.
        Arch. Intern. Med. 2004; 164: 1179-1184
        • Wasner G.
        • Deuschl G.
        Chapter 50 pain in Parkinson's disease.
        Handb. Clin. Neurol. 2006; 81: 747-760
        • Goetz C.G.
        • Tanner C.M.
        • Levy M.
        • Wilson R.S.
        • Garron D.C.
        Pain in Parkinson's disease.
        Mov. Disord. 1986; 1: 45-49
        • Tang N.K.
        • Crane C.
        Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links.
        Psychol. Med. 2006; 36: 575-586
        • Cummings J.L.
        Depression and Parkinson's disease: a review.
        Am. J. Psychiatry. 1992; 149: 443-454
        • Kostic V.S.
        • Pekmezovic T.
        • Tomic A.
        • Jecmenica-Lukic M.
        • Stojkovic T.
        • Spica V.
        • et al.
        Suicide and suicidal ideation in Parkinson's disease.
        J. Neurol. Sci. 2010; 289: 40-43
        • Stenager E.N.
        • Wermuth L.
        • Stenager E.
        • Boldsen J.
        Suicide in patients with Parkinson's disease. An epidemiological study, Acta Psychiatr.
        Scand. 1994; 90: 70-72
        • Myslobodsky M.
        • Lalonde F.M.
        • Hicks L.
        Are patients with Parkinson's disease suicidal?.
        J. Geriatr. Psychiatry Neurol. 2001; 14: 120-124
        • Calne D.B.
        • Snow B.J.
        • Lee C.
        Criteria for diagnosing Parkinson's disease.
        Ann. Neurol. 1992; 32: S125-S127
        • Bergstralh E.J.
        • Kosanke J.L.
        Computerized matching of cases to controls.
        Mayo Found. Tech. Rep. 1995; 56
        • Tomlinson C.L.
        • Stowe R.
        • Patel S.
        • Rick C.
        • Gray R.
        • Clarke C.E.
        Systematic review of levodopa dose equivalency reporting in Parkinson's disease.
        Mov. Disord. 2010; 25: 2649-2653
        • Office K.N.S.
        Anual Report on the Cause of Death Statistics.
        2014
        • Politis M.
        • Niccolini F.
        Serotonin in Parkinson's disease.
        Behav. Brain Res. 2015; 277: 136-145
        • Macleod A.D.
        • Taylor K.S.
        • Counsell C.E.
        Mortality in Parkinson's disease: a systematic review and meta-analysis.
        Mov. Disord. 2014; 29: 1615-1622
        • Nazem S.
        • Siderowf A.D.
        • Duda J.E.
        • Brown G.K.
        • Ten Have T.
        • Stern M.B.
        • et al.
        Suicidal and death ideation in Parkinson's disease.
        Mov. Disord. 2008; 23: 1573-1579
        • Sato K.
        • Hatano T.
        • Yamashiro K.
        • Kagohashi M.
        • Nishioka K.
        • Izawa N.
        • et al.
        Prognosis of Parkinson's disease: time to stage III, IV, V, and to motor fluctuations.
        Mov. Disord. 2006; 21: 1384-1395
        • Postuma R.B.
        • Aarsland D.
        • Barone P.
        • Burn D.J.
        • Hawkes C.H.
        • Oertel W.
        • et al.
        Identifying prodromal Parkinson's disease: pre-motor disorders in Parkinson's disease.
        Mov. Disord. 2012; 27: 617-626
        • Forsaa E.B.
        • Larsen J.P.
        • Wentzel-Larsen T.
        • Alves G.
        What predicts mortality in Parkinson disease?: a prospective population-based long-term study.
        Neurology. 2010; 75: 1270-1276
        • Melamed E.
        • Friedberg G.
        • Zoldan J.
        Psychosis: impact on the patient and family.
        Neurology. 1999; 52: S14-S16
        • Harkavy-Friedman J.M.
        • Restifo K.
        • Malaspina D.
        • Kaufmann C.A.
        • Amador X.F.
        • Yale S.A.
        • et al.
        Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide, Am.
        J. Psychiatry. 1999; 156: 1276-1278
        • Nock M.K.
        • Borges G.
        • Bromet E.J.
        • Alonso J.
        • Angermeyer M.
        • Beautrais A.
        • et al.
        Cross-national prevalence and risk factors for suicidal ideation, plans and attempts.
        Br. J. Psychiatry. 2008; 192: 98-105
        • Beaulieu-Boire I.
        • Lang A.E.
        Behavioral effects of levodopa.
        Mov. Disord. 2015; 30: 90-102
        • Ravina B.
        • Camicioli R.
        • Como P.G.
        • Marsh L.
        • Jankovic J.
        • Weintraub D.
        • et al.
        The impact of depressive symptoms in early Parkinson disease,.
        Neurology. 2007; 69: 342-347