Neurological disorders confer increased suicide risk

  • Erlangsen A & al.
  • JAMA
  • 4 Feb 2020

  • curated by Susan London
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

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.