Parkinson’s Disease-Related Risk of Suicide and Effect of Deep Brain Stimulation: Meta-Analysis

Abstract

Background. Previous studies investigated the risk of suicide in patients with Parkinson’s disease (PD) but reported discrepant results. Deep brain stimulation (DBS) is an effective therapy for PD, while its effect on suicide risk has seldom been researched. This meta-analysis aimed to estimate the risk of suicide and/or suicidal ideation in PD patients and in PD patients who underwent DBS. Methods. Relevant articles published in the PubMed or EMBASE or CNKI database from 1990 to December 2019 were sourced, and the combined standardized mortality rate (SMR) or odds ratio (OR) was pooled. Result. A total of 1070 articles were found. After screening, 4 cross-sectional studies, 4 cohort studies, 2 randomized controlled trial studies, and 2 case-control studies were included in this meta-analysis. Pooled data indicated that PD patients may have increased risk of suicide (lnSMR, 0.459; 95% confidence interval (CI), 0.286 to 0.632; p<0.001). No significant difference was found in the risk of suicide when comparing PD patients who underwent DBS with PD patients who received only drug therapy (OR = 2.844, 95%CI: 0.619 to 13.072, p=0.179). DBS may increase the risk of suicide and/or suicidal ideation in PD patients compared with general population (lnSMR = 3.383, 95%CI: 2.839 to 3.927, p<0.001). Conclusion. PD patients have higher risk of suicide and/or suicidal ideation compared with controls, while PD patients who received DBS tend to have an increased risk of suicide or suicidal ideation. Psychological evaluation is needed in PD patients, and pre- and post-operation evaluations are necessary for PD patients who underwent DBS.

Risk of Suicidal Ideation and Behavior in Individuals With Parkinson Disease

“…Another contentious association is reported between DBS and increased suicide risk. A recent meta-analysis of patients with PD after DBS showed similar rates of suicidal behavior (1%) as found in our study, while another study demonstrated an increased rate of completed suicide in patients with PD post-DBS compared with general population . However, there has been no convincing evidence that DBS increases the risk of suicide compared with pharmacotherapy alone .…”

“…54 However, there has been no convincing evidence that DBS increases the risk of suicide compared with pharmacotherapy alone. 54 In either case, physicians must appreciate the increased suicide risk in all patients with PD patients and care should be taken when considering patients for DBS or other treatment options. Monitoring and managing suicidality should be a priority, especially for those with psychiatric risk factors, such as preexisting depression or other mood disorders.…”

“…A recent meta-analysis of patients with PD after DBS showed similar rates of suicidal behavior (1%) as found in our study, 53 while another study demonstrated an increased rate of completed suicide in patients with PD post-DBS compared with general population. 54 However, there has been no convincing evidence that DBS increases the risk of suicide compared with pharmacotherapy alone. 54 In either case, physicians must appreciate the increased suicide risk in all patients with PD patients and care should be taken when considering patients for DBS or other treatment options.…”

Suicidal ideation among people with Parkinson's disease and comparison with a control group

“…13 Prevalence of suicide risk in PD varies widely depending on the population (decreased or unchanged in USA, Denmark, Finland, and Canada but increased in South Korea, England, Netherlands, and Sweden); however, cultural differences or differences in the standard management of PD and PD depression could explain at least in part these findings. 14 Some factors have been associated with an increased risk of suicide in PD, such as deep brain stimulation or dopamine agonists withdrawal, 16,17 whereas mechanisms such as alterations in immune function and serotonin neurotransmission have been implicated in suicide in the general population. 18,19 According to the literature, aggressive management of depression could be the best approach for suicide prevention, 15 but studies focused on suicide in PD are needed.…”

Suicide in Deep Brain Stimulation for Parkinson’s Disease: A Retrospective Case-Control Study

“…Parkinson’s disease (PD) is a neurodegenerative disorder that affects up to 3% of adults over 65 years of age and is primarily characterized by motor symptoms including bradykinesia, resting tremor, and muscle rigidity [ 1 ]. In addition to motor symptoms, PD patients often experience cognitive impairment, behavioral changes, and mood disorders such as depression [ 2 ].…”