Risk of Suicide Among Patients With Parkinson Disease

Chen, Ying‐Yeh; Sun, Yu; Hu, Ya Hui; Li, Chung‐Yi; Artaud, Fanny; Carcaillon‐Bentata, Laure; Elbaz, Alexis; Lee, Pei Chen

doi:10.1001/jamapsychiatry.2020.4001

Cited by 21 publications

(30 citation statements)

References 58 publications

(90 reference statements)

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“…No specific high- or low-risk periods have been identified. In contrast to Alzheimer’s disease, where a high risk for suicide is usually found early and then decreases [ 35 , 36 ], our study observed persistent maintenance of suicide risk in PD, as in studies in Denmark and Taiwan [ 4 , 35 ].…”

Section: Discussionsupporting

confidence: 60%

“…Although inconsistent, some studies have reported an association between dopaminergic agonists and suicide in patients with PD [ 12 ]. However, other studies have not supported this association [ 4 , 44 ]. Additionally, although some reports have suggested an increased risk of suicide in patients with PD and subthalamic nucleus stimulation, the association remains unclear [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 92%

“…Specifically, in the case of studies showing no association between PD patients and suicide risk, the control group was not comparable to the PD group in terms of demographic and health-related characteristics, the time as a variable was not considered [ 15 – 18 ], and the number of suicide events was not sufficient to examine the association between PD and suicide [ 15 , 17 ]. By supplementing these limitations with propensity scores matching and the risk-set matching methodology, our estimate that Parkinson's patients have an approximately doubled risk of suicide is similar to the findings of Danish studies in 2015 (men: HR, 1.92 [95% CI, 1.26–2.92]; women: HR, 2.26 [95% CI, 1.25–4.08]) and 2020 (HR, 1.7 [95% CI, 1.5–1.9]) [ 14 , 35 ], as well as the UK (adjusted odds ratio, 2.41 [95% CI, 1.15–5.07]) [ 41 ] and Taiwan (HR, 1.9 [95% CI, 1.6–2.3]) [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The World Health Organization (WHO) reported that approximately 804,000 people died by suicide in 2012, and by 2020 that number is expected to reach 1.5 million [ 2 , 3 ]. Older people, in particular, are at a higher risk of suicide worldwide than other age groups, and the number of suicides is expected to increase over the next few decades as the population ages rapidly [ 4 , 5 ]. Therefore, it is important to target the elderly to reduce the burden of suicide.…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 40%–50% of people with PD are affected by depression and 30%–40% by anxiety disorders such as generalized anxiety, social phobia, and panic attacks [ 8 – 10 ]. In addition to the long-established link between psychiatric disorders and suicide [ 11 ], the physical limitations caused by PD and the increased risk of suicide in the elderly require attention to the suicidal potential of people with PD [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Association between new-onset Parkinson’s disease and suicide risk in South Korea: a nationwide cohort study

et al. 2022

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Background Parkinson’s disease (PD) is an increasingly common neurodegenerative disease in an aging society. Whether PD is associated with an increased suicide risk is unclear. Thus, we investigated the effect of new-onset PD on suicide. Methods Using the National Health Insurance Service Senior Sample Cohort of South Korea, 17,143 incident PD patients and 17,143 risk set controls, matched by propensity score, were selected for follow-up. The incidence rate of suicide and 95% confidence interval (CI) were calculated based on a generalized linear model of the Poisson distribution. Effect sizes were expressed as hazard ratios (HRs) using the Cox proportional hazards model with a robust variance estimator that incorporated clustering within matched pairs. Results The incidence rate of suicide was 206.7 cases per 100,000 person-years (95% CI, 172.8–246.9) among the PD cohort. Compared to the matched controls, patients with PD were 2.64 times (HR, 2.64; 95% CI, 1.31–5.30) more likely to commit suicide during the first 180 days of follow-up and 2.47 times (HR, 2.47; 95% CI, 1.42–4.28) within the first 365 days of follow-up. During the entire follow-up period, patients with PD were 2.26 times more likely to commit suicide than were their matched controls (HR, 2.26; 95% CI, 1.67–3.06). Conclusion Our findings indicated an increased risk of suicide in patients with new-onset PD, regardless of the period after diagnosis. Incorporating mental health care with social and environmental interventions into primary care and PD-specialized care can help reduce suicide risk in people with PD, improving suicide prevention, identification, and risk assessment.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association between new-onset Parkinson’s disease and suicide risk in South Korea: a nationwide cohort study

et al. 2022

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Loneliness and Risk of Parkinson Disease

Terracciano,

Luchetti,

Karakose

et al. 2023

JAMA Neurol

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ImportanceLoneliness is associated with morbidity and mortality, including higher risk of neurodegenerative diseases. To our knowledge, no study has examined whether the association between loneliness and detrimental outcomes extends to Parkinson disease (PD).ObjectiveTo assess whether loneliness is associated with risk of incident PD and whether the association is independent of other risk factors or modified by age, sex, and genetic vulnerability.Design, Setting, and ParticipantsThis prospective cohort study included a population-based sample of UK Biobank participants aged 38 to 73 years with loneliness data and without a diagnosis of PD at baseline who were first assessed from March 13, 2006, to October 1, 2010, and followed up to October 9, 2021.ExposureFeeling lonely and covariates that are known risk factors for or prodromal features of PD.Main Outcome and MeasureIncident PD was ascertained through UK National Health Service health records.ResultsOf 491 603 participants (mean [SD] age, 56.54 [8.09] years; 54.4% female), 2822 developed PD during the 15-year follow-up. Individuals who reported being lonely had a higher risk of PD (hazard ratio [HR], 1.37; 95% CI, 1.25-1.51), an association that remained after accounting for demographic factors, socioeconomic status, social isolation, PD polygenetic risk score, smoking, physical activity, body mass index, diabetes, hypertension, stroke, myocardial infarction, depression, and ever seeing a psychiatrist (fully adjusted model: HR 1.25; 95% CI, 1.12-1.39). The association between loneliness and incident PD was not moderated by sex (HR for interaction, 0.98; 95% CI, 95% CI, 0.81-1.18), age (HR for interaction, 0.99; 95% CI, 0.98-1.01), or polygenic risk score (HR for interaction, 0.93; 95% CI, 0.85-1.02). Contrary to expectations for a prodromal syndrome, when stratified by time, loneliness was not associated with risk for incident PD during the first 5 years (HR, 1.15; 95% CI, 0.91-1.45) but was associated with PD risk during the subsequent 10 years (HR, 1.32; 95% CI, 1.19-1.46).Conclusions and RelevanceThis large cohort study found that loneliness was associated with risk of incident PD across demographic groups and independent of depression and other prominent risk factors and genetic risk. The findings add to the evidence that loneliness is a substantial psychosocial determinant of health.

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Risk of Suicidal Ideation and Behavior in Individuals With Parkinson Disease

Mai,

Chao,

Xiao

et al. 2024

JAMA Neurol

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ImportanceSuicide risk may be increased in patients with Parkinson disease (PD), a common neurodegenerative condition. Mood disorders, especially depression, are prevalent in patients with PD who report suicidality.ObjectiveTo address inconsistent results from studies of suicidal ideation and behavior in patients with PD.Data SourcesThe study team searched MEDLINE and Embase from inception to June 14, 2023, and further screened the bibliographies of relevant studies to ensure a comprehensive search.Study SelectionOriginal studies, published in English, discussing either suicidal ideation, behavior, or both in adults with PD were included. Accepted study designs included cross-sectional, case-control, and cohort studies. Studies that only included patients with PD after deep brain stimulation were excluded.Data Extraction and SynthesisThis meta-analysis was conducted in line with the PRISMA guidelines. Two authors reviewed each study and extracted the data independently, with discrepancies referred to a third independent author.Main Outcomes and MeasuresOutcomes included the prevalence of suicidal ideation and behavior, measured as proportions, and the risk of suicidal behavior in patients with PD relative to controls, measured in both odds ratio (OR) and hazards ratio (HR).ResultsA total of 28 studies comprising 505 950 PD patients were included in the final analysis. The prevalence of suicidal ideation was evaluated in 14 studies (22.2%; 95% CI, 14.6-32.3) and suicidal behavior in 21 studies (1.25%; 95% CI, 0.64-2.41). Excluding 4 outliers, prevalence of suicidal behavior was significantly higher in prospective studies (1.75%; 95% CI, 1.03-2.95) than retrospective studies (0.50%; 95% CI, 0.24-1.01). Excluding 1 outlier, OR of suicidal behavior was pooled across 10 studies and significant (OR, 2.15; 95% CI, 1.22-3.78; P = .01). HR of suicidal behavior was assessed in 9 studies (HR, 1.73; 95% CI, 1.40-2.14; P &lt; .001).Conclusions and RelevanceThis meta-analysis involving more than 500 000 patients with PD found 22.2% and 1.25% of patients with PD to have suicidal ideation and behavior, respectively. Patients with PD had 2 times the risk of suicidal behavior than controls. Early recognition and management of suicidality in PD can help reduce mortality.

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Risk of Suicide Among Patients With Parkinson Disease

Cited by 21 publications

References 58 publications

Association between new-onset Parkinson’s disease and suicide risk in South Korea: a nationwide cohort study

Association between new-onset Parkinson’s disease and suicide risk in South Korea: a nationwide cohort study

Loneliness and Risk of Parkinson Disease

Risk of Suicidal Ideation and Behavior in Individuals With Parkinson Disease

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