Suicidal ideation in youth with tic disorders

Abstract

Background This study examined the incidence and clinical correlates of suicidal ideation (SI) in youth with tic disorders (TD). The independent contribution of tics, anxiety, depressive and externalizing symptoms on SI severity in youth with TD was assessed. Method Participants were 75 treatment-seeking youth with a TD (N = 75) aged 6–18. Participants completed diagnostic assessments, clinician-ratings, self- and parent-report measures of emotional functioning and the presence and/or severity of suicidal ideation. Results Based on youth-report, 61% of youth endorsed at least some symptoms of SI, and 8% endorsed symptoms that exceeded the clinically significant cut-off. Parents reported SI in 11% of cases, with generally poor agreement between parent- and youth-report. Suicidal ideation correlated with higher anxiety, depressive and externalizing symptoms, affective lability, and with poorer distress tolerance and overall functioning. Anxiety, depressive and externalizing symptoms showed an independent relationship with SI. Tic severity was not associated with SI. Rather, higher tic severity was associated with an increase in anxiety symptoms, which in turn, was associated with greater SI severity. Limitations Cross-sectional data limits causal conclusions. Diagnosis was based on unstructured assessments by expert clinicians, including consensus diagnosis, rather than structured clinical interviews. Conclusions Around 8–11% of youth with TD experienced SI. Tic severity did not have any direct influence on SI, however the presence of comorbid anxiety and depressive symptoms significantly increases this risk. Results suggest that it is psychiatric comorbidity, rather than tics themselves, that predispose youth with tic disorders to increased risk of suicidality.

Mortality risk in a nationwide cohort of individuals with tic disorders and with tourette syndrome

“…Prior evidence suggests that individuals with TS have a higher rate of suicidal ideation, which also may apply for a higher rate of suicide. A high rate of suicidal ideations (26.8%) was reported in a consecutive clinical sample of all ages, as well as in a selected sample of adults with malignant TS (35%) .…”

“…Several factors may contribute to this increased risk of premature death, but more research on factors that can improve life expectancy and quality of life in this vulnerable group of individuals is needed. 7,19 Prior evidence suggests that individuals with TS have a higher rate of suicidal ideation, [20][21][22][23][24][25] which also may apply for a higher rate of suicide. A high rate of suicidal ideations (26.8%) was reported in a consecutive clinical sample of all ages, 20 as well as in a selected sample of adults with malignant TS (35%).…”

Tourette syndrome research highlights from 2016

“…Self-reported depressive symptoms were as common and severe in TS as in tic-free patients with major depression, though people with TS endorsed irritability more frequently 27 . Suicidal ideation was present in at least 8% of 75 youth ages 6–18 with a tic disorder in a clinical setting, and was independent of tic severity 28 .…”

Paediatric deep brain stimulation: ethical considerations in malignant Tourette syndrome

“…At the time of the recommendation update in 2015, 5 existing studies suggested that tic severity was associated with anxiety symptoms, which, in turn, were associated with SI. 25 These studies argued that anxiety secondary to tic severity could be treated with traditional psychosocial methods, rendering DBS unnecessary to alleviate SI. 5 12 Since the recommendation's publication, a new study revealed the relationship between TS and suicide was underestimated.…”