Suicide and multiple sclerosis: an epidemiological investigation.

Abstract

In a nationwide investigation the risk of death by suicide for patients with multiple sclerosis (MS) was assessed using records kept at the Danish Multiple Sclerosis Registry (DMSR) and the Danish National Register of Cause of Death. The investigation covers all MS patients registered with DSMR with an onset of the disease within the period 1953-85, or for whom MS was diagnosed in the same period. Fifty three of the 5525 cases in the onset cohort group committed suicide. Using the figures from the population death statistics by adjustment to number of subjects, duration of observation, sex, age, and calendar year at the start of observation, the expected number of suicides was calculated to be nearly 29. The cumulative lifetime risk of suicide from onset of MS, using an actuarial method of calculation, was 1*95%. The standard mortality ratio (SMR) of suicide in MS was 1-83. It was highest for males and for patients with onset ofMS before the age of 30 years and those diagnosed before the age of 40. The SMR was highest within the first five years after diagnosis.

Psychiatric Issues in Multiple Sclerosis

“…The most compelling reason to investigate psychiatric disorders among persons with MS is that reported rates of completed suicide in MS populations are high [6], and psychiatric disorders appear to be the major risk factor for suicidality [7]. Death certificate-based reviews indicate that suicide may be the cause of death for MS clinic patients in as many as 15% of all cases.…”

Evidence-based guideline: Assessment and management of psychiatric disorders in individuals with MS

“…1,2 Undetected and untreated mental illness may worsen functioning 3 and quality of life, [4][5][6][7][8] decrease treatment adherence, 9 and increase risk of suicide. [10][11][12][13][14][15][16] Improved detection, diagnosis, and treatment practices in medical settings where individuals with emotional disorders are often first seen would help ameliorate these negative outcomes. This guideline reviews the evidence and makes recommendations for identifying, diagnosing, and treating psychiatric disorders in individuals with MS.…”

“…31 Suicide may be at least twice as common. [10][11][12][13][14][15][16] Prevalence estimates for pseudobulbar affect (PBA) range from 6.5% to 46.2% [32][33][34] ; the prevalence of euphoria is unknown. 35 Depressive and manic/hypomanic symptoms may occur with high-dose corticosteroids, 36 but the association between depressed mood and disease-modifying therapies is unclear.…”

Psycho-social and medical patterns of psychiatric disorders in multiple sclerosis patients, Baghdad-Iraq

“…People with multiple sclerosis and psychosis are more likely to have plaques involving the temporal horns bilaterally 12 . The authors suggested that psychosis in multiple sclerosis is distinct from schizophrenia as it has a later age at onset, quicker resolution, fewer relapses, better response to treatment and a better prognosis 13 .…”