In a survey, 32.3% of patients with dystonia reported a lifelong history of suicidal ideation. This is a significantly higher rate of suicidal ideation than the general population rate of 9.2%. This is evident from study results published in Neurology.
Suicidality stigma and studies have shown that up to 90% of patients with the movement disorder have comorbid psychiatric disorders, including anxiety and major depression. As a result, the study’s researchers hypothesized that patient suicidal behavior may not be revealed during routine neurological exams.
They recruited patients to complete a confidential 97-question online survey based on a previously used questionnaire and the Columbia-Suicide Severity Rating Scale (C-SSRS). They also received general demographics, clinical history, and psychiatric history.
The final cohort consisted of 542 participants (mean age 57.4 ± 13.3 years; 80.8% women). The study researchers analyzed the prevalence rates for the entire cohort and according to the type of dystonia. The group comprised 424 patients with focal dystonia (322 with larynx, 57 with cervical, 29 with focal hand, 11 with craniofacial, 4 with lower extremity, 1 with abdominal / stocky), 63 with multifocal / segmental, 54 with generalized and 1 with Hemidystonia.
From the cohort, 32.3% of the patients reported a lifelong history of suicidal ideation (more precise Fisher test: odds ratio (OD), 9.8; 95% CI, 6.4-15.4; corrected P = 2.2e -16). Patients with generalized dystonia reported the highest incidence (50%) of suicidal ideation (OD 9.7; 95% CI 3.2-36.3; corrected P = 4.7e-06), followed by 46.0% in patients with multifocal / segmental dystonias (OD) 8.0; 95% CI, 2.9-25.9; corrected P = 6.9e-06), 33.3% in patients with focal dystonias, including cervical, focal hand, craniofacial, lower extremities, abdominal / trunk shapes (OD, 5.1; 95%) CI 2, 2-13.0; corrected P = 2.5e-05) and 26.1% in patients with laryngeal dystonia (OD 3.4; 95% CI 2.2-5.6; corrected P = 2.7e-08).
Approximately 1 in 4 patients reported that their history of suicidal ideation was related to dystonia. The largest ratio, 1: 2 dystonia-induced vs. non-dystonia-induced suicidality, was associated with generalized and focal dystonia (excluding larynx dystonia). In patients with generalized dystonia, 16.7% reported suicidal ideation at the time of the study.
Approximately 17% of patients reported attempting suicide, with the highest incidence being seen in patients with generalized dystonia (ideas to attempts ratio of 4: 1).
The patients most frequently reported the following psychiatric disorders: general anxiety (43.4%), depression (40.4%), and social anxiety (29.1%). Thoughts of suicide were significantly associated with these psychiatric disorders (all P ≤.0004). Depression was associated with all forms of focal dystonia (all P ≤ 1.4e-05). Social anxiety was significantly associated with suicidal behavior in the total group of dystonia patients (P = 0.0004).
The limitations of the study included possible biases in self-reporting and variations in sample sizes.
“Relatively lower risk” patients with focal dystonia showed more significant associations between suicidal behavior and psychiatric disorders compared to “higher risk” patients with multifocal / segmental and generalized dystonia.
Therefore, in addition to considering the psychiatric history, assessing the interaction with the symptoms of dystonia, the patient’s suicidal tendency, and other stressors, according to the study’s researchers. They concluded that “suicidality in dystonia can be a critical, if not yet recognized, characteristic of isolated dystonia. Screening for suicide risk should be included as part of a clinical evaluation of patients with dystonia to prevent suicide-related injuries and death. “
Worthley A, Simonyan K. Suicidal ideation and attempted suicide in patients with isolated dystonia. Neurol. Published online January 27, 2021. doi: 10.1212 / WNL.0000000000011596