Study Finds Patients With Parkinson Disease at Greater Risk of Death by Suicide

Patients with Parkinson disease (PD) were shown to be at greater risk of suicide than control matched participants in the general population, according to study findings published last week in JAMA Psychiatry.

In prior studies, risk of mental health disorders such as depression and anxiety has been noted as greater among PD populations. Moreover, the adverse implications of the coronavirus disease 2019 pandemic have brought about a rise in feelings of loneliness amid social distancing regulations, which was associated with greater patient-reported PD severity and lower quality of life.

In the present study, researchers acknowledge the common nature of comorbidities with mental disorders among patients with PD (PwP), but they note that it is unclear whether this stark risk may be associated with an increased risk of suicide.

“PD causes progressive physical disability, which is an important suicide risk factor in younger and middle-aged populations; whether PD is associated with elevated suicide risk is understudied,” highlighted the researchers.

Utilizing a large representative PD cohort within Taiwan’s National Health Insurance system, researchers compared the risk of suicide in PwP (n = 35,891; women = 17,482 [48.7%]; mean [SD] age = 72.5 [10.1] years) and control-matched participants of the general population (n = 143,577; women = 69,928 [48.7%]; mean [SD] age = 72.5 [10.1] years), with several potential risk factors additionally examined:

• differences in characteristics (sociodemographic attributes, medical and mental disorders, and methods of suicide)
• factors associated with suicide risk (disease duration, PD severity, medical and mental comorbidities) in PwP.

PwP diagnosed between January 2005 and December 2014 were followed up until December 2016, with Cox proportional models and HRs used to estimate the association between PD and the risk of suicide over the follow-up period.

Across the time span of the study, a total of 151 PwP and 300 control participants were found to have died by suicide. Researchers found that the risk of suicide in PwP was more than 2-fold the risk in control participants (HR, 2.1; 95% CI, 1.7-2.5) after adjusting for markers of socioeconomic position, medical comorbidities, and dementia.

The association between PD and suicide risk remained after controlling for mental disorders, with PwP shown to be at a nearly 2 times greater risk than control participants (HR, 1.9; 95% CI, 1.6-2.3). Notably, those who died by suicide in the PD cohort were slightly younger than control participants who died by suicide (patients with PD: mean [SD] age = 74.0 [10.4] years; control participants: mean [SD] age = 76.0 [10.2] years; P = .05), with PwP also found to be more likely to live in urban areas and have mental disorders:

• depression: 15 of 151 patients with PD (9.9%) vs 15 of 300 control participants (5.0%)
• other mental disorders: 12 patients with PD (8.0%) vs 11 control participants (3.7%) (P = .02)
• adopt jumping as a method of suicide (21 patients with PD [13.9%] vs 16 control participants [5.3%]) (P < .01).

“Integrating mental health care into primary care and PD specialty care, along with socioenvironmental interventions, may help decrease the risk of suicide in patients with PD,” concluded the study authors.

Reference

Chen YY, Yu S, Hu YH, et al. Risk of suicide among patients with Parkinson disease. JAMA Psychiatry. Published online December 16, 2020. doi:10.1001/jamapsychiatry.2020.4001

^{If you are thinking about suicide, please call the National Suicide Prevention Lifeline at 800-273-TALK (8255).}