Parkinson's disease tied to greater risk of suicidal behaviour and ideation: JAMA

Late-life suicide is a preventable cause of death, particularly for older adults who face an increased risk due to factors like high disease prevalence, health care barriers, and psychosocial problems. Chronic neurological disorders, such as Parkinson's disease, pose a particular concern, with many patients experiencing non-motor symptoms and psychological burdens, such as depression and anxiety, which affect up to 30 to 50% of patients.

According to an original Investigation published in JAMA Neurology, researchers have concluded that Patients with Parkinson's disease may be at increased risk of both suicidal thoughts and behaviour. Therefore, physicians should be vigilant and have a high level of suspicion to detect these issues early and provide appropriate care.

This meta-analysis of 28 studies found a high prevalence of suicidal ideation and behaviour in patients with PD. Compared with controls, patients with PD experienced two times the risk of engaging in suicidal behaviour.

Patients with Parkinson's disease (PD) may have an increased risk of suicide, according to a study. Mood disorders, especially depression, are common in PD patients who report suicidality. The study team searched for relevant studies in MEDLINE and Embase from inception to June 2023 and included original studies in English that discussed suicidal ideation, behaviour, or both in adults with PD. Excluded were studies that only included patients after deep brain stimulation. The meta-analysis followed the PRISMA guidelines, with two authors reviewing each study and extracting data independently, with discrepancies referred to a third independent author. Outcomes included the prevalence of suicidal ideation and behaviour, measured as proportions, and the risk of suicidal behaviour in PD patients relative to controls, measured in odds ratio (OR) and hazards ratio (HR).

Key findings from this investigation are:

• Researchers included 28 studies comprising 505,950 PD patients.
• The prevalence of suicidal ideation and suicidal behaviour was evaluated in 14 studies and 21 studies, respectively.
• Excluding four outliers, the prevalence of suicidal behaviour was significantly higher in prospective studies compared to the retrospective studies.
• Excluding one outlier, OR of suicidal behaviour was pooled across ten studies and significant with OR, 2.15.
• HR of suicidal behavior was assessed in 9 studies with an HR of 1.73

Concluding further, they said, In this meta-analysis, we found 22.2% and 1.25% of patients with PD to have suicidal ideation and behaviour, respectively. PD patients had two times the risk of suicidal behavior than controls. Early recognition and management of suicidality in PD can help in reducing mortality.

Study limitations include heterogeneity due to study design, geographic variation, and differences in patient demographics, unavoidable variability in the definitions of suicidal ideation and behaviour, prospective cross-sectional design.

Reference:

Mai AS, Chao Y, Xiao B, et al. Risk of Suicidal Ideation and Behavior in Individuals With Parkinson's Disease: A Systematic Review and Meta-Analysis. JAMA Neurol. Published online November 13, 2023. doi:10.1001/jamaneurol.2023.4207