In a survey, 32.3% of patients with dystonia reported a lifetime history of suicidal ideations, which is a considerably higher rate of suicidal ideation than the general population’s rate of 9.2%, according to study results published in Neurology.
Stigma surrounds suicidality and studies have indicated that up to 90% of patients with the movement disorder have comorbid psychiatric disorders, including anxiety and major depression. As a result, study researchers hypothesized that patients’ suicidal behavior may not be disclosed during routine neurologic evaluations.
They recruited patients to complete a confidential online survey of 97 questions based on a previously used questionnaire and the Columbia-Suicide Severity Rating Scale (C-SSRS). They also obtained general demographics, clinical history, and psychiatric history.
The final cohort included 542 participants (mean age, 57.4±13.3 years; 80.8% women). Study researchers analyzed prevalence rates of the overall cohort and according to the form of dystonia. The group included 424 patients with focal dystonia (322 with laryngeal, 57 with cervical, 29 with focal hand, 11 with craniofacial, 4 with lower limb, 1 with abdominal/truncal), 63 with multifocal/segmental, 54 with generalized, and 1 with hemidystonia.
Of the cohort, 32.3% of patients reported a lifetime history of suicidal ideations (Fisher’s exact 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 ideations (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 limb, abdominal/truncal forms (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).
About 1 of 4 patients reported their history of suicidal ideations was related to dystonia. The greatest ratio, 1:2 dystonia-induced vs nondystonia-induced suicidality, was related to generalized and focal dystonias (except for laryngeal dystonia). Among patients with generalized dystonia, 16.7% reported the presence of suicidal ideations at the time of the study.
Roughly 17% of patients reported having made a suicide attempt, with the highest incidence among those patients with generalized dystonia (4:1 ratio of ideations to attempts).
Patients most frequently reported the following psychiatry disorders: generalized anxiety (43.4%), depression (40.4%), and social anxiety (29.1%). Suicidal ideations 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 related to suicidal behavior in the overall group of dystonia patients (P =.0004).
Limitations of the study included possible self-reporting bias and variation in sample sizes.
“Relatively lower-risk” patients with focal dystonia indicated more significant associations between suicidal behavior and psychiatric disorders compared with “higher-risk” patients with multifocal/segmental and generalized dystonias.
Therefore, in addition to considering psychiatric history, it is crucial to evaluate interplay with dystonia symptoms, the individual’s propensity to suicide, and other stressors, the study researchers said. They concluded that “suicidality in dystonia may be a critical, albeit yet unrecognized, trait of isolated dystonia. The screening for suicidal risk should be incorporated as part of a clinical evaluation of patients with dystonia in order to prevent suicide-induced injury and death.”
Worthley A, Simonyan K. Suicidal ideations and attempts in patients with isolated dystonia. Neurol. Published online January 27, 2021. doi:10.1212/WNL.0000000000011596