medwireNews: Patients with Parkinson’s disease (PD) are twice as likely to exhibit suicidal behavior as people with other non-neurologic diseases or the general population, suggests a meta-analysis of more than 500,000 patients.
Overall, the analysis of 28 studies found that 22.2% of PD patients showed suicidal ideation, including past and current thoughts about suicide, and 1.25% exhibited suicidal behavior, encompassing suicide attempts and deaths by suicide.
“Suicide remains a major health problem, especially in developed countries,” write Eng-King Tan (Duke-NUS Medical School, Singapore) and colleagues in JAMA Neurology. “Early detection and management of suicidality is an area where further efforts are needed.”
The study analyzed 505,950 PD patients across 28 studies that recorded suicidal ideation or behavior. The percentage of women in the studies ranged from 1.3% to 62.7% and the mean age ranged from 41.5 to 81.2 years.
Of the studies included in the meta-analysis, 15 were cross-sectional, eight were retrospective cohort studies, and three were case–control studies. Most were of high quality according to the Joanna Briggs Institute Critical Appraisal Tools, although eight studies failed to explicitly identify and adjust for confounders and only three included details of a follow-up period, which ranged from 2 to 8 years.
The researchers observed 637 suicidal ideation events across 14 studies including 3323 patients with PD, indicating a prevalence of 22.2%.
Meanwhile, 2700 events of suicidal behavior were identified across 21 studies including 423,148 participants, comprising PD patients and non-PD controls. This gave a prevalence of 1.25%.
Looking at the risk for suicidal behavior in PD patients compared with individuals with other non-neurologic diseases or the general population, the researchers found that across 10 studies it was significantly increased by an odds ratio of 2.15 among patients with PD. A similarly increased risk was observed for PD patients when calculating the hazards ratio, which came out as 1.73 across nine studies.
According to Tan and colleagues, suicidality can be difficult to detect in PD patients, and tends to be severe when recognized.
“Numerous barriers prevent patients from reaching out and getting the help they need, such as stigma toward receiving mental health care, lack of knowledge, limited accessibility, and financial or logistical issues,” they write. “As such, a treatment gap exists that requires much effort to reduce.”
Tan and colleagues also observe that retrospective studies may underestimate the true prevalence of suicidal behavior, finding a lower prevalence with this study design than with a prospective design, at 0.50% versus 1.75%.
They suggest this may be because “only completed suicides and suicidal attempts requiring medical attention are detected and documented in medical databases,” so prospective studies may be “more sensitive to suicidal ideation and behavior and provide more reliable data.”
The authors acknowledge that the studies used in the meta-analysis were heterogeneous in terms of study design, geographical location, and patients, and they were careful to exclude outliers and analyze sensitivity. Other limitations include the evolution of terminologies in suicide research over the past decades and the inability of cross-sectional studies to account for completed suicides.
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