How Prevalent Is Suicide in Parkinson's Disease?

The dramatic headline “Suicide is Five Times More Likely in Parkinson’s Disease” caught my attention. It made it seem as though everyone with Parkinson’s Disease (PD) was either thinking about suicide, attempting suicide or committing suicide.

I was skeptical and asked Benzi Kluger, MD, neurologist and specialist in the non-motor symptoms of PD, at the University of Colorado at Denver.

Dr. Kluger’s comments about the study (at the bottom of this post) are as follows:

1) This is a relatively small study. There were just over 100 patients followed for 8 years and only 2 suicides. With such a small sample the chance of error is high. One more or less suicide would have totally changed their results.

2) Suicidal ideation (thoughts) seem to be higher in PD, which is not surprising because depression is also more frequent.

3) Suicide is a cultural phenomena and higher in Serbia, where this study was done, than in the US.

4) Some studies suggest suicide may be at increased risk after DBS, but again these studies are small.

5) There is probably some increased risk for suicide with PD, but larger studies are needed in this country to reliably estimate this risk. Physicians, patients and care givers should be aware of this risk and take it seriously.

1: J Neurol Sci. 2009 Sep 7. [Epub ahead of print]

Suicide and suicidal ideation in Parkinson's disease

Kostiæ VS, Pekmezoviæ T, Tomiæ A, Jeèmenica-Lukiæ M, Stojkoviæ T, Spica V, Svetel M, Stefanova E, Petroviæ I, Džoljic E.

Institute of Neurology CCS, School of Medicine, Belgrade, Serbia.

Little is known about the prevalence and correlates of suicidal behavior in Parkinson's disease (PD). In the first part of the study, we followed a cohort of 102 consecutive PD patients for 8 years and found that the suicide-specific mortality was 5.3 (95% CI 2.1-12.7) times higher than expected. In the second part, we tested 128 PD patients for death and suicidal ideation and administered an extensive neurological, neuropsychological and psychiatric battery. Current death and/or suicidal ideation was registered in 22.7%. On univariate logistic regression analysis, psychiatric symptoms (depression, but also anxiety and hopelessness), but not the PD-related variables, were associated with such ideation. On multivariate logistic regression analysis this association held for major depression (odds ratio=4.6; 95% CI 2.2-9.4; p<0.001), psychosis (odds ratio=19.2; 95% CI 1.4-27.3; p=0.026), and increasing score of the Beck Hopelessness Scale (odds ratio=1.2; 95% CI 1.0-1.4; p=0.008). In conclusion, the suicide risk in PD may not be as high as it is expected, but it is certainly not trivial. According to our data almost a quarter of PD patients had death and/or suicidal ideation, that may significantly influence their quality of life.

PMID: 19737673 [PubMed - as supplied by publisher]

Comments

[Bob Dawson]

Well, I don't want to ruin anyone's day, but there is a timing issue that we face. If I don't want to end up being totally crippled and unable to feed or wash or dress myself, bed-ridden for years, then I consider that I would have to commit suicide before becoming too incompetent to commit suicide. And when is that point in time? If I wait too long, I may not have the presence of mind and the physical ability to do it. If I go too soon, it would be just my luck that they announce the cure the next day, and all the businessmen at my funeral would be joking, saying "He always said that timing is everything...hahaha!)
But thinking about death, natural or self-inflicted, happens to just about anybody with a downward spiraling not-fixable disease. And having thought about it, I put on the Blues real loud and drive those blues away. Let's do some living while we can. But I am still in the early to mid stages of the disease, so it is easy for me to talk.

[parkinson illness]

There were just over 100 patients followed for 8 years and only 2 suicides. With such a small sample the chance of error is high.

[Rachel Tortolini]

Should we not distinguish between suicide and euthanasia? Suicide carries with it a lot of culturally negative baggage that should not enter into such studies. After all, choosing life over suicide might be just prolonging a painful death in reality. I like to think of euthanasia self-inflicted as a choice to go when I have the ability. To rationally get my affairs in order, be with friends and take the final exit before I am no longer able to take care of these thing myself seems eminently preferrable. This is planned not a sudden off the cuff (condemned) suicide. So please let us have clarity over choice of words. For those nearing the final exit this is not suicide.

[Susan]

Comtemplating self-directed euthanasia before this hateful disease can rob us of our independence and dignity does not mean that we "don't want to live anymore." The exact opposite is true for me. I love and revere my life but I feel like I am standing on the train track with my foot stuck in the rails, and late-stage Parkinson's is the train whistling in the distance! There is nowhere to run but to oblivion. I cannot reconcile these options in my head (Invalid or death) so my mind runs like a mouse in a maze looking for a way out. Please, give me door number three and I'll gladly choose it! I am only fifty years old! I have a job I love, a husband I adore and the sweetest son in the world. I have family and friends and dreams and want to believe that my disease will progress slowly and buy me precious time, but I can tell you one thing, there is no way I am going to allow my family to be made bankrupt by medical bills, or be responsible for what's left of me when Parkinson's has ravaged my body, mind and spirit. So...door number three, anybody?