Suicide and MS

Pompili et al. Suicide risk in multiple sclerosis: A systematic review of current literature. J Psychosom Res. 2012; 73:411-417.

BACKGROUND: Studies have shown that suicidal ideation is often revealed among MSers. Mental health assessment of physically ill MSers should form part of routine clinical evaluation, particularly in chronic illness.

OBJECTIVE: The aim of the present paper was to investigate whether there was a relationship between MS and suicidal behaviour.

METHODS: A systematic review of the literature was conducted to determine the potential association between MS and suicidal behaviour  A total of 12 articles from peer-reviewed journals were considered and selected for this review.

RESULTS: Most studies have documented a higher suicide rate in MSers compared to the general population, and suicide was associated with several risk factors: Depression severity, social isolation, younger age, progressive disease subtype, lower income, earlier disease course, higher levels of physical disability, and not driving.

CONCLUSIONS: Clinicians should be aware of the fact that suicidality may occur with higher frequency in MSers, the available data suggest that the risk of self-harm is higher than expected in MS patients.

"Suicide is a an awful thing, and is commoner in MSers. I will never forget the first time a patient I was looking after committed suicide. I will never be free of the guilt; could I have prevented it? Nor will I have my questions answered: Why? Was life so bad? We need to do everything we can to avoid it. If you have a problem with mood and anxiety and have had suicidal thoughts don't ignore them let your nurse, family doctor or neurologist know. There are things that can be done to help you."

"The following is the Suicidal Intent Scale that is commonly used to assess suicide risk."

Pierce Suicidal Intent Scale

  0 Somebody present
  1 Somebody nearby or in contact (as by phone)
  2 No-one nearby or in contact

  0 Timed so that intervention is probable
  1 Timed so that intervention is unlikely
  2 Timed so that intervention is highly unlikely

Precautions against discovery:
  0 No precautions
  1 Passive precautions eg avoiding others but doing nothing to prevent their intervention 
       (e.g. alone in room, door unlocked)
  2 Active precautions (eg locked doors)

Acting to gain help during or after attempt
  0 Notified helper regarding attempt
  1 Contacted but did not specifically notify helper regarding the attempt
  2 Did not contact or notify potential helper

Final acts in anticipation of death:
  0 None
  1 Partial preparation or ideation
  2 Definite plans made (eg changes in will, taking out insurance)

Suicide note:
  0 No note
  1 Note written but torn up
  2 Presence of note

Self report Patient's statement of lethality
  0 Thought that what he had done would not kill him
  1 Unsure whether what he had done would kill him
  2 Believed that what he had done would kill him

Stated intent
  0 Thought that what he had done would not kill him
  1 Unsure whether what he had done would kill him
  2 Believed that what he had done would kill him

  0 Impulsive, no premeditation
  1 Considered act for approx 1 hour
  2 Considered act for approx 1 day
  3 Considered act for more than 1 day

Reaction to act
  0 Patient glad he had recovered
  1 Patient uncertain whether he is glad or sorry
  2 Patient sorry he has recovered

Risk Predictable outcome in terms of lethality of patient's act 
and circumstances known to him/her
  0 Survival certain
  1 Death unlikely
  2 Death likely or certain

Would death have occured without medical treatment?
  0 No
  1 Uncertain
  2 Yes

Total score:
  0-3 Low risk
  4-10 Medium risk
  11+ High risk