ClinicSpeak: risk factors for suicide in MSers

Do you want to hear about suicide risk and MS? #ClinicSpeak #MSBlog #MSResearch

"We are continously crticised by various stakeholders for telling it like it is. My response to this is that if you don't know how serious/disabling MS can be how can you make an informed deciscion about treatments that have risks. Sure the risks and benefits of a MS treatment must be weighed against the risks of the disease? One MS Society that wanted to use my 'holistic approach to MS' tube map actually asked me to remove the terminal phase of the disease, in particular suicide and assisted suicide from the map. I refused. This may change once the Mouse Doctor buys me the pair of rose-tinted spectales he promised me in his post from the 1st April."

"The following paper addresses one the MS taboos; suicide and suicidal ideation. Suicide rates in MSer are about 4x higher than back ground rates; reports range from 2x to 7x higher. I am not surprised MS is a disablig disease that affects young people and it associated with very high rates of depression and anxiety. Not surprisingly the main risk factors for suicidal ideation was (1) reduced leisure time, (2) depression and (3) social exclusion. In contrast (1) having a purpose in life, (2) being productive and (3) having comfort in faith and spiritual beliefs reduced suicidal ideation."

"The question is should we be routinely screening for suicide risk whenever we see patients with MS in our clinics? We tend to do this in clinical trials; study subjects have to complete a suicide risk assessment at each visit so that we can identify those that are at risk and do something about it. If you want I could upload the screening tool for you all to use?"

Strupp et al. Risk Factors for Suicidal Ideation in Patients Feeling Severely Affected by Multiple Sclerosis. J Palliat Med. 2016 Apr 5.

BACKGROUND: Being severely affected by multiple sclerosis (MS) brings substantial physical and psychological challenges. Contrary to common thinking that MS is not lethal, there is a higher mortality risk in patients also reflected in alarming rates of assisted suicide, and - where possible - euthanasia.

OBJECTIVE: Analyzing independent variables promoting suicidal ideation in severely affected MS patients.

DESIGN: A self-report questionnaire with 25 needs categories including one self-assessment item "prone to suicidal ideation" was applied.

SETTING/SUBJECTS: Included were patients reporting feeling subjectively severely affected by MS. Of 867 patients addressed, 573 (66.1%) completed the questionnaires.

MEASUREMENTS: 32 items being potential risk factors for suicidal ideation were tested for statistical significance using a multivariate logistic regression model with stepwise, backward elimination procedure.

RESULTS: 22.1% of 573 patients (median age 51, range 20-83) had suicidal ideation. 48.4% suffered from secondary progressive, 24.7% from relapsing-remitting and 21.9% from primary progressive MS. A set of six statistically significant criteria for suicidal ideation were found. Three items were risk factors for suicidal ideation: the extent to which MS affects leisure time (p < 0.001), depression (p < 0.000), and feeling socially excluded (p < 0.002). Three items reduced the odds of suicidal ideation: having a purpose in life (p < 0.000), being productive (p < 0.000), and having comfort in faith and spiritual beliefs (p < 0.024).

CONCLUSION: This study identified potentially modifiable factors that may help preventing suicide in people with MS. Integrating palliative care (PC) with its multidisciplinary approach could be beneficial to reduce patient's burden.

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