Saturday, 9 April 2016

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.

10 comments:

  1. I felt depressed during my first relapse, I was very unwell at the time suffering from an infection, brainstem relapse, depression, anxiety and stress. For a short time I considered walking in the road but then thought if I survive being hit I will be in a worse state than I am now. I have not felt like that before or since that relapse.
    What I find interesting reading is about depression and the immune system and that the immune system influences the brain and can make people depressed.

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  2. for me this makes no sense, ProfG.
    Aren’t you talked many times that societal appreciation of a QoL of a person with EDSS > 7 is worse then death?
    As this is inevitable perspective for virtually any progressive MSer, and I’m pretty sure for RRMSer also, what the problem is with the suicidal ideation?

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    1. "As this is inevitable perspective for virtually any progressive MSer, and I’m pretty sure for RRMSer also"

      No, it's not.

      But MS or not, we *all* lose it all one day.

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    2. Ask any decent neurologist.

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    3. A high EDSS score is not the only reason for suicidal tendencies.

      As my MS has progressed over the last 20 ears my ability to do the things that gave me pleasure have become difficult to impossible, gardening, dog walking being two of them oroginally. Medical retirement now its walking, balance and always having to catheterise. My physical abilities have declined dramatically but the mental appreciation of my situation has not changed. This is about my QoL

      Thankfully I have not felt suicidal but I do get depressed and disillusioned

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  3. I applaud Team G's holistic approach and the fact that they're not scared to talk about subjects that many others wouldn't touch with a barge pole. I know someone with MS who committed suicide. Everything is relative. He knew people with MS who were in a much worse physical state than him, yet, he felt his life had ended because he was unable to work and provide for his family, even though physically he was still able to get around albeit with walking aids (he wasn't even in a wheelchair yet) and his cognition was still Ok (although he didn't have the concentration or memory to be able to work in the job that he did). With the right physical, mental and other support e.g. from employers, correct drug management (to delay MS progression) and ongoing monitoring, this should all help feed into a healthier state of mind. That's why a holistic approach is so important.

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    1. I agree with a holistic approach is so important.

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  4. I've had MS for years and had 3 bouts of depression treated by psychotherapy. I've been fine, but recently I've been prescribed drugs that have been mind changing. Maybe doctors should be looking more closely at the side effects of medication.

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  5. Lol does that mean to be happier we should all look for faith or spirituality? I ask as an angry atheist without MS?
    Bojana

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