Increased Risk of Suicidal Ideation in Patients with Spinocerebellar Ataxias
Levi Peppel1, Ruo-Yah Lai3, Puneet Opal4, Jeremy Schmahmann5, Christopher Gomez6, Henry Paulson7, Theresa Zesiewicz8, Susan Perlman9, George Wilmot10, Sarah Ying11, Chiadi Onyike12, K Bushara13, Michael Geschwind14, Karla Figueroa15, Stefan Pulst15, S Subramony16, Antoine Duquette17, Tetsuo Ashizawa18, Ali Hamedani19, Marie Davis20, Sharan Srinivasan7, Matthew Burns16, Lauren Moore21, Vikram Shakkottai22, Liana Rosenthal23, Sheng-Han Kuo24, Chi-Ying Lin2
1Neurology, Baylor College of Medicine, 2Baylor College of Medicine, 3Columbia University Medical Center, 4Northwestern University Med Sch, 5Massachusettes General Hospital, 6University of Chicago, 7University of Michigan, 8University of South Florida, 9UCLA, 10Emory University Dept of Neurology, 11MEEI, 12Johns Hopkins University SOM, 13University of Minnesota, 14UCSF, 15University of Utah, 16University of Florida, 17CHUM, 18Methodist Hospital Research Institute, 19Hospital of the University of Pennsylvania, 20VA Puget Sound, 21National Ataxia Foundation, 22University of Texas Southwestern Medical Center, 23Johns Hopkins School of Medicine, 24Columbia University
Objective:
To test if individuals with spinocerebellar ataxias (SCAs) are at an increased risk for suicidal ideation.
Background:
Suicidal ideation has been identified in a variety of neurological disorders and has tremendous impacts on patients and their families. However, suicidality has not been extensively studied in patients with SCAs.
Design/Methods:
We studied 781 patients with genetically confirmed SCAs from the Clinical Research Consortium for the Study of Cerebellar Ataxia cohort. We investigated the prevalence of suicidal ideation in SCA1, 2, 3, and 6, and compared that to the general population using Fisher’s Exact test to generate an odds ratio. We investigated the clinical characteristics that may contribute to suicidal ideation in SCAs, including age, disease duration, sex, ataxia severity, and PHQ-8 scores (measured over a two-week period) using Independent sample t-test and the Mann-Whitney U test to compare patients with and without suicidal ideation.
Results:
Suicidal ideation was present in 11.8% of participants with SCAs, and when compared to the 9.2% in historical controls from the general global population, had an odds ratio of 1.32 (p = 0.002). Suicidal ideation was most prominent in SCA3 cases (odds ratio = 1.74, p = 0.003). SCA patients with suicidal ideation have longer years of disease duration (11.48 ± 6.88 vs. 9.93 ± 8.63, p=0.015), more severe ataxia as rated by the scale for the assessment and rating of ataxia (17.40 ± 8.76 vs. 12.94 ± 7.83, p < 0.001), and more severe depression (10.38 ± 5.72 vs. 4.95 ± 4.80, p < 0.001) than those without suicidal ideation.
Conclusions:
Suicidal ideation is more prevalent in SCAs than the general population. Our study highlights the importance of screening suicidal risk as part of the clinical evaluation for SCAs.