Category: Huntington's Disease
Objective: The aim of this study was to describe the risk of suicidality among individuals with versus those without Huntington disease (HD) from Enroll-HD.
Background: High rates of suicidality have been reported in HD; however, real-world data on suicidality risk and contributing factors are scant.
Method: Enroll-HD is a global research platform for individuals with/at risk for HD, and their relatives. Suicidality data were collected annually (2012–2020) using the Problem Behavioral Assessment scale (PBA). HD stage was assessed by Total Functional Capacity (TFC) score and Shoulson–Fahn staging: TFC 7–13/stage 1–2 (early), TFC 3–6/stage 3 (middle), TFC 0–2/stage 4–5 (late). Chorea severity was measured by Total Maximal Chorea (TMC) score. Causal inference analysis was performed using inverse probability weighting and marginal structural models. HD stage (exposure variable), employment, antipsychotics or antidepressants use, smoking, TMC score, age group, body mass index, education, marital status, sex, past alcohol or substance use, region, and PBA baseline depression were included. All but the last 5 were time varying. Hazard ratios (HRs) of first suicidality with 95% CIs were estimated via a conditional outcome model.
Results: Data for 10,796 and 4992 individuals in HD and non-HD groups, respectively, were included. Hazard of suicidality (via PBA) was higher for the following categories (all P<.05): early (HR=1.41) and middle (1.81) stage HD (but not late stage HD) vs non-HD. Hazards of suicidality were also higher for the following: age 18–30 (HR=1.71)/>60 years; obesity (1.46)/normal weight; past alcohol use (1.45)/nonuse; antipsychotics (1.35) or antidepressants (1.25) use/nonuse; being single, divorced, widowed, or legally separated (1.36)/married or in a partnership; and depression (7.32)/no depression (via PBA) at baseline. The TMC categories were non-informative.
Conclusion: This study highlights a significantly increased suicidality hazard during early and middle HD stages, after controlling for factors associated with HD and suicidality. These findings emphasize the need for attention to suicidality risk and contributing risk factors in HD, particularly in early and middle HD stages.
To cite this abstract in AMA style:
S. Reshef, V. Sung, G. Smith, O. Harari, D. Zhang, M. Forrest Gordon, R. Willock, R. Ribalov, J. Robles-Zurita, E. Furr Stimming. Hazard ratios of suicidality in a large Huntington disease population compared with controls: marginal structural modeling of Enroll-HD registry data [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/hazard-ratios-of-suicidality-in-a-large-huntington-disease-population-compared-with-controls-marginal-structural-modeling-of-enroll-hd-registry-data/. Accessed June 15, 2025.« Back to 2023 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/hazard-ratios-of-suicidality-in-a-large-huntington-disease-population-compared-with-controls-marginal-structural-modeling-of-enroll-hd-registry-data/