Objective: To examine the prevalence of suicidal ideation and suicide risk in patients with Parkinson’s disease (PD) and to assess the relationship between suicidal ideation and suicide risk in PD.

Background: In addition to motor symptoms, PD also carries a high burden of neuropsychiatric comorbidities. While depression is a known risk factor for suicidal ideation and suicide in PD [1], there is a dearth of studies on the prevalence of suicidality in PD.

Method: A total of 143 PD patients were screened for the Treating Anxiety in Parkinson’s Disease with a Multi-Strain Probiotic study (NCT03968133), a randomized controlled trial aimed to assess the effect of a multi-strain probiotic in PD patients with mild-to-moderate anxiety. Patients were mainly recruited from a movement disorders clinic in Canada. As part of screening, patients completed the Parkinson Anxiety Scale, the Beck Depression Inventory-II (BDI-II), and the Mini International Neuropsychiatric Interview (MINI), version 6.0.0. Suicidal ideation was scored as present if patients endorsed a score of 1 or greater on the BDI-II item 9 (Suicidal Thoughts or Wishes). Suicide risk was assessed using the Suicidality Module of the MINI, which classifies suicidality into no, low, moderate, and high risk. Binary logistic regression was conducted to assess if a particular patient was at risk of suicide based on the BDI-II item 9 score after controlling for age and gender.

Results: Of those screened for the trial, 127 patients completed the BDI-II and the MINI. According to the BDI-II item 9, 19 PD patients (15.0%) reported thoughts of killing themselves but would not carry them out, as indicated by a score of 1. No patients scored above 1 on this item. Based on the MINI, 1 patient (0.8%) was at moderate risk of suicide, 25 (19.7%) were at low risk, and 101 (79.5%) were at no risk. No patients were at high suicide risk. Patients who scored higher on the BDI-II item 9 were at a higher risk of suicide (OR = 33.79, p < .001, 95% CI: 9.21-123.98), when adjusted for age and gender. This model explained 42.7% (Nagelkerke R²) of the variance in suicide risk and was able to correctly classify 111 patients out of 126 patients.

Conclusion: Around 20% of PD patients in our study were at risk of suicide, highlighting the importance of screening PD patients for suicidality during routine clinical visits. Our results also indicate that the BDI-II item 9 is useful in screening for suicide risk in PD.

References: [1] M.D. Shepard, K. Perepezko, M.P.G. Broen, J.T. Hinkle, A. Butala, K.A. Mills, J. Nanavati, N.M. Fischer, P. Nestadt, G. Pontone, Suicide in Parkinson’s disease, J. Neurol. Neurosurg. Psychiatry. 90 (2019) 822–829. doi:10.1136/jnnp-2018-319815.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/suicidal-ideation-and-suicide-risk-in-parkinsons-disease/