Suicidal Ideations and Attempts in Patients With Isolated Dystonia

Abstract

Objective: To evaluate the hypothesis that individuals with isolated dystonia are at an increased risk for suicidal behavior, we administered an anonymous electronic survey to patients with dystonia, asking them about their history of suicidal ideations and suicide attempt.

Methods: A total of 542 patients with dystonia completed an online 97-question survey, which captured the demographics of suicidal behavior and major psychiatric disorders. Statistical analyses examined the prevalence of suicidal behavior in patients with dystonia compared to the prevalence of suicidal ideations and attempt in the general global population and assessed the significance of risk associations between suicidality and psychiatric history in these patients.

Results: Overall, 32.3% of patients with isolated dystonia reported a lifetime history of suicidal behavior, which was significantly different from the reported rates of suicidal ideation (9.2%) and attempt (2.7%) in the general global population. The prevalence of suicidality was higher in patients with multifocal/segmental and generalized forms of dystonia (range of 46%-50%) compared to patients with focal dystonias (range of 26.1%-33.3%). The highest suicidal ideation-to-attempt ratio of 4:1 was found in patients with generalized dystonia. Suicidality in patients with focal dystonia was significantly associated with history of depression and anxiety disorders.

Conclusion: Patients with isolated dystonia have an increased, albeit unrecognized, prevalence of suicidal behavior compared to the general global population. Screening for suicidal risk should be incorporated as part of the clinical evaluation of patients with dystonia to prevent their suicide-induced injury and death.

Figure. Incidence of Suicidal Behavior and Psychiatric Disorders in Isolated Dystonia

Multilevel pie charts depict the rates of suicidality and the time of occurrence (in the past or at present) in patients with (A) focal dystonia, (B) laryngeal dystonia, (C) multifocal/segmental dystonia, and (D) generalized dystonia. Corresponding stacked bar charts depict the rates of psychiatric disorders in these patients. Double asterisk marks a significant association between suicidality and psychiatric history; single asterisk marks a trend to significant association between suicidality and psychiatric history. ADHD = attention-deficit/hyperactivity disorder; GAD = generalized anxiety disorder; OCD = obsessive-compulsive disorder; SUD = substance use disorder.