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March 16, 2021; 96 (11) Article

Suicidal Ideations and Attempts in Patients With Isolated Dystonia

Alexis Worthley, View ORCID ProfileKristina Simonyan
First published January 27, 2021, DOI: https://doi.org/10.1212/WNL.0000000000011596
Alexis Worthley
From the Department of Otolaryngology–Head and Neck Surgery (A.W., K.S.), Massachusetts Eye and Ear; Department of Otolaryngology–Head and Neck Surgery (K.S.), Harvard Medical School; and Department of Neurology (K.S.), Massachusetts General Hospital, Boston.
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Kristina Simonyan
From the Department of Otolaryngology–Head and Neck Surgery (A.W., K.S.), Massachusetts Eye and Ear; Department of Otolaryngology–Head and Neck Surgery (K.S.), Harvard Medical School; and Department of Neurology (K.S.), Massachusetts General Hospital, Boston.
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  • ORCID record for Kristina Simonyan
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Suicidal Ideations and Attempts in Patients With Isolated Dystonia
Alexis Worthley, Kristina Simonyan
Neurology Mar 2021, 96 (11) e1551-e1560; DOI: 10.1212/WNL.0000000000011596

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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.

Glossary

C-SSRS=
Columbia–Suicide Severity Rating Scale;
CI=
confidence interval;
OR=
odds ratio;
REDCap=
Research Electronic Data Capture

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 511

  • CME Course: NPub.org/cmelist

  • Received July 27, 2020.
  • Accepted in final form December 7, 2020.
  • © 2021 American Academy of Neurology
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