Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
J Affect Disord. 2013 Oct;151(1):248-58. doi: 10.1016/j.jad.2013.06.001. Epub 2013 Jul 20.
Previous studies indicate increased prevalences of suicidal ideation, suicide attempts, and completed suicide in Huntington's disease (HD) compared with the general population. This study investigates correlates and predictors of suicidal ideation in HD.
The study cohort consisted of 2106 HD mutation carriers, all participating in the REGISTRY study of the European Huntington's Disease Network. Of the 1937 participants without suicidal ideation at baseline, 945 had one or more follow-up measurements. Participants were assessed for suicidal ideation by the behavioural subscale of the Unified Huntington's Disease Rating Scale (UHDRS). Correlates of suicidal ideation were analyzed using logistic regression analysis and predictors were analyzed using Cox regression analysis.
At baseline, 169 (8.0%) mutation carriers endorsed suicidal ideation. Disease duration (odds ratio [OR]=0.96; 95% confidence interval [CI]: 0.9-1.0), anxiety (OR=2.14; 95%CI: 1.4-3.3), aggression (OR=2.41; 95%CI: 1.5-3.8), a previous suicide attempt (OR=3.95; 95%CI: 2.4-6.6), and a depressed mood (OR=13.71; 95%CI: 6.7-28.0) were independently correlated to suicidal ideation at baseline. The 4-year cumulative incidence of suicidal ideation was 9.9%. Longitudinally, the presence of a depressed mood (hazard ratio [HR]=2.05; 95%CI: 1.1-4.0) and use of benzodiazepines (HR=2.44; 95%CI: 1.2-5.0) at baseline were independent predictors of incident suicidal ideation, whereas a previous suicide attempt was not predictive.
As suicidal ideation was assessed by only one item, and participants were a selection of all HD mutation carriers, the prevalence of suicidal ideation was likely underestimated.
Suicidal ideation in HD frequently occurs. Assessment of suicidal ideation is a priority in mutation carriers with a depressed mood and in those using benzodiazepines.
先前的研究表明，与普通人群相比，亨廷顿病（HD）患者出现自杀意念、自杀企图和自杀死亡的比例更高。本研究旨在调查 HD 患者自杀意念的相关因素和预测因素。
研究队列包括 2106 名 HD 基因突变携带者，均参加了欧洲亨廷顿病网络的 REGISTRY 研究。在基线时没有自杀意念的 1937 名参与者中，有 945 名有一个或多个随访测量值。使用统一亨廷顿病评定量表（UHDRS）的行为分量表评估参与者的自杀意念。使用逻辑回归分析自杀意念的相关因素，使用 Cox 回归分析自杀意念的预测因素。
基线时，169 名（8.0%）基因突变携带者表示有自杀意念。疾病持续时间（比值比[OR]=0.96；95%置信区间[CI]：0.9-1.0）、焦虑（OR=2.14；95%CI：1.4-3.3）、攻击性（OR=2.41；95%CI：1.5-3.8）、既往自杀企图（OR=3.95；95%CI：2.4-6.6）和抑郁情绪（OR=13.71；95%CI：6.7-28.0）与基线时的自杀意念独立相关。自杀意念的 4 年累积发生率为 9.9%。纵向分析显示，基线时存在抑郁情绪（风险比[HR]=2.05；95%CI：1.1-4.0）和使用苯二氮䓬类药物（HR=2.44；95%CI：1.2-5.0）是发生自杀意念的独立预测因素，而既往自杀企图不是预测因素。
由于自杀意念仅通过一个项目进行评估，且参与者是所有 HD 基因突变携带者的一个选择，因此自杀意念的发生率可能被低估。
HD 患者经常出现自杀意念。在有抑郁情绪和使用苯二氮䓬类药物的基因突变携带者中，应优先评估自杀意念。
