Strupp Julia, Ehmann Carolin, Galushko Maren, Bücken Raphael, Perrar Klaus Maria, Hamacher Stefanie, Pfaff Holger, Voltz Raymond, Golla Heidrun
1 Department of Palliative Medicine, University Hospital of Cologne , Cologne, Germany .
2 Institute for Medical Statistics, Informatics, and Epidemiology, University Hospital of Cologne , Cologne, Germany .
J Palliat Med. 2016 May;19(5):523-8. doi: 10.1089/jpm.2015.0418. Epub 2016 Apr 5.
Being severely affected by multiple sclerosis (MS) brings substantial physical and psychological challenges. Contrary to common thinking that MS is not lethal, there is a higher mortality risk in patients also reflected in alarming rates of assisted suicide, and - where possible - euthanasia.
Analyzing independent variables promoting suicidal ideation in severely affected MS patients.
A self-report questionnaire with 25 needs categories including one self-assessment item "prone to suicidal ideation" was applied.
SETTING/SUBJECTS: Included were patients reporting feeling subjectively severely affected by MS. Of 867 patients addressed, 573 (66.1%) completed the questionnaires.
32 items being potential risk factors for suicidal ideation were tested for statistical significance using a multivariate logistic regression model with stepwise, backward elimination procedure.
22.1% of 573 patients (median age 51, range 20-83) had suicidal ideation. 48.4% suffered from secondary progressive, 24.7% from relapsing-remitting and 21.9% from primary progressive MS. A set of six statistically significant criteria for suicidal ideation were found. Three items were risk factors for suicidal ideation: the extent to which MS affects leisure time (p < 0.001), depression (p < 0.000), and feeling socially excluded (p < 0.002). Three items reduced the odds of suicidal ideation: having a purpose in life (p < 0.000), being productive (p < 0.000), and having comfort in faith and spiritual beliefs (p < 0.024).
This study identified potentially modifiable factors that may help preventing suicide in people with MS. Integrating palliative care (PC) with its multidisciplinary approach could be beneficial to reduce patient's burden.
受多发性硬化症（MS）的严重影响会带来巨大的身体和心理挑战。与MS不致命的普遍看法相反，患者存在较高的死亡风险，这也反映在令人担忧的协助自杀率以及（在可能的情况下）安乐死率上。
分析促使重度MS患者产生自杀念头的独立变量。
采用一份包含25个需求类别的自填式问卷，其中包括一个自我评估项目“有自杀念头倾向”。
地点/研究对象：纳入的是主观感觉受MS严重影响的患者。在867名被邀请的患者中，573名（66.1%）完成了问卷。
使用具有逐步向后排除程序的多变量逻辑回归模型，对作为自杀念头潜在风险因素的32个项目进行统计学显著性检验。
573名患者（中位年龄51岁，范围20 - 83岁）中有22.1%有自杀念头。48.4%患有继发进展型MS，24.7%患有复发缓解型MS，21.9%患有原发进展型MS。发现了一组六个对自杀念头具有统计学显著性的标准。三个项目是自杀念头的风险因素：MS对休闲时间的影响程度（p < 0.001）、抑郁（p < 0.000）以及感觉被社会排斥（p < 0.002）。三个项目降低了自杀念头的几率：有生活目标（p < 0.000）、有成效（p < 0.000）以及在信仰和精神信念上感到慰藉（p < 0.024）。
本研究确定了可能有助于预防MS患者自杀的潜在可改变因素。将姑息治疗（PC）及其多学科方法整合起来可能有助于减轻患者负担。
