Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Biol Psychiatry. 2017 Jul 15;82(2):111-118. doi: 10.1016/j.biopsych.2016.08.023. Epub 2016 Aug 26.
Persons with neuropsychiatric disorders are at increased risk of suicide, but there is little data concerning Tourette's and chronic tic disorders (TD/CTD). We aimed to quantify the risk of suicidal behavior in a large nationwide cohort of patients with TD/CTD, establish the contribution of psychiatric comorbidity to this risk, and identify predictors of suicide.
Using a validated algorithm, we identified 7736 TD/CTD cases in the Swedish National Patient Register during a 44-year period (1969-2013). Using a matched case-cohort design, patients were compared with general population control subjects (1:10 ratio). Risk of suicidal behavior was estimated using conditional logistic regressions. Predictors of suicidal behavior in the TD/CTD cohort were studied using Cox regression models.
In unadjusted models, TD/CTD patients, compared with control subjects, had an increased risk of both dying by suicide (odds ratio: 4.39; 95% confidence interval [CI]: 2.89-6.67) and attempting suicide (odds ratio: 3.86; 95% CI: 3.50-4.26). After adjusting for psychiatric comorbidities, the risk was reduced but remained substantial. Persistence of tics beyond young adulthood and a previous suicide attempt were the strongest predictors of death by suicide in TD/CTD patients (hazard ratio: 11.39; 95% CI: 3.71-35.02, and hazard ratio: 5.65; 95% CI: 2.21-14.42, respectively).
TD/CTD are associated with substantial risk of suicide. Suicidal behavior should be monitored in these patients, particularly in those with persistent tics, history of suicide attempts, and psychiatric comorbidities. Preventive and intervention strategies aimed to reduce the suicidal risk in this group are warranted.
患有神经精神障碍的人自杀风险增加，但有关图雷特氏症和慢性抽动障碍（TD/CTD）的资料很少。我们旨在量化大规模全国性 TD/CTD 患者队列中的自杀行为风险，确定精神共病对这种风险的贡献，并确定自杀的预测因素。
使用经过验证的算法，我们在 44 年期间（1969-2013 年）在瑞典国家患者登记处确定了 7736 例 TD/CTD 病例。使用匹配的病例-队列设计，将患者与一般人群对照（1:10 比例）进行比较。使用条件逻辑回归估计自杀行为风险。使用 Cox 回归模型研究 TD/CTD 队列中自杀行为的预测因素。
在未调整的模型中，与对照相比，TD/CTD 患者自杀死亡的风险增加（优势比：4.39；95%置信区间[CI]：2.89-6.67）和自杀未遂的风险增加（优势比：3.86；95% CI：3.50-4.26）。调整精神共病后，风险降低，但仍相当大。成年后持续存在抽动和先前自杀未遂是 TD/CTD 患者自杀死亡的最强预测因素（风险比：11.39；95% CI：3.71-35.02 和风险比：5.65；95% CI：2.21-14.42）。
TD/CTD 与自杀风险显著相关。应在这些患者中监测自杀行为，特别是那些有持续性抽动、自杀未遂史和精神共病的患者。需要针对该人群制定预防和干预策略，以降低自杀风险。
