Suicidal Behavior in Prodromal Huntington DiseaseFiedorowicz J.G.a, b · Mills J.A.a · Ruggle A.a · Langbehn D.a · Paulsen J.S.a, c, d · PREDICT-HD Investigators of the Huntington Study Group
Departments of aPsychiatry, Carver College of Medicine, bEpidemiology, College of Public Health, cNeurology, Carver College of Medicine, and dPsychology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, Iowa, USA
Jane S. Paulsen, PhD
Department of Psychiatry, University of Iowa
500 Newton Rd., 1-305 MEB
Iowa City, IA 52242 (USA)
Tel. +1 319 353 4551, E-Mail firstname.lastname@example.org
Do you have an account?
Background: Several studies have suggested a greater risk of suicide in Huntington disease (HD); however, unique risk factors for suicide in HD are not established. Objective: We sought to determine risk factors for suicidal behavior, defined as suicide or attempted suicide, in prodromal HD. Methods: From the prospective PREDICT-HD cohort, we identified 735 cases with HD gene expansion but no manifest symptoms of HD and 194 non-gene-expanded controls. In survival analysis, a number of potential risk factors for suicidal behavior were assessed, including symptoms of depression, hopelessness, substance abuse, marital status, gender, and psychiatric history. Results: During a mean of 3.7 years of prospective follow-up, 12 cases (1.6%) attempted suicide and 1 completed suicide (0.1%). No suicides were observed among controls. In univariate Cox proportional hazards regression models, a history of suicide attempts (HR 8.5, 95% CI 2.8–26.1, p < 0.0002) and a Beck Depression Inventory II score >13 (HR 7.2, 95% CI 2.3–22.0, p < 0.0006) were associated with suicidal behavior. These risk factors had independent effects in multivariate models. A history of incarceration in the past 2 years was also associated (HR 12.5, 95% CI 2.7–56.6, p < 0.002), though uncommon. No further risk factors were identified. Conclusion: A history of suicide attempts and the presence of depression are strongly predictive of suicidal behavior in prodromal HD. As these risk factors are among the most robust risk factors for suicide, established suicide risk factors appear applicable to those with prodromal HD.
© 2011 S. Karger AG, Basel
- Landegent JE, Jansen in de Wal N, Fisser-Groen YM, Bakker E, van der Ploeg M, Pearson PL: Fine mapping of the Huntington disease linked D4S10 locus by non-radioactive in situ hybridization. Hum Genet 1986;73:354–357.
- The Huntington’s Disease Collaborative Research Group: A novel gene containing a trinucleotide repeat that is expanded and unstable on Huntington’s disease chromosomes. Cell 1993;72:971–983.
- Myers RH: Huntington’s disease genetics. NeuroRx 2004;1:255–262.
- Walker FO: Huntington’s disease. Lancet 2007;369:218–228.
- Huntington G: On chorea: George Huntington, M.D. J Neuropsychiatry Clin Neurosci 2003;15:109–112.
- Baliko L, Csala B, Czopf J: Suicide in Hungarian Huntington’s disease patients. Neuroepidemiology 2004;23:258–260.
- Reed TE, Chandler JH: Huntington’s chorea in Michigan. I. Demography and genetics. Am J Hum Genet 1958;10:201–225.
- Lanska DJ, Lavine L, Lanska MJ, Schoenberg BS: Huntington’s disease mortality in the United States. Neurology 1988;38:769–772.
- Di Maio L, Squitieri F, Napolitano G, Campanella G, Trofatter JA, Conneally PM: Suicide risk in Huntington’s disease. J Med Genet 1993;30:293–295.
- Farrer LA: Suicide and attempted suicide in Huntington disease: implications for preclinical testing of persons at risk. Am J Med Genet 1986;24:305–311.
- Schoenfeld M, Myers RH, Cupples LA, Berkman B, Sax DS, Clark E: Increased rate of suicide among patients with Huntington’s disease. J Neurol Neurosurg Psychiatry 1984;47:1283–1287.
- Sorensen SA, Fenger K: Causes of death in patients with Huntington’s disease and in unaffected first degree relatives. J Med Genet 1992;29:911–914.
- Alonso ME, Ochoa A, Boll MC, Sosa AL, Yescas P, Lopez M, Macias R, Familiar I, Rasmussen A: Clinical and genetic characteristics of Mexican Huntington’s disease patients. Mov Disord 2009;24:2012–2015.
- Hayden MR, Ehrlich R, Parker H, Ferera SJ: Social perspectives in Huntington’s chorea. S Afr Med J 1980;58:201–203.
- Brothers CR: Huntington’s chorea in Victoria and Tasmania. J Neurol Sci 1964;11:405–420.
- Chiu E, Alexander L: Causes of death in Huntington’s disease. Med J Aust 1982;1:153.
- Haines JL, Conneally PM: Causes of death in Huntington disease as reported on death certificates. Genet Epidemiol 1986;3:417–423.
- Bolt JM: Huntington’s chorea in the West of Scotland. Br J Psychiatry 1970;116:259–270.
- Lipe H, Schultz A, Bird TD: Risk factors for suicide in Huntingtons disease: a retrospective case controlled study. Am J Med Genet 1993;48:231–233.
- Dewhurst K, Oliver JE, McKnight AL: Socio-psychiatric consequences of Huntington’s disease. Br J Psychiatry 1970;116:255–258.
- Haw C, Harwood D, Hawton K: Dementia and suicidal behavior: a review of the literature. Int Psychogeriatr 2009;21:440–453.
- Hawton K, Arensman E, Wasserman D, Hulten A, Bille-Brahe U, Bjerke T, Crepet P, Deisenhammer E, Kerkhof A, De Leo D, Michel K, Ostamo A, Philippe A, Querejeta I, Salander-Renberg E, Schmidtke A, Temesvary B: Relation between attempted suicide and suicide rates among young people in Europe. J Epidemiol Community Health 1998;52:191–194.
- Welch SS: A review of the literature on the epidemiology of parasuicide in the general population. Psychiatr Serv 2001;52:368–375.
- Dubovsky SL, Dubovsky AN: Mood disorders and the outcome of suicidal thoughts and attempts. Crit Care Clin 2008;24:857–874, ix.
- Paulsen JS, Nehl C, Hoth KF, Kanz JE, Benjamin M, Conybeare R, McDowell B, Turner B: Depression and stages of Huntington’s disease. J Neuropsychiatry Clin Neurosci 2005;17:496–502.
- Nock MK, Kessler RC: Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey. J Abnorm Psychol 2006;115:616–623.
- Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, Bruffaerts R, Chiu WT, de Girolamo G, Gluzman S, de Graaf R, Gureje O, Haro JM, Huang Y, Karam E, Kessler RC, Lepine JP, Levinson D, Medina-Mora ME, Ono Y, Posada-Villa J, Williams D: Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry 2008;192:98–105.
- Robins Wahlin TB: To know or not to know: a review of behaviour and suicidal ideation in preclinical Huntington’s disease. Patient Educ Couns 2007;65:279–287.
- Almqvist EW, Bloch M, Brinkman R, Craufurd D, Hayden MR: A worldwide assessment of the frequency of suicide, suicide attempts, or psychiatric hospitalization after predictive testing for Huntington disease. Am J Hum Genet 1999;64:1293–1304.
- Paulsen JS, Hoth KF, Nehl C, Stierman L: Critical periods of suicide risk in Huntington’s disease. Am J Psychiatry 2005;162:725–731.
Fiedorowicz JG, Weldon K, Bergus G: Determining suicide risk (Hint: A screen is not enough). J Fam Pract 2010;59:256–260.
- Foster T, Gillespie K, McClelland R: Mental disorders and suicide in Northern Ireland. Br J Psychiatry 1997;170:447–452.
- Henriksson MM, Aro HM, Marttunen MJ, Heikkinen ME, Isometsa ET, Kuoppasalmi KI, Lonnqvist JK: Mental disorders and comorbidity in suicide. Am J Psychiatry 1993;150:935–940.
- Rich CL, Young D, Fowler RC: San Diego suicide study. I. Young vs old subjects. Arch Gen Psychiatry 1986;43:577–582.
Fiedorowicz JG, Black DW, Coryell WH: Suicide and Mental Morbidity; in Shrivastava A (ed): Handbook of Suicide Behaviour. London, Royal College of Psychiatrists, in press.
- Duff K, Paulsen JS, Beglinger LJ, Langbehn DR, Stout JC: Psychiatric symptoms in Huntington’s disease before diagnosis: the PREDICT-HD study. Biol Psychiatry 2007;62:1341–1346.
- Coryell WH: Clinical assessment of suicide risk in depressive disorder. CNS Spectr 2006;11:455–461.
- Paulsen JS, Hayden M, Stout JC, Langbehn DR, Aylward E, Ross CA, Guttman M, Nance M, Kieburtz K, Oakes D, Shoulson I, Kayson E, Johnson S, Penziner E: Preparing for preventive clinical trials: the PREDICT-HD study. Arch Neurol 2006;63:883–890.
- Langbehn DR, Brinkman RR, Falush D, Paulsen JS, Hayden MR: A new model for prediction of the age of onset and penetrance for Huntington’s disease based on CAG length. Clin Genet 2004;65:267–277.
- Robins Wahlin TB, Lundin A, Dear K: Early cognitive deficits in Swedish gene carriers of Huntington’s disease. Neuropsychology 2007;21:31–44.
- Solomon AC, Stout JC, Weaver M, Queller S, Tomusk A, Whitlock KB, Hui SL, Marshall J, Jackson JG, Siemers ER, Beristain X, Wojcieszek J, Foroud T: Ten-year rate of longitudinal change in neurocognitive and motor function in prediagnosis Huntington disease. Mov Disord 2008;23:1830–1836.
- Biglan KM, Ross CA, Langbehn DR, Aylward EH, Stout JC, Queller S, Carlozzi NE, Duff K, Beglinger LJ, Paulsen JS: Motor abnormalities in premanifest persons with Huntington’s disease: the PREDICT-HD study. Mov Disord 2009;24:1763–1772.
- Spitzer RL, Endicott J, Fleiss JL, Cohen J: The psychiatric status schedule: a technique for evaluating psychopathology and impairment in role functioning. Arch Gen Psychiatry 1970;23:41–55.
- Sarason IG, Johnson JH, Siegel JM: Assessing the impact of life changes: development of the Life Experiences Survey. J Consult Clin Psychol 1978;46:932–946.
- Huntington Study Group: Unified Huntington’s Disease Rating Scale: reliability and consistency. Mov Disord 1996;11:136–142.
Beck AT, Steer RA, Brown GK: Manual for the Beck Depression Inventory-II. San Antonio, Psychological Corporation, 1996.
- Beck AT, Steer RA, Ball R, Ranieri W: Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess 1996;67:588–597.
- Inoue T, Kitagawa M, Tanaka T, Nakagawa S, Koyama T: Depression and major depressive disorder in patients with Parkinson’s disease. Mov Disord 2010;25:44–49.
- Beck AT, Weissman A, Lester D, Trexler L: The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol 1974;42:861–865.
- Beck AT, Steer RA, Kovacs M, Garrison B: Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry 1985;142:559–563.
- Fiedorowicz JG, Leon AC, Keller MB, Solomon DA, Rice JP, Coryell WH: Do risk factors for suicidal behavior differ by affective disorder polarity? Psychol Med 2009;39:763–771.
- Brent DA, Bridge J, Johnson BA, Connolly J: Suicidal behavior runs in families: a controlled family study of adolescent suicide victims. Arch Gen Psychiatry 1996;53:1145–1152.
- Marangell LB, Bauer MS, Dennehy EB, Wisniewski SR, Allen MH, Miklowitz DJ, Oquendo MA, Frank E, Perlis RH, Martinez JM, Fagiolini A, Otto MW, Chessick CA, Zboyan HA, Miyahara S, Sachs G, Thase ME: Prospective predictors of suicide and suicide attempts in 1,556 patients with bipolar disorders followed for up to 2 years. Bipolar Disord 2006;8:566–575.
- Benjamini Y, Hochberg Y: Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Series B (Methodol) 1995;57:289–300.
- DeJong J, Virkkunen M, Linnoila M: Factors associated with recidivism in a criminal population. J Nerv Ment Dis 1992;180:543–550.
- Cherpitel CJ, Tam TW: Variables associated with DUI offender status among whites and Mexican Americans. J Stud Alcohol 2000;61:698–703.
- Babinski LM, Hartsough CS, Lambert NM: Childhood conduct problems, hyperactivity-impulsivity, and inattention as predictors of adult criminal activity. J Child Psychol Psychiatry 1999;40:347–355.
- Beautrais AL: Suicide and serious suicide attempts in youth: a multiple-group comparison study. Am J Psychiatry 2003;160:1093–1099.
- Fiedorowicz JG, Coryell WH: Cholesterol and suicide attempts: a prospective study of depressed inpatients. Psychiatry Res 2007;152:11–20.
- Kuo WH, Gallo JJ, Tien AY: Incidence of suicide ideation and attempts in adults: the 13-year follow-up of a community sample in Baltimore, Maryland. Psychol Med 2001;31:1181–1191.
- Holl AK, Wilkinson L, Painold A, Holl EM, Bonelli RM: Combating depression in Huntington’s disease: effective antidepressive treatment with venlafaxine XR. Int Clin Psychopharmacol 2010;25:46–50.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.