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Published on: June 9, 2018
Suicidal Ideation Assessment in Individuals with Premanifest and Manifest Huntington Disease
Melissa Wesson1, Nicholas R Boileau2, Joel S Perlmutter3,4
1Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA.
Insights
Huntington disease (HD) patients exhibit higher rates of suicidal ideation than the general population. Multimodal assessment including clinician and self-report measures is crucial for all disease stages.
Area of Science:
- Neuroscience
- Psychiatry
- Genetics
Background:
- Huntington disease (HD) is a progressive neurodegenerative disorder.
- HD is associated with an increased risk of suicide and suicidal ideation.
Purpose of the Study:
- Compare suicide ideation prevalence in HD patients versus the general population.
- Identify factors associated with increased suicidal thoughts in HD.
- Evaluate agreement between clinician-rated and self-reported suicidal ideation assessments.
Main Methods:
- Examined 496 participants with premanifest or manifest HD.
- Clinician-rated ideation measured by Problem Behaviors Assessment - short form.
- Self-reported ideation assessed using HDQLIFE Concern with Death and Dying item bank.
- Logistic regression and kappa agreement coefficients used for analysis.
Main Results:
- HD sample showed significantly higher suicidal ideation (19.76%) and plans (2.1%) than the general population.
- Females had 6.8x higher odds of suicidal ideation (clinician-rated).
- Hispanic/Latinos had 10.9x higher odds (self-reported).
- Fair agreement between clinician and self-report, but no overlap in early HD.
Conclusions:
- Multimodal assessment (clinician and self-report) is critical for identifying suicidal ideation in HD.
- Assessment should be conducted at all stages of Huntington disease.
- Recognizing demographic disparities in reporting is important for targeted interventions.
Background:
Huntington disease (HD) is associated with increased risk of suicide.
Objective:
This study compares suicide ideation in HD to the general population, assesses factors associated with increased prevalence of suicidal thoughts, and compares clinician-rated to self-reported assessments of suicidal ideation.
Methods:
We examined 496 participants with premanifest or manifest HD. Clinician-rated suicidal ideation was measured using the Problem Behaviors Assessment - short form. Self-reported ideation was measured using two items from the HDQLIFE Concern with Death and Dying item bank. Independent sample t-tests were conducted to compare the prevalence of suicidal thoughts between our HD sample and the U.S.
Population:
Logistic regression analyses were used to determine characteristics associated with higher odds of clinically significant suicidal ideation. Kappa agreement coefficients were calculated to evaluate concurrence between clinician-rated and self-reported assessments.
Results:
Our sample had a significantly higher occurrence of suicidal ideation (19.76%) and suicidal plans (2.1%) than the general population (p < 0.0001). Odds of clinically significant suicidal ideation were 6.8 times higher in females (p = 0.04) on the clinician measure, and Hispanic/Latinos had 10.9 times higher odds than non-Hispanics (p = 0.025) on the self-report measure. Clinician-rated assessment had fair agreement (k = 0.2-0.4) with self-reported assessments, except in early stage HD where there was no overlap in the identification of participants with clinically significant suicidal ideation.
Discussion:
Assessment for suicidal ideation and clinically significant suicidal thoughts in HD with a multimodal approach that includes clinician-rated and self-report measures is critical at all stages of the disease.
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