Suicide and patients with neurologic diseases. Methodologic problems
E. N. Stenager and E. Stenager
Department of Psychiatry, Odense University, Denmark.
OBJECTIVE--The suicide risk in patients with many neurologic diseases has
been reported to be greater than that in the general population. Studies on
the subject are, however, often encumbered with methodologic problems. We
appraised these problems and, based on an evaluation, reappraised knowledge
of the suicide risk in patients with specific neurologic diseases. DATA
SOURCE--Using the computerized database MEDLINE, we identified all
published reports with the key words suicide, attempted suicide, and
neurologic diseases. STUDY SELECTION--We assessed and reviewed studies
concerning the most common neurologic diseases for methodologic problems in
the study design. DATA EXTRACTION--The following methodologic problems
emerged during our review: (1) choice of study type, ie, autopsy study or
follow-up study; (2) choice of study population; (3) choice of control
groups; (4) epidemiologic/statistical methods used; and (5) validity of
statistics reported. DATA SYNTHESIS--We analyzed the methodologic problems
in studies of patients with multiple sclerosis, epilepsy, Huntington's
chorea, spinal cord lesions, cranial trauma, brain tumors, Parkinson's
disease, vascular disorders, and migraine. In most of the studies, the
methods used gave rise to uncertainty about the conclusion presented.
CONCLUSION--An increased suicide risk was found in patients suffering from
multiple sclerosis and spinal cord lesions as well as in selected groups of
patients with epilepsy. In other neurologic diseases, the suicide risk may
be increased, but the results are uncertain due to the methodologic
problems in the study design.
