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Methodologic Problems

Elsebeth Nylev Stenager, MD; Egon Stenager, MD

Arch Neurol. 1992;49(12):1296-1303.

Abstract
• 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.

Author Affiliations
From the Institute of Clinical Research, Department of Psychiatry and Neuropsychiatric Research Unit, Odense (Denmark) University.

Footnotes
Accepted for publication June 26, 1992.

Presented in part as a poster at the Fourth European Symposium on Suicidal Behaviour, Odense, Denmark, June 12, 1992, and at the Third Meeting of the European Neurological Society, Lausanne, Switzerland, June 29, 1992.

Reprint requests to the Neuropsychiatric Research Unit, Odense University Hospital, Odense, Denmark (Dr Stenager).

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