Suicidal ideation and behavior in Huntington's disease: Systematic review and recommendations

• Published in: Journal of affective disorders 2019-05, Vol.250, p.319-329
• Main Authors: Kachian, Zachary R., Cohen-Zimerman, Shira, Bega, Danny, Gordon, Barry, Grafman, Jordan
• Format: Article
• Language: English
• Subjects: Huntington’s disease; Suicidal behavior; Suicidal ideation; Suicide; Systematic review
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2019.03.043

•This is the first review to evaluate suicide rates in Huntington's disease (HD) patients.•HD patients are at an increased risk for suicide throughout the course of disease.•Depression is the most consistent risk factor for suicide in HD.•Future research should investigate the etiology of high suicide risk in HD.•Overall, there is a lack of standard measures for suicidality in HD research. An increased risk of suicide in Huntington's disease (HD) patients is well documented, with rates significantly higher than those of the general population as well as other neurodegenerative diseases. However, despite its prevalence, the magnitude of this phenomenon as well as its predictors and etiology are still poorly understood. We performed the first systematic review of all the studies published between March 1993 and December 2018 which investigated HD patients and gene carriers that reported suicidal ideation, suicide attempt, or suicide as an outcome. This review reveals that some aspects of suicidality in HD are more clearly understood than others. We confirm an increased risk of suicidal ideation, suicide attempt, and suicide for HD patients. We found that suicidal ideation is elevated throughout the course of the disease, and that psychiatric comorbidities are common risk factors with depression being the most prominent. Important data are still largely missing, specifically regarding cognitive and neuroanatomical mechanisms and potential effective interventions. Moreover, inconsistencies in terminology, assessment tools, and outcome measures limit the comparability of the research and the conclusions that can be drawn. Incidence of suicidal ideation, suicide attempt, and suicide are higher among those with HD relative to the non-HD population. It is therefore important that suicidal thoughts and behaviors are closely monitored in HD clinics and that clinical trials use standardized scales. Future research should focus on better understanding the etiology of this high suicide risk and on testing the efficacy of potential interventions.