Multiple Sclerosis Society of Canada

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MS Society funded researcher explores rates of suicide in people with MS

Background:

The symptoms experienced by people living with MS are unpredictable and vary from person to person. Physical symptoms, such as balance impairment and difficulty walking, are clearly visible, however, there are symptoms that are not as readily seen such as depression and fatigue. Depression, which can manifest both as a symptom of MS and as a co-morbidity (co-existing condition), is a major risk factor for people with MS that consider, attempt or commit suicide.

A recently published review article in Multiple Sclerosis Journal, co-authored by MS Society-funded researcher and neuropsychiatrist Dr. Anthony Feinstein from the University of Toronto, looks at the link between MS and suicide based on previously published epidemiological studies. The article also discusses the prevalence of suicide attempts and risk factors related to suicide in MS.

The Study:

The review article compiled evidence from nine different studies on suicide rates in people with MS from Finland, Denmark, Sweden, US, Canada (Manitoba and Nova Scotia specifically) and the United Kingdom ranging from 1953 to 2006. Population sizes in the studies ranged from 1,595 to 12,834 people. To determine if rates of suicide are elevated, researchers looked at the standard mortality ratio (SMR), which is a ratio of the observed number of deaths in people living with MS over a certain period of time, to the number of deaths expected in the general population during the same period. If the SMR is greater than 1.0, this means that there is an increased rate of suicide, however it may not be statistically significant. There are higher frequencies of studies on suicide from Scandinavian countries due to their extensive databases.

Results:

Findings from the different studies were generally consistent with a consensus that there is an increased prevalence of suicide in the MS population. For example, the Finnish study reported an SMR of 1.7. Three Danish studies reported similar findings with reported SMRs of 1.83, 1.62, and 2.12.

Information on suicide rates in a Canada-wide study among people living with MS is limited. However, looking at suicide attempt and intent in provincial studies, one report from Nova Scotia identified that suicide attempts were three times higher in people with MS compared to the non-MS population. A survey of people with MS in Germany questioned how often individuals think about suicide on a scale ranging from “never” to “all the time.” The results revealed that over 20% of participants have considered suicide “often,” “very often,” or “all the time.”

Furthermore, studies show that younger males who are within the first five years of diagnosis are at greater vulnerability and have higher suicidal intent. Finally, the review discusses factors which are related to suicide in people living with MS, such as depression and the lack of social bonds or loneliness.

Comment:

This review of studies on suicide and MS reinforces the complex physical, social and emotional impacts of the disease and need for appropriate support. A recently published study on impressions towards physician assisted death (PAD) (also referred to as medical assistance in dying (MAID)) reported that a high proportion of individuals with MS would consider PAD under certain situations. These findings together highlight that effort, in part, should be focused on identifying and managing factors that reduce quality of life for people living with MS and which lead to depression, thoughts of death, and suicide. These studies also raise awareness of the need for improved programs, services, social support and resources that can help people living with MS cope with their disease in a positive manner.

The recently launched Canadian MS Progression Cohort may help capture a variety of information about the social and economic impacts of MS. This in turn will help the MS community understand risk factors contributing to depression and suicide in the Canadian MS population and inform clinical practice.

The MS Society offers a variety of programs and services to help people affected by multiple sclerosis effectively manage and cope with the disease. Connect with an MS navigatorby calling 1-844-859-6789 or email msnavigators@mssociety.ca.

Source:

Feinstein, A & Pavisian B (2017) Multiple sclerosis and suicide. Mult Scler. 24(7): 504-8.