title: Suicidal behavior in prodromal Huntington disease.
abstract: BACKGROUND
  Several studies have suggested a greater risk of suicide in Huntington disease (HD); however, unique risk factors for suicide in HD are not established.
  
  
  OBJECTIVE
  We sought to determine risk factors for suicidal behavior, defined as suicide or attempted suicide, in prodromal HD.
  
  
  METHODS
  From the prospective PREDICT-HD cohort, we identified 735 cases with HD gene expansion but no manifest symptoms of HD and 194 non-gene-expanded controls. In survival analysis, a number of potential risk factors for suicidal behavior were assessed, including symptoms of depression, hopelessness, substance abuse, marital status, gender, and psychiatric history.
  
  
  RESULTS
  During a mean of 3.7 years of prospective follow-up, 12 cases (1.6%) attempted suicide and 1 completed suicide (0.1%). No suicides were observed among controls. In univariate Cox proportional hazards regression models, a history of suicide attempts (HR 8.5, 95% CI 2.8-26.1, p < 0.0002) and a Beck Depression Inventory II score >13 (HR 7.2, 95% CI 2.3-22.0, p < 0.0006) were associated with suicidal behavior. These risk factors had independent effects in multivariate models. A history of incarceration in the past 2 years was also associated (HR 12.5, 95% CI 2.7-56.6, p < 0.002), though uncommon. No further risk factors were identified.
  
  
  CONCLUSIONS
  A history of suicide attempts and the presence of depression are strongly predictive of suicidal behavior in prodromal HD. As these risk factors are among the most robust risk factors for suicide, established suicide risk factors appear applicable to those with prodromal HD.
authors.affiliation: Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA.
authors.forename: Jess G
authors.initials: JG
authors.lastname: Fiedorowicz
authors.forename: James A
authors.initials: JA
authors.lastname: Mills
authors.forename: Adam
authors.initials: A
authors.lastname: Ruggle
authors.forename: Douglas
authors.initials: D
authors.lastname: Langbehn
authors.forename: Jane S
authors.initials: JS
authors.lastname: Paulsen
mesh_terms: D000328:Adult; D016208:Databases, Factual; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006816:Huntington Disease / Q000453:epidemiology / Q000235:genetics / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D016896:Treatment Outcome; D019680:Trinucleotide Repeat Expansion