title: Risk Factors for Suicidal Ideation in Patients Feeling Severely Affected by Multiple Sclerosis.
abstract: Being severely affected by multiple sclerosis (MS) brings substantial physical and psychological challenges. Contrary to common thinking that MS is not lethal, there is a higher mortality risk in patients also reflected in alarming rates of assisted suicide, and - where possible - euthanasia.
  
  
  
  Analyzing independent variables promoting suicidal ideation in severely affected MS patients.
  
  
  
  A self-report questionnaire with 25 needs categories including one self-assessment item "prone to suicidal ideation" was applied.
  
  
  
  Included were patients reporting feeling subjectively severely affected by MS. Of 867 patients addressed, 573 (66.1%) completed the questionnaires.
  
  
  
  32 items being potential risk factors for suicidal ideation were tested for statistical significance using a multivariate logistic regression model with stepwise, backward elimination procedure.
  
  
  
  22.1% of 573 patients (median age 51, range 20-83) had suicidal ideation. 48.4% suffered from secondary progressive, 24.7% from relapsing-remitting and 21.9% from primary progressive MS. A set of six statistically significant criteria for suicidal ideation were found. Three items were risk factors for suicidal ideation: the extent to which MS affects leisure time (p < 0.001), depression (p < 0.000), and feeling socially excluded (p < 0.002). Three items reduced the odds of suicidal ideation: having a purpose in life (p < 0.000), being productive (p < 0.000), and having comfort in faith and spiritual beliefs (p < 0.024).
  
  
  
  This study identified potentially modifiable factors that may help preventing suicide in people with MS. Integrating palliative care (PC) with its multidisciplinary approach could be beneficial to reduce patient's burden.
authors.affiliation: 1 Department of Palliative Medicine, University Hospital of Cologne , Cologne, Germany .
authors.forename: Julia
authors.initials: J
authors.lastname: Strupp
authors.affiliation: 1 Department of Palliative Medicine, University Hospital of Cologne , Cologne, Germany .
authors.forename: Carolin
authors.initials: C
authors.lastname: Ehmann
authors.affiliation: 1 Department of Palliative Medicine, University Hospital of Cologne , Cologne, Germany .
authors.forename: Maren
authors.initials: M
authors.lastname: Galushko
authors.affiliation: 1 Department of Palliative Medicine, University Hospital of Cologne , Cologne, Germany .
authors.forename: Raphael
authors.initials: R
authors.lastname: Bücken
authors.affiliation: 1 Department of Palliative Medicine, University Hospital of Cologne , Cologne, Germany .
authors.forename: Klaus Maria
authors.initials: KM
authors.lastname: Perrar
authors.affiliation: 2 Institute for Medical Statistics, Informatics, and Epidemiology, University Hospital of Cologne , Cologne, Germany .
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hamacher
authors.affiliation: 3 IMVR-Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University Hospital of Cologne , Cologne, Germany .
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
authors.affiliation: 1 Department of Palliative Medicine, University Hospital of Cologne , Cologne, Germany .|4 Center for Integrated Oncology, University Hospital of Cologne , Cologne, Germany .|5 Clinical Trials Center, University Hospital of Cologne , Cologne, Germany .
authors.forename: Raymond
authors.initials: R
authors.lastname: Voltz
authors.affiliation: 1 Department of Palliative Medicine, University Hospital of Cologne , Cologne, Germany .
authors.forename: Heidrun
authors.initials: H
authors.lastname: Golla
mesh_terms: D003863:Depression; D006801:Humans; D009103:Multiple Sclerosis; D012307:Risk Factors; D059020:Suicidal Ideation; D013405:Suicide