title: Increased suicide risk and clinical correlates of suicide among patients with Parkinson's disease.
abstract: Parkinson's disease (PD) is a debilitating, neurodegenerative condition frequently complicated by psychiatric symptoms. Patients with PD may be at higher risk for suicide than the general population, but previous estimates are limited and conflicting. The aim of this study is to estimate the suicide rate based on the clinical case registry and to identify risk factors for suicide among patients diagnosed with PD.
  
  
  
  The target sample consisted of 4362 patients diagnosed with PD who were evaluated at a general hospital in Seoul, South Korea, from 1996 to 2012. The standardized mortality ratio for suicide among PD patients was estimated. In order to identify the clinical correlates of suicide, case-control study was conducted based on retrospective chart review. The 29 suicide cases (age: 62.3 ± 13.7 years; females: 34.5%) were matched with 116 non-suicide controls (age: 63.5 ± 9.2 years; females 56.9%) by the year of initial PD evaluation.
  
  
  
  The SMR for suicide in PD patients was 1.99 (95% CI 1.33-2.85). Mean duration from time of initial diagnosis to suicide among cases was 6.1 ± 3.5 years. Case-control analysis revealed that male, initial extremity of motor symptom onset, history of depressive disorder, delusion, any psychiatric disorder, and higher L-dopa dosage were significantly associated with suicide among PD patients. Other PD-related variables such as UPDRS motor score were not significantly associated with death by suicide.
  
  
  
  Suicide risk in PD patients is approximately 2 times higher than that in the general population. Psychiatric disorders, and also L-dopa medication need further attention with respect to suicide.
authors.affiliation: Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Taeyeop
authors.initials: T
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Hochang Benjamin
authors.initials: HB
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Myung Hee
authors.initials: MH
authors.lastname: Ahn
authors.affiliation: Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Juyeon
authors.initials: J
authors.lastname: Kim
authors.affiliation: Clinical Nurse Specialist, Department of Neurology, Asan Medical Center, Republic of Korea.
authors.forename: Mi Sun
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: sunjubrain@gmail.com.
authors.forename: Sun Ju
authors.initials: SJ
authors.lastname: Chung
authors.affiliation: Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: suhurhong@gmail.com.
authors.forename: Jin Pyo
authors.initials: JP
authors.lastname: Hong
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology*; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013405:Suicide
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: Parkinson's disease; Psychiatric disorder; Risk factors; Suicide