Suicide in Tourette’s and Chronic Tic Disorders

• Published in: Biological psychiatry (1969) Vol. 82; no. 2; pp. 111 - 118
• Main Authors: de la Cruz, Lorena Fernández, PhD, Rydell, Mina, PhD, Runeson, Bo, MD, PhD, Brander, Gustaf, MSc, Rück, Christian, MD, PhD, D’Onofrio, Brian M., PhD, Larsson, Henrik, MD, PhD, Lichtenstein, Paul, PhD, Mataix-Cols, David, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.07.2017
• Subjects: Adolescent; Adult; Case-Control Studies; Child; Chronic tic disorder; Cohort Studies; Comorbidity; Female; Humans; Male; Medicin och hälsovetenskap; Middle Aged; Mortality, Premature; Neurologi; Neurology; Premature mortality; Psychiatric epidemiology; Psychiatry; Psykiatri; Registries - statistics & numerical data; Suicide; Suicide - statistics & numerical data; Suicide attempt; Suicide, Attempted - statistics & numerical data; Sweden - epidemiology; Tic Disorders - epidemiology; Tourette Syndrome - epidemiology; Tourette’s disorder; Young Adult; premature mortality; suicide attempt; psychiatric epidemiology; chronic tic disorders; Tourette's disorder; suicide; Chronic tic disorder; Premature mortality; Suicide; Psychiatric epidemiology; Suicide attempt; Tourette’s disorder
• ISSN: 0006-3223; 1873-2402; 1873-2402
• DOI: 10.1016/j.biopsych.2016.08.023

Abstract Background Persons with neuropsychiatric disorders are at increased risk of suicide, but there is little data concerning Tourette’s and chronic tic disorders (TD/CTD). We aimed to quantify the risk of suicidal behavior in a large nationwide cohort of patients with TD/CTD, establish the contribution of psychiatric comorbidity to this risk, and identify predictors of suicide. Methods Using a validated algorithm, we identified 7,736 TD/CTD cases in the Swedish National Patient Register during a 44-year period (1969–2013). Using a matched case-cohort design, patients were compared with general population controls (1:10 ratio). Risk of suicidal behavior was estimated using conditional logistic regressions. Predictors of suicidal behavior in the TD/CTD cohort were studied using Cox regression models. Results In unadjusted models, TD/CTD patients had an increased risk of both dying by suicide (OR=4·39 [95% CI, 2·89 – 6·67]) and attempting suicide (OR=3·86 [95% CI, 3·50 – 4·26]), compared with controls. After adjusting for psychiatric comorbidities, the risk was reduced but remained substantial. Persistence of tics beyond young adulthood and a previous suicide attempt were the strongest predictors of death by suicide in TD/CTD patients (HR=11·39 [95% CI, 3·71 – 35·02] and 5.65 [95% CI, 2·21 – 14·42], respectively). Discussion TD/CTD are associated with substantial risk of suicide. Suicidal behavior should be monitored in these patients, particularly in those with persistent tics, history of suicide attempts, and psychiatric comorbidities. Preventive and intervention strategies aimed to reduce the suicidal risk in this group are warranted.