Risk Factors for Suicidal Ideation in Patients Feeling Severely Affected by Multiple Sclerosis

Background: 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. Objective: Analyzing independent variables promoting suicidal ideation in severely affected MS patients. Design: A self-report questionnaire with 25 needs categories including one self-assessment item "prone to suicidal ideation" was applied. Setting/Subjects: Included were patients reporting feeling subjectively severely affected by MS. Of 867 patients addressed, 573 (66.1%) completed the questionnaires. Measurements: 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. Results: 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). Conclusion: 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.