Suicidal behavior in patients with multiple sclerosis and organic depression

Abstract

Background. Patients with multiple sclerosis (MS) are at high risk of depression, often associated with suicidal ideation and behavior, yet key suicide risk factors in this population remain poorly understood. Objective. To identify risk factors for suicidal behavior in patients with MS and depression. Materials and Methods. This 10year prospective observational study included 157 patients with MS and depressive disorders. Clinical assessment used standardized tools: BDI, STAI, VAS, EDSS, PASAT, and MFI20. Researchers evaluated stressful life events, MS subtypes (RRMS, SPMS, PPMS), prior isolated syndromes, comorbidities, DMT use, and brain MRI findings. MS diagnosis followed the McDonald criteria (2017); depression was diagnosed per ICD10. Suicidal ideation was assessed with the Scale for Suicidal Ideation. Results. Suicidal behavior was identified in 38.85 % of MS patients with depression, significantly more prevalent in women (26.11 %) than in men (12.74 %). Antivital experiences (93.44 %) and passive suicidal thoughts (49.18 %) were most common; suicidal plans and intent were present in 31.15 % and 14.75 % of cases, respectively. Nonfatal suicide attempts occurred in 6.56 % of patients: one third were women with RRMS (EDSS 1.5 ± 1.0), and one third were men with PPMS (EDSS 2.5 ± 1.0). Risk factors for suicidal behavior: high level of anxiety, concurrent development of motor, coordination, and pelvic disorders, severe pain syndrome, anxiety disorders with emotional instability and sleep disturbances, acute stress response (MS exacerbation), and significant stressful life events.