Suicide Attempts in Patients With Amyotrophic Lateral Sclerosis: An Analysis of the Korean National Health Insurance Database

Hyung Keun Park, MD, PhD; Seok-Jin Choi, MD; Ye-Jee Kim, PhD; Sung-Min Kim, MD, PhD; Yoon-Ho Hong, MD, PhD; Jung-Joon Sung, MD, PhD

J Clin Psychiatry 2023;84(6):22m14754

ABSTRACT

Objective: The knowledge of the common risk factors for suicide attempts may not be simply applicable to patients with amyotrophic lateral sclerosis (ALS). We aimed to identify risk factors associated with suicide attempts in patients with ALS and to determine the annual prevalence and periods of vulnerability associated with attempts.

Methods: This nationwide cohort study was performed using the Korean National Health Insurance Database. All patients with ALS concomitantly registered for the Exempted Calculation of Health Insurance for rare, incurable diseases between 2011 and 2017 were identified. We used the Cox proportional hazards regression model and competing risk model to identify the risk factors for suicide attempts. The multivariable models were adjusted for potential risk factors from the univariate analysis.

Results: Among 2,955 incident patients, 47 attempted suicide. After adjusting for sex, previous attempts, and previous psychiatric disorders, the hazard ratios for psychiatric hospitalization before ALS diagnosis were 3.17 (95% confidence interval [CI], 1.31–7.70; P = .01) and 3.02 (95% CI, 1.32–6.90; P = .01) in the Cox regression model and the competing risk model, respectively. The annual prevalence of suicide attempts was 0.29%–1.12%. Twenty (42.6%) and 9 (19.1%) attempts occurred within 3 months and 12–18 months after diagnosis, respectively.

Conclusions: Psychiatric hospitalization increased the risk of suicide attempts, which clustered at the early stage or on losing autonomy. Those with a history of psychiatric hospitalization should receive an in-depth evaluation and be cautiously monitored.

J Clin Psychiatry 2023;84(6):22m14754

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