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Suicide in Tourette's and Chronic Tic Disorders
Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
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2017 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 82, no 2, p. 111-118Article in journal (Refereed) Published
Abstract [en]

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 7736 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 control subjects (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, compared with control subjects, had an increased risk of both dying by suicide (odds ratio: 4.39; 95% confidence interval [CI]: 2.89-6.67) and attempting suicide (odds ratio: 3.86; 95% CI: 3.50-4.26). 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 (hazard ratio: 11.39; 95% CI: 3.71-35.02, and hazard ratio: 5.65; 95% CI: 2.21-14.42, respectively).

Conclusions: 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.

Place, publisher, year, edition, pages
Elsevier, 2017. Vol. 82, no 2, p. 111-118
Keywords [en]
Chronic tic disorder, Premature mortality, Psychiatric epidemiology, Suicide, Suicide attempt, Tourette’s disorder
National Category
Psychiatry Neurology
Research subject
Psychiatry; Neurology
Identifiers
URN: urn:nbn:se:oru:diva-54658DOI: 10.1016/j.biopsych.2016.08.023ISI: 000403670500007PubMedID: 27773353OAI: oai:DiVA.org:oru-54658DiVA, id: diva2:1064516
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00569 2015-00075Swedish Research Council, K2013-61P-22168
Note

Funding Agencies:

David and Astrid Hagelen Foundation  

KID (Karolinska Institutet Ph.D. stipend)

American Foundation for Suicide Prevention  

Indiana Clinical and Translational Sciences Institute  

Shire Pharmaceuticals 

Available from: 2017-01-12 Created: 2017-01-12 Last updated: 2017-10-22Bibliographically approved

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Larsson, Henrik

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