Международный неврологический журнал 6 (60) 2013

Introduction. Suicidal behavior is of multifactoral nature in which social and psychological factors play a considerable role. There is no unanimous opinion concerning the reason for suicidality in the patients with multiple sclerosis (MS). Depression is the most significant determiner of suicidal intentions in the patients with MS. Suicidal thoughts are more typical of persons with MS than of the representatives of the general population. In some patients with MS suicidal ideation can activate the control mechanism over their life under the conditions of a complicated unforeseen disease. Searching of suicidality predictors in people with MS adds special urgency to the issues of diagnostics and prevention of suicides among the corresponding cohort of patients.

Materials and methods. The research included 182 in-patients with MS (64 men and 118 women) aged from 21 up to 58 years that formed two groups: the main (with suicidal tendencies) - 29 (15,93%) patients and control (without suicidal tendencies) - 153 (84,07%). The following research methods were used:  clinical-neurological - Kurtzke Expanded Disability Status Scale (EDSS), psychopathological - Beck depression inventory, State Trait Anxiety Inventory by Spielberger-Hanin. The statistical analyses were performed by means of Pearson's χ2 test. Criteria for exclusion of the patients from the research included burdened psychopathological heredity, mood fluctuations and alcohol abuse in the past medical history, cognitive decline according to the MMSE scale up to 26 points.  

Results. According to the data of the follow-up observation performed during 5 years it was established that 3 (1,64%) of the patients with suicidal tendencies attempted suicide, 2 of them were fatal. The patients of the main and control groups were divided by gender almost equally - 34,48% of men and 65,55% of women with suicidal ideation; 35,95% and 64,05% without suicidal tendencies correspondingly. Suicidal tendencies in the patients with MS were most often observed  during the first 5 years of the disease. As to the marital status in the main group of the patients single men and women prevailed (divorced, unmarried, widowed) - 65,52%, highly educated - 41,38%.  As to the social status employees and working disabled people were divided equally in both groups.  In the main group maintained disabled people prevailed – 58,63%.  

According to the hypothesis testing results concerning connection of social and demographic indicators with suicidality in the patients with MS it was established that such factors as sex, age, place of residence and social status of the patients did not show significant differences between the main and control groups (p>0,05). Thus, these characteristics did not greatly influence formation of suicidality in the patients with MS, at the same time single (divorced) patients and highly-educated patients manifested suicidal tendencies more often (p<0,05). It was statistically established that the duration, type of the clinical course and disability severity did not influence formation of suicidal tendencies in the patients with MS (p>0,05).

According to the BDI data all the patients of the main group (n=29) manifested depressive disorders of different intensity. According to the STAI data there was no low reactive and personal anxiety among the patients of the main group, high reactive anxiety was observed in 75,87% of the patients,  personal anxiety - in 93,10%. The hypothesis testing results concerning influence of the depression, reactive and personal anxiety with suicidal tendencies in the patients with MS evidenced that the BDI level was significantly higher in the patients with suicidal tendencies (р<0,05). It was statistically established that a high level of the reactive and personal anxiety influenced the availability of suicidal tendencies in the patients with MS (р<0,05). According to the BDI data 86,2% of the patients from the main group had different degrees of sexual dysfunction that significantly influenced formation of suicidality in the patients with MS (р<0,05).

Conclusions. Suicidal tendencies were observed in 15,93% of the patients with MS, 1,64% of the patients with suicidal tendencies committed suicide. Suicidality factors in case of MS included loneliness, higher education, high degree of depression and anxiety, sexual dysfunction.   Psychometric testing for detection of depression (depression screening) in order to determine suicidality should become a part of clinical examination of the patients with MS.