Suicide in Parkinson’s Disease: A Systematic Review

Author(s): Isabella Berardelli, Daniele Belvisi, Adele Nardella, Giulia Falcone, Dorian A. Lamis, Giovanni Fabbrini, Alfredo Berardelli, Paolo Girardi, Maurizio Pompili*

Journal Name: CNS & Neurological Disorders - Drug Targets
(Formerly Current Drug Targets - CNS & Neurological Disorders)

Volume 18 , Issue 6 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Psychiatric disorders and suicide have been reported in patients suffering from Parkinson’s disease. The aims of the present paper were to determine whether patients with Parkinson’s disease have an increased rate of suicide and to identify the clinical features possibly associated with suicide risk in Parkinson’s disease. We also reviewed the studies on suicide risk in Parkinson’s disease in patients after deep brain stimulation. We performed a Medline, Excerpta Medica, PsycLit, PsycInfo and Index Medicus search to identify all articles published on this topic from 1970 to 2019. The following search terms were used: suicide OR suicide attempt OR suicidal ideation OR suicide risk AND Parkinson’s disease AND Parkinson’s disease and deep brain stimulation. The studies we identified that assessed the suicide rate associated with Parkinson’s disease yielded contrasting results, although an increase in suicidal ideation did emerge. The studies on the effect of deep brain stimulation on suicide risk in Parkinson’s disease also reported mixed findings. Psychiatric symptoms, including depression, appear to be associated with suicide risk in patients with Parkinson’s disease undergoing medical and after surgical treatment. The studies reviewed suggest that suicidal ideation is increased in Parkinson’s disease. Further longitudinal studies designed to assess suicidality in this condition are still needed.

Keywords: Suicide risk, suicidal ideation, Parkinson’s disease, deep brain stimulation, psychiatric disorders, depression.

Aarsland D, Kramberger MG. Neuropsychiatric symptoms in Parkinson’s disease. J Parkinsons Dis 2015; 5(3): 659-67.
Berg D, Postuma RB, Adler CH, et al. MDS research criteria for prodromal Parkinson’s disease. Mov Disord 2015; 30(12): 1600-11.
Castrioto A, Thobois S, Carnicella S, Maillet A, Krack P. Emotional manifestations of PD: Neurobiological basis. Mov Disord 2016; 31(8): 1103-13.
Voon V, Napier TC, Frank MJ, et al. Impulse control disorders and levodopa-induced dyskinesias in Parkinson’s disease: An update. Lancet Neurol 2017; 16(3): 238-50.
Ffytche DH, Creese B, Politis M, et al. The psychosis spectrum in Parkinson disease. Nat Rev Neurol 2017; 13(2): 81-95.
Reijnders JS, Ehrt U, Weber WE, Aarsland D, Leentjens AF. A systematic review of prevalence studies of depression in Parkinson’s disease. Mov Disord 2008; 23(2): 183-9.
Schapira AHV, Chaudhuri KR, Jenner P. Non-motor features of Parkinson disease. Nat Rev Neurosci 2017; 18(7): 435-50.
Broen MP, Narayen NE, Kuijf ML, Dissanayaka NN, Leentjens AF. Prevalence of anxiety in Parkinson’s disease: A systematic review and meta-analysis. Mov Disord 2016; 31(8): 1125-33.
Weil RS, Schrag AE, Warren JD, Crutch SJ, Lees AJ, Morris HR. Visual dysfunction in Parkinson’s disease. Brain 2016; 139(11): 2827-43.
Bartoli F, Pompili M, Lillia N, et al. Rates and correlates of suicidal ideation among stroke survivors: A meta-analysis. J Neurol Neurosurg Psychiatry 2017; 88(6): 498-504.
Pompili M, Forte A, Palermo M, et al. Suicide risk in multiple sclerosis: A systematic review of current literature. J Psychosom Res 2012; 73(6): 411-7.
Berman AL, Silverman MM, Bongar BM. Comprehensive textbook of suicidology. 2nd ed. New York: Guilford Press 2000.
Lewis DS, Anderson KH, Feuchtinger J. Suicide prevention in neurology patients: Evidence to guide practice. J Neurosci Nurs 2014; 46(4): 241-8.
Pompili M, Forte A, Berman AL, Lamis DA. The association between physical illness/medical conditions and suicide risk. In: The International Handbook of Suicide Prevention. 2nd ed. Wiley & Sons, Ltd, Chichester 2016; pp. 133-48.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ 2009; 339: b2700.
Stenager EN, Wermuth L, Stenager E, Boldsen J. Suicide in patients with Parkinson’s disease. An epidemiological study. Acta Psychiatr Scand 1994; 90(1): 70-2.
Myslobodsky M, Lalonde FM, Hicks L. Are patients with Parkinson’s disease suicidal? J Geriatr Psychiatry Neurol 2001; 14(3): 120-4.
Nazem S, Siderowf AD, Duda JE, et al. Suicidal and death ideation in Parkinson’s disease. Mov Disord 2008; 23(11): 1573-9.
Kummer A, Cardoso F, Teixeira AL. Suicidal ideation in Parkinson’s disease. CNS Spectr 2009; 14(8): 431-6.
Mainio A, Karvonen K, Hakko H, Särkioja T, Räsänen P. Parkinson’s disease and suicide: A profile of suicide victims with Parkinson’s disease in a population-based study during the years 1988-2002 in Northern Finland. Int J Geriatr Psychiatry 2009; 24(9): 916-20.
Kostić VS, Pekmezović T, Tomić A, et al. Suicide and suicidal ideation in Parkinson’s disease. J Neurol Sci 2010; 289(1-2): 40-3.
Lee T, Lee HB, Ahn MH, et al. Increased suicide risk and clinical correlates of suicide among patients with Parkinson’s disease. Parkinsonism Relat Disord 2016; 32: 102-7.
Berardelli I, Belvisi D, Corigliano V, et al. Suicidal ideation, perceived disability, hopelessness and affective temperaments in patients affected by Parkinson’s disease. Int J Clin Pract 2018; 73(3)e13287
Belvisi D, Berardelli I, Ferrazzano G, et al. The clinical correlates of suicidal ideation in Parkinson’s disease. Parkinsonism Relat Disord 2019; S1353-8020(19): 30093-0098.
Li W, Abbas MM, Acharyya S, et al. Suicide in Parkinson’s disease. Mov Disord Clin Pract (Hoboken) 2018; 5(2): 177-82.
Fasano A, Daniele A, Albanese A. Treatment of motor and non-motor features of Parkinson’s disease with deep brain stimulation. Lancet Neurol 2012; 11(5): 429-42.
Houeto JL, Mesnage V, Mallet L, et al. Behavioural disorders, Parkinson’s disease and subthalamic stimulation. J Neurol Neurosurg Psychiatry 2002; 72(6): 701-7.
Soulas T, Gurruchaga JM, Palfi S, Cesaro P, Nguyen JP, Fénelon G. Attempted and completed suicides after subthalamic nucleus stimulation for Parkinson’s disease. J Neurol Neurosurg Psychiatry 2008; 79(8): 952-4.
Voon V, Krack P, Lang AE, et al. A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson’s disease. Brain 2008; 131(Pt 10): 2720-8.
Krack P, Batir A, Van Blercom N, et al. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 2003; 349(20): 1925-34.
Burkhard PR, Vingerhoets FJ, Berney A, Bogousslavsky J, Villemure JG, Ghika J. Suicide after successful deep brain stimulation for movement disorders. Neurology 2004; 63(11): 2170-2.
Funkiewiez A, Ardouin C, Cools R, et al. Effects of levodopa and subthalamic nucleus stimulation on cognitive and affective functioning in Parkinson’s disease. Mov Disord 2006; 21(10): 1656-62.
Lhommée E, Klinger H, Thobois S, et al. Subthalamic stimulation in Parkinson’s disease: Restoring the balance of motivated behaviours. Brain 2012; 135(Pt 5): 1463-77.
Rocha S, Monteiro A, Linhares P, et al. Long-term mortality analysis in Parkinson’s disease treated with deep brain stimulation. Parkinsons Dis 2014.2014717041
Strutt AM, Simpson R, Jankovic J, York MK. Changes in cognitive-emotional and physiological symptoms of depression following STN-DBS for the treatment of Parkinson’s disease. Eur J Neurol 2012; 19(1): 121-7.
Witt K, Daniels C, Reiff J, et al. Neuropsychological and psychiatric changes after deep brain stimulation for Parkinson’s disease: A randomised, multicentre study. Lancet Neurol 2008; 7(7): 605-14.
Weintraub D, Duda JE, Carlson K, et al. Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial. J Neurol Neurosurg Psychiatry 2013; 84(10): 1113-8.
Follett KA, Weaver FM, Stern M, et al. Pallidal versus subthalamic deep-brain stimulation for Parkinson’s disease. N Engl J Med 2010; 362(22): 2077-91.
Weaver FM, Follett KA, Stern M, et al. Randomized trial of deep brain stimulation for Parkinson disease: Thirty-six-month outcomes. Neurology 2012; 79(1): 55-65.
Boel JA, Odekerken VJ, Schmand BA, et al. Cognitive and psychiatric outcome 3 years after globus pallidus pars interna or subthalamic nucleus deep brain stimulation for Parkinson’s disease. Parkinsonism Relat Disord 2016; 33: 90-5.
Lhommée E, Wojtecki L, Czernecki V, et al. Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson’s disease with early motor complications (EARLYSTIM trial): Secondary analysis of an open-label randomised trial. Lancet Neurol 2018; 17(3): 223-31.
Pompili M. The increase of suicide rates: The need for a paradigm shift. Lancet 2018; 392(10146): 474-5.
Sauerbier A, Cova I, Rosa-Grilo M, Taddei RN, Mischley LK, Chaudhuri KR. Treatment of nonmotor symptoms in Parkinson’s disease. Int Rev Neurobiol 2017; 132: 361-79.
Mills KA, Greene MC, Dezube R, Goodson C, Karmarkar T, Pontone GM. Efficacy and tolerability of antidepressants in Parkinson’s disease: A systematic review and network meta-analysis. Int J Geriatr Psychiatry 2018; 33(4): 642-51.
Berardelli I, Bloise MC, Bologna M, et al. Cognitive behavioral group therapy versus psychoeducational intervention in Parkinson’s disease. Neuropsychiatr Dis Treat 2018; 14: 399-405.
Shepard MD, Perepezko K, Broen MPG, et al. Suicide in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2019; 90(7): 822-9.
Pompili M. Exploring the phenomenology of suicide. Suicide Life Threat Behav 2010; 40(3): 234-44.
Pompili M. Phenomenology of suicide. Cham, Switzerland: Springer Nature 2017.
Webb RT, Kontopantelis E, Doran T, Qin P, Creed F, Kapur N. Suicide risk in primary care patients with major physical diseases: A case-control study. Arch Gen Psychiatry 2012; 69(3): 256-64.
Lewis DS, Anderson KH, Feuchtinger J. Suicide prevention in neurology patients: Evidence to guide practice. J Neurosci Nurs 2014; 46(4): 241-8.
Eliasen A, Dalhoff KP, Horwitz H. Neurological diseases and risk of suicide attempt: A case-control study. J Neurol 2018; 265(6): 1303-9.
Serafini G, Calcagno P, Lester D, Girardi P, Amore M, Pompili M. Suicide risk in Alzheimer’s disease: A systematic review. Curr Alzheimer Res 2016; 13(10): 1083-99.
Du L, Zeng J, Liu H, et al. Fronto-limbic disconnection in depressed patients with suicidal ideation: A resting-state functional connectivity study. J Affect Disord 2017; 215: 213-7.
Tremblay L, Worbe Y, Thobois S, Sgambato-Faure V, Féger J. Selective dysfunction of basal ganglia subterritories: From movement to behavioral disorders. Mov Disord 2015; 30(9): 1155-70.
Mitchell JE, Crosby R, de Zwaan M, et al. Possible risk factors for increased suicide following bariatric surgery. Obesity (Silver Spring) 2013; 21(4): 665-72.
Peterhänsel C, Petroff D, Klinitzke G, Kersting A, Wagner B. Risk of completed suicide after bariatric surgery: A systematic review. Obes Rev 2013; 14(5): 369-82.
Manoloudakis N, Labiris G, Karakitsou N, Kim JB, Sheena Y, Niakas D. Characteristics of women who have had cosmetic breast implants that could be associated with increased suicide risk: A systematic review, proposing a suicide prevention model. Arch Plast Surg 2015; 42(2): 131-42.
Pompili M, Girardi P, Tatarelli G, Angeletti G, Tatarelli R. Suicide after surgical treatment in patients with epilepsy: A meta-analytic investigation. Psychol Rep 2006; 98(2): 323-38.
Foncke EM, Schuurman PR, Speelman JD. Suicide after deep brain stimulation of the internal globus pallidus for dystonia. Neurology 2006; 66(1): 142-3.
Thobois S, Ardouin C, Lhommée E, et al. Non-motor dopamine withdrawal syndrome after surgery for Parkinson’s disease: Predictors and underlying mesolimbic denervation. Brain 2010; 133(Pt 4): 1111-27.
Cyron D. Mental side effects of deep brain stimulation (DBS) for movement disorders: The futility of denial. Front Integr Nuerosci 2016; 10: 17.
Temel Y, Tan S, Visser-Vandewalle V, Sharp T. Parkinson’s disease, DBS and suicide: a role for serotonin? Brain 2009; 132(Pt 10)e126
Mann JJ. Neurobiology of suicidal behaviour. Nat Rev Neurosci 2003; 4(10): 819-28.
Cowen PJ. Serotonin and depression: Pathophysiological mechanism or marketing myth? Trends Pharmacol Sci 2008; 29(9): 433-6.
Hershey T, Revilla FJ, Wernle A, Gibson PS, Dowling JL, Perlmutter JS. Stimulation of STN impairs aspects of cognitive control in PD. Neurology 2004; 62(7): 1110-4.
Temel Y, Blokland A, Steinbusch HW, Visser-Vandewalle V. The functional role of the subthalamic nucleus in cognitive and limbic circuits. Prog Neurobiol 2005; 76(6): 393-413.
Frank MJ, Samanta J, Moustafa AA, Sherman SJ. Hold your horses: Impulsivity, deep brain stimulation, and medication in parkinsonism. Science 2007; 318(5854): 1309-12.
Combs HL, Folley BS, Berry DT, et al. Cognition and depression following deep brain stimulation of the subthalamic nucleus and globus pallidus pars internus in Parkinson’s disease: A meta-analysis. Neuropsychol Rev 2015; 25(4): 439-54.
Wang XH, Zhang L, Sperry L, et al. Target selection recommendations based on impact of deep brain stimulation surgeries on nonmotor symptoms of parkinson’s disease. Chin Med J (Engl) 2015; 128(24): 3371-80.
Jęśko H, Wencel P, Strosznajder RP, Strosznajder JB. Sirtuins and their roles in brain aging and neurodegenerative disorders. Neurochem Res 2017; 42(3): 876-90.
Singh P, Hanson PS, Morris CM. SIRT1 ameliorates oxidative stress induced neural cell death and is down-regulated in Parkinson’s disease. BMC Neurosci 2017; 18(1): 46.
Nivoli A, Porcelli S, Albani D, et al. Association between sirtuin 1 gene rs10997870 polymorphism and suicide behaviors in bipolar disorder. Neuropsychobiology 2016; 74(1): 1-7.
Lu G, Li J, Zhang H, Zhao X, Yan LJ, Yang X. Role and possible mechanisms of sirt1 in depression. Oxid Med Cell Longev 2018; 20188596903
Martins IJ. Heat shock gene inactivation and protein aggregation with links to chronic diseases. Diseases 2018; 6(2): 1-5.
Martins IJ. Electroconvulsive therapy and heat shock gene inactivation in neurodegenerative diseases. Ann Neurodegener Dis 2018; p. 1028.
Martins IJ. Brain stimulation therapies in neuropsychiatric and neurodegenerative diseases. Int J Genom Data Min 2018; p. 1.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Page: [466 - 477]
Pages: 12
DOI: 10.2174/1871527318666190703093345
Price: $65

Article Metrics

PDF: 49
PRC: 1