Multiple sclerosis and suicide attempts: A review including a meta-analysis of prevalence

Background. Multiple sclerosis is an autoimmune inflammatory demyelinating disorder, and persons diagnosed with multiple sclerosis have a shorter life expectancy than the general population. Recent meta-analyses have examined the association between MS and suicide and between MS and suicidal ideation. The objective of the present review was to examine if MS is associated with a higher risk of suicide attempt. We hypothesised that MS patients were at increased risk of suicide attempts. Methods. Four databases (PubMed including MEDLINE, EMBASE, Web of Science, and PsycINFO) were searched systematically for studies assessing the risk of attempted suicide in people with MS. Eligibility criteria were studies designed as cohort, case-control, or cross-sectional studies with attempted suicide as the outcome and published in English. Lifetime prevalence of suicide attempt was calculated through a meta-analysis, and the results were presented as a forest plot. Sensitivity analyses were used to investigate the heterogeneity among studies. Results. 13 studies were identified from 533 records, providing a total population of 50,004 participants of whom 599 had attempted suicide. The weighted overall prevalence of suicide attempts among people with MS was 0.04 (95% CI 0.02-0.06) with a Cochran’s  value of 591.05, which rejected the null hypothesis of homogeneous studies. The performed sensitivity analysis resulted in an  of 81% as the lowest possible value, which still indicated a high level of heterogeneity. Conclusion. To our knowledge, this is the first study to examine the association between MS and suicide attempts in a meta-analysis. The results suggest a significant association between MS and suicide attempts. However, the small number of the included studies and the heterogeneous nature of these studies indicate a need for more studies based on more homogeneous samples.