Original ArticleSuicidal thought and behavior in individuals with restless legs syndrome
Introduction
Restless legs syndrome (RLS) is a chronic sensorimotor disorder characterized by an inescapable urge to move the legs, most often at night, when rest and sleep are most desired. The need to move of RLS appears as the RLS sufferer is at their most tired state, and in the greatest need for rest. At night, uncontrollable urges to move intervene and sleep is foiled, causing chronic and disabling sleeplessness [1], [2]. Indeed, quality of life in RLS sufferers is well below population norms in both mental and physical domains, and matches that of patients with other chronic conditions such as diabetes and osteoarthritis [3], [4], [5]. Unsurprisingly, major depressive disorder is also very common among those with RLS, with the likelihood of prevalent depression being two-and-a-half to five times more frequent in persons with RLS compared to those without RLS [6], [7], [8].
The likelihood of depression and the severity of insomnia both increase as RLS symptoms worsen in severity [9]. One recent study found that the presence of RLS was associated with a greater than fifty-fold increase in the odds of severe depression assessed by the Beck Depression Inventory [10]. Indeed, symptoms of RLS when they are severe can leave the unfortunate RLS sufferer powerless and despondent. Disturbed sleep, insomnia, and depression are well-known risk factors for suicidality [11], [12], [13], and a recent longitudinal study highlighted a strong association between sleep disturbances and suicidal risk independent of depression [14]. Given these notable associations, we wished to study whether there is an association between RLS and suicidal thought and behavior. We aimed to determine the frequency of lifetime suicidal ideation or suicide attempts in patients with moderate-to-severe RLS and age-sex matched controls and to identify clinical correlates of suicidal behavior in patients suffering from RLS.
Section snippets
Participants, recruitment, & assessment of RLS
Patients with RLS were recruited from May 2017 to January 2018 using advertisements on the website and newsletter of the RLS Foundation and through email solicitation to individuals identified with RLS through Research Match. Control participants were recruited through email solicitation to individuals identified through Research Match and the Yale Research Studies Registry, both registries of persons interested in research participation, between May 2017 and November 2017. Both advertisements
Characteristics of RLS and control groups
One-hundred ninety two RLS (162 women, 84.4%) and 158 control participants (131 women, 82.9%) were included in the study. RLS and control groups were comparable for age (p = 0.54), sex (p = 0.71), Caucasian race (p = 0.36), current marital status, education, and income (Table 1). Participants with RLS were significantly less likely than control participants to have a lifetime history of alcohol abuse (p = 0.0008), but were marginally more likely to have a lifetime history of drug abuse
Discussion
The main findings of this study demonstrate that lifetime suicidal ideation and suicide attempts are highly prevalent among persons with largely moderate-to-severe RLS, occurring in more than one-quarter of persons with RLS compared to less than one-tenth of age, sex, and demographically comparable controls without RLS. While suicidal thought or behavior was highly associated with a lifetime history of depression, the suicidal outcome was also independently associated with having RLS in the
Study funding
None.
Acknowledgements
The authors would like to acknowledge the RLS Foundation and the help they provided in identifying participants with RLS.
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2021, Mayo Clinic ProceedingsThe Long-Term Psychiatric and Cardiovascular Morbidity and Mortality of Restless Legs Syndrome and Periodic Limb Movements of Sleep
2021, Sleep Medicine ClinicsCitation Excerpt :One cohort study utilizing longitudinal medical claim data from a large sample of US patients (n = 169373) found that those with physician-diagnosed RLS had an increased risk of suicide and self-harm during the 6-year follow-up period (adjusted hazard ratio [HR] 2.66, 1.70–4.15).24 In a recent cross-sectional study,25 more participants with RLS had lifetime suicidal ideation or behavior than controls (27.1% vs 7.0%, respectively; P<.00001). Furthermore, suicidality was linked to RLS severity: the probability of suicidal ideation or behavior increased if previous RLS symptoms were severe or very severe.
The prospective associations between different types of sleep disturbance and suicidal behavior in a large sample of chinese college students
2021, Journal of Affective DisordersCitation Excerpt :Moreover, Para et al. (2019) surveyed 192 RLS participants and 158 controls and found that, compared with control group, RLS participants had a roughly 3-fold increased risk of lifetime suicidal ideation even after accounting for depression and other confounders. However, the limited studies are cross-sectional (Bishop et al., 2018; Para et al., 2019; Talih et al., 2016; Tseng et al., 2019; Zhuang et al., 2019), making it difficult to establish the causal relationship. Moreover, it is worth mentioning that all existing studies were based on western populations, so it is unclear if these findings could be generalized to other populations.
Sleep disturbance in patients in an inpatient hospital mediates relationship between PTSD and suicidal ideation
2021, Journal of Psychiatric ResearchConvergence of psychiatric symptoms and restless legs syndrome: A cross-sectional study in an elderly French population
2020, Journal of Psychosomatic ResearchCitation Excerpt :There are some limitations, including limited therapeutic approvals for alpha 2 delta ligands in the treatment of RLS in Europe [53]. Also, and importantly, suicidal ideation is a reported adverse effect of pregabalin [54], and is common in RLS [55], underscoring the need for close monitoring in RLS patients. The convergence in potential pharmacological treatments for RLS and GAD might also encourage examination of common neurotransmitter pathways, considering that the nexus of psychiatric disorders and RLS is poorly understood [9].
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Co-first authors; these authors contributed equally to the manuscript.