Document Type : Original Article
TSocial Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
Razi Educational and Therapeutic Psychiatric Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
Multiple Sclerosis Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Psychosomatic Medicine Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
Background: Considering the high probability of suicidal behaviors in multiple sclerosis (MS) population of other countries and the unlikeliness of its diagnosis in patients with MS by specialists, the current research targets the frequency of suicidal thoughts and mood symptoms in a group of patients with MS in Iran. Also, we investigated the relationships among suicidal thoughts, anxiety, depression, anticipated stigma, social support, some disease characteristics, and sociodemographic factors.
Methods: A sample of 276 subjects were selected from community-based MS clinics and referral out-patient MS clinic of Sina Hospital affiliated to Tehran University of Medical Sciences, Tehran, Iran. Participants completed the Patient Health Questionnaire (PHQ), the Hospital Anxiety and Depression Scale (HADS), the Chronic Illness Anticipated Stigma Scale (CIASS), the Multidimensional Scale of Perceived Social Support (MSPSS), and a personal information questionnaire.
Results: 36.2% of the participants had suicidal thoughts. Suicidal ideation was significantly more likely among people who reported higher anxiety and depression scores or anticipated stigma from their friends and families. Women and patients with higher education experienced suicidal ideation more frequently than others.
Conclusion: The importance of comorbidities of suicidal thoughts with anticipated stigma, depression, and anxiety in patients with MS, emphasizing the need for paying attention to it, and considering effective therapeutic interventions focused on alleviating perceived stigma as well as mood symptoms.
- Heydarpour P, Khoshkish S, Abtahi S, Moradi-Lakeh M, Sahraian MA. Multiple sclerosis epidemiology in Middle East and North Africa: A systematic review and meta-analysis. Neuroepidemiology 2015; 44(4): 232-44.
- Etemadifar M, Sajjadi S, Nasr Z, Firoozeei TS, Abtahi SH, Akbari M, et al. Epidemiology of multiple sclerosis in Iran: A systematic review. Eur Neurol 2013; 70(5-6): 356-63.
- Feinstein A, Magalhaes S, Richard JF, Audet B, Moore C. The link between multiple sclerosis and depression. Nat Rev Neurol 2014; 10(9): 507-17.
- Viner R, Patten SB, Berzins S, Bulloch AG, Fiest KM. Prevalence and risk factors for suicidal ideation in a multiple sclerosis population. J Psychosom Res 2014; 76(4): 312-6.
- Marrie RA. What is the risk of suicide in multiple sclerosis? Mult Scler 2017; 23(6): 755-6.
- Feinstein A, Pavisian B. Multiple sclerosis and suicide. Mult Scler 2017; 23(7): 923-7.
- Askari F, Ghajarzadeh M, Mohammadifar M, Azimi A, Sahraian MA, Owji M. Anxiety in patients with multiple sclerosis: association with disability, depression, disease type and sex. Acta Med Iran 2014; 52(12): 889-92.
- Moghadam Ahmadi A, Mobini A, Kabiri F, Bidaki R, Bozorg B. Relationship between anxiety and depression with disability over multiple sclerosis patients in Rafsanjan, Iran. Arch Neurosci 2018; 5(2): e63503.
- Tauil C, Grippe T, Dias R, Dias-Carneiro R, Carneiro N, Aguilar A, et al. Suicidal ideation, anxiety, and depression in patients with multiple sclerosis. Arq Neuropsiquiatr 2018; 76(5): 296-301.
- Kane JC, Elafros MA, Murray SM, Mitchell EMH, Augustinavicius JL, Causevic S, et al. A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 2019; 17(1): 17.
- Cadden MH, Arnett PA, Tyry TM, Cook JE. Judgment hurts: The psychological consequences of experiencing stigma in multiple sclerosis. Soc Sci Med 2018; 208: 158-64.
- Quinn DM, Chaudoir SR. Living with a concealable stigmatized identity: The impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. J Pers Soc Psychol 2009; 97(4): 634-51.
- Carpiniello B, Pinna F. The reciprocal relationship between suicidality and stigma. Front Psychiatry 2017; 8: 35.
- Dadfar M, Kalibatseva Z, Lester D. Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients. Trends Psychiatry Psychother 2018; 40(2): 144-51.
- Altura KC, Patten SB, Fiest KM, Atta C, Bulloch AG, Jette N. Suicidal ideation in persons with neurological conditions: prevalence, associations and validation of the PHQ-9 for suicidal ideation. Gen Hosp Psychiatry 2016; 42: 22-6.
- Louzon SA, Bossarte R, McCarthy JF, Katz IR. Does suicidal ideation as measured by the PHQ-9 Predict Suicide among VA patients? Psychiatr Serv 2016; 67(5): 517-22.
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001; 16(9): 606-13.
- Razykov I, Hudson M, Baron M, Thombs BD. Utility of the Patient Health Questionnaire-9 to assess suicide risk in patients with systemic sclerosis. Arthritis Care Res (Hoboken) 2013; 65(5): 753-8.
- Razykov I, Ziegelstein RC, Whooley MA, Thombs BD. The PHQ-9 versus the PHQ-8--is item 9 useful for assessing suicide risk in coronary artery disease patients? Data from the Heart and Soul Study. J Psychosom Res 2012; 73(3): 163-8.
- Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord 2009; 114(1-3): 163-73.
- Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67(6): 361-70.
- Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The Hospital Anxiety and Depression Scale (HADS): Translation and validation study of the Iranian version. Health Qual Life Outcomes 2003; 1: 14.
- Earnshaw VA, Quinn DM, Kalichman SC, Park CL. Development and psychometric evaluation of the Chronic Illness Anticipated Stigma Scale. J Behav Med 2013; 36(3): 270-82.
- Nejatisafa AA, Mozafari S, Noorbala AA, Asgarian FS, Earnshaw VA, Sahraian MA, et al. Psychometric evaluation of the Persian version of the Chronic Illness Anticipated Stigma Scale (CIASS). Int J Behav Med 2017; 24(4): 634-40.
- Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional scale of perceived social support. J Pers Assess 1988; 52(1): 30-41.
- Bagherian-Sararoudi R, Hajian A, Ehsan HB, Sarafraz MR, Zimet GD. Psychometric properties of the Persian version of the Multidimensional Scale of Perceived Social Support in Iran. Int J Prev Med 2013; 4(11): 1277-81.
- Lewis VM, Williams K, KoKo C, Woolmore J, Jones C, Powell T. Disability, depression and suicide ideation in people with multiple sclerosis. J Affect Disord 2017; 208: 662-9.
- Turner AP, Williams RM, Bowen JD, Kivlahan DR, Haselkorn JK. Suicidal ideation in multiple sclerosis. Arch Phys Med Rehabil 2006; 87(8): 1073-8.
- Mousavi SG, Keramatian K, Maracy MR, Fouladi M. Suicidal ideation, depression, and aggression among students of three universities of Isfahan, Iran in 2008. Iran J Psychiatry Behav Sci 2012; 6(1): 47-53.
- Ekramzadeh S, Javadpour A, Draper B, Mani A, Withall A, Sahraian A. Prevalence and correlates of suicidal thought and self-destructive behavior among an elderly hospital population in Iran. Int Psychogeriatr 2012; 24(9): 1402-8.
- Ziaei R, Viitasara E, Soares J, Sadeghi-Bazarghani H, Dastgiri S, Zeinalzadeh AH, et al. Suicidal ideation and its correlates among high school students in Iran: A cross-sectional study. BMC Psychiatry 2017; 17(1): 147.
- Saberi-Zafaghandi MB, Hajebi A, Eskandarieh S, Ahmadzad-Asl M. Epidemiology of suicide and attempted suicide derived from the health system database in the Islamic Republic of Iran: 2001-2007. East Mediterr Health J 2012; 18(8): 836-41.
- Rezaee-Zavareh MS, Karimi-Sari H, Alavian SM. Iran, sanctions, and research collaborations. Lancet 2016; 387(10013): 28-9.
- Ghafari S, Fallahi-Khoshknab M, Nourozi K, Mohammadi E. Patients' experiences of adapting to multiple sclerosis: A qualitative study. Contemp Nurse 2015; 50(1): 36-49.
- Brenner P, Burkill S, Jokinen J, Hillert J, Bahmanyar S, Montgomery S. Multiple sclerosis and risk of attempted and completed suicide - a cohort study. Eur J Neurol 2016; 23(8): 1329-36.
- Koslow SH, Ruiz P, Nemeroff CB. A concise guide to understanding suicide: epidemiology, pathophysiology and prevention. Cambridge, UK: Cambridge University Press; 2014.
- Malekian A, Afshar H, Ahamadzadeh G. Cultural issues in anxiety disorders: Some particularities of the Iranian culture. Int J Body Mind Culture 2014; 1(1): 54-8.
- Fredrikson S, Cheng Q, Jiang GX, Wasserman D. Elevated suicide risk among patients with multiple sclerosis in Sweden. Neuroepidemiology 2003; 22(2): 146-52.