Review
Suicide risk in type 1 diabetes mellitus: A systematic review

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Abstract

Background

Research has shown that suicide risk is often present in patients suffering from type 1 diabetes mellitus (DM-1).

Objectives

The aim of the present paper was to investigate whether there was a relationship between DM-1 and suicidal behavior and to determine whether or not people affected by DM-1 are at an increased risk of completed suicide, attempted suicide, and suicidal ideation.

Data sources

We performed a careful MedLine, ExcerptaMedica, PsycLit, PsycInfo and Index Medicus search to identify all papers on the topic for the period 1970 to 2013 written in English. The following search terms were used: (suicide OR suicide attempt OR ideation) AND (diabetes mellitus). Where a title or abstract seems to describe a study eligible for inclusion, the full article was examined.

Eligibility criteria

We included only original articles published in English peer-reviewed journals. We excluded meta-analyses and systematic reviews, studies that were not clear about follow-up times, the method of statistical analysis, diagnostic criteria or the number of patients included, and studies only on patients affected by type 2 diabetes mellitus (DM-2).

Results

The research reviewed indicated that patients with DM-1 are at an increased risk for suicide, although no clear consensus exists regarding the level of the increased risk.

Limitations

The studies used different measurement techniques and different outcomes, and they assessed patients at different time points.

Conclusions and implications

Our findings support the recommendation that a suicide risk assessment of patients with DM-1 should be part of the routine clinical assessment. The assessment of patients at risk should consist of the evaluation of current and previous suicidal behaviors (both suicidal ideation and attempted suicide).

Introduction

Research has documented high rates of psychiatric disorders among medical patients in general [1], [2], [3], [4]. Suicidal ideation, which is frequently present in patients with major depression [5], is also common in patients suffering from medical illnesses [6], and this suicidal ideation in medically ill patients may arise from a comorbid depression [7].

There are more than 30 million people worldwide suffering from type 1 diabetes mellitus (DM-1) [8], an illness resulting in autoimmune damage to the insulin-secreting islet cells and caused by a mixture of genetic and non-genetic factors [9]. DM-1 is often characterized by multi-organ involvement, and the damage to the primary target organ typically drives the clinical presentation and distinguishes the disease. Patients with DM-1 have almost doubled risk of depression compared to the general population [10], and psychiatric symptoms are frequent in patients with DM-1 and other autoimmune diseases [11].

The aims of the present paper were to examine research on the association between DM-1 and suicidal behavior and to determine whether or not people affected by DM-1 are at an increased risk of completed suicide, attempted suicide, and suicidal ideation.

Section snippets

Methods

In order to provide a systematic review about DM-1 and suicidal behavior, we performed a careful MedLine, ExcerptaMedica, PsycLit, PsycInfo and Index Medicus search to identify all papers in English for the period 1970 to 2013. The following search terms were used: (suicide OR suicide attempt OR ideation) AND (diabetes mellitus). The articles were restricted to those published in English peer-reviewed journals. Where a title or abstract seems to describe a study eligible for inclusion, the full

Search strategy

The combined search strategies yielded a total of 331 records to be screened. We first reviewed titles and abstracts and applied the selection criteria outlined above with the exception of study design. This process led to the exclusion of 291 records from the 331 originally selected. The large majority of studies excluded failed to mention in the title or abstract any of the outcome indicators specified above. In the second stage of the screening process, two new reviewers read the full

Discussion

The research reviewed above has indicated that, in general, patients with DM-1 have a higher risk for suicide than the general population does [13], [19], [21], [24], [30], [31]. Patients with DM-1 are 3 to 4 times more likely to attempt suicide than the general population [21], and patients with DM-1 have a 61% higher risk of experiencing suicidal thoughts than individuals without DM-1 [26]. On the other hand, not all research reports a higher risk of suicide in patients with DM-1 [16], [27],

Conclusions

Given the association between DM-1 and suicide, it is of great importance to prevent suicide in these patients. The results of this review support the recommendation that a suicide risk assessment of patients with DM-1 should be part of the routine clinical assessment. The assessment of patients at risk should include an evaluation of current suicidal ideation and previous suicidal behavior since premorbid suicidal ideation is an important risk factor for later completed suicide. Preventive

Conflict of interest statement

The authors declare no conflict of interest.

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