Association of Restless Legs Syndrome With Risk of Suicide and Self-harm

Sheng Zhuang, Muzi Na, John W. Winkelman, Djibril Ba, Chun Feng Liu, Guodong Liu, Xiang Gao

Research output: Contribution to journalArticle

Abstract

Importance: Restless legs syndrome (RLS) is a common neurologic disorder that has been previously found to be associated with higher odds of suicidal ideation. In the context of the increasing suicide rate in the United States, the evidence regarding the association between RLS and the risk of suicide and self-harm is limited. Objective: To investigate the association between RLS and risk of suicide and self-harm. Design, Setting, and Participants: This cohort study was performed using Truven Health MarketScan national claims data from 2006 to 2014; the baseline data were from 2006 to 2008, and the follow-up data covered 6 years (January 1, 2009, to December 31, 2014). Included were 24 179 nonpregnant participants with RLS and 145 194 age- and sex-matched participants without RLS at baseline (2006-2008), who were free of suicide, self-harm, cardiovascular disease, or cancer at study baseline. Data analysis was performed from February 1, 2018, to January 1, 2019. Exposure: Diagnosis of RLS, as identified by the International Classification of Diseases, Ninth Revision code. Main Outcomes and Measures: Incident suicide and self-harm event, identified by the International Classification of Diseases, Ninth Revision diagnosis code. Results: Among 169 373 participants in the current analysis, the mean (SD) age was 49.4 (9.1) years; 53 426 (31.5%) participants were men. During a mean (SD) follow-up duration of 5.2 (2.2) years, 119 incident suicide and self-harm cases were identified. Individuals with RLS had a higher risk of suicide or self-harm compared with those without RLS (adjusted hazard ratio, 2.66; 95% CI, 1.70-4.15), after adjusting for lifestyle factors (eg, alcohol and obesity), presence of chronic diseases (eg, depression, insomnia, diabetes, chronic kidney disease, peripheral neuropathy, iron-deficiency anemia, and Parkinson disease), and use of medications. Excluding those with depression, insomnia, obstructive sleep apnea, and other common chronic conditions, the significant association between RLS and suicide or self-harm persisted (adjusted hazard ratio, 4.14; 95% CI, 2.17-7.92). Conclusions and Relevance: Restless legs syndrome was associated with a high risk of suicide and self-harm, and the risk was independent of most identified diseases and conditions.

Original languageEnglish (US)
Pages (from-to)e199966
JournalJAMA network open
Volume2
Issue number8
DOIs
StatePublished - Aug 2 2019

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Restless Legs Syndrome
Suicide
Sleep Initiation and Maintenance Disorders
International Classification of Diseases
Depression
Deficiency Diseases
Suicidal Ideation
Iron-Deficiency Anemias
Peripheral Nervous System Diseases
Obstructive Sleep Apnea
Nervous System Diseases
Chronic Renal Insufficiency
Parkinson Disease
Life Style
Chronic Disease
Cohort Studies
Cardiovascular Diseases
Obesity
Alcohols
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Zhuang, Sheng ; Na, Muzi ; Winkelman, John W. ; Ba, Djibril ; Liu, Chun Feng ; Liu, Guodong ; Gao, Xiang. / Association of Restless Legs Syndrome With Risk of Suicide and Self-harm. In: JAMA network open. 2019 ; Vol. 2, No. 8. pp. e199966.
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abstract = "Importance: Restless legs syndrome (RLS) is a common neurologic disorder that has been previously found to be associated with higher odds of suicidal ideation. In the context of the increasing suicide rate in the United States, the evidence regarding the association between RLS and the risk of suicide and self-harm is limited. Objective: To investigate the association between RLS and risk of suicide and self-harm. Design, Setting, and Participants: This cohort study was performed using Truven Health MarketScan national claims data from 2006 to 2014; the baseline data were from 2006 to 2008, and the follow-up data covered 6 years (January 1, 2009, to December 31, 2014). Included were 24 179 nonpregnant participants with RLS and 145 194 age- and sex-matched participants without RLS at baseline (2006-2008), who were free of suicide, self-harm, cardiovascular disease, or cancer at study baseline. Data analysis was performed from February 1, 2018, to January 1, 2019. Exposure: Diagnosis of RLS, as identified by the International Classification of Diseases, Ninth Revision code. Main Outcomes and Measures: Incident suicide and self-harm event, identified by the International Classification of Diseases, Ninth Revision diagnosis code. Results: Among 169 373 participants in the current analysis, the mean (SD) age was 49.4 (9.1) years; 53 426 (31.5{\%}) participants were men. During a mean (SD) follow-up duration of 5.2 (2.2) years, 119 incident suicide and self-harm cases were identified. Individuals with RLS had a higher risk of suicide or self-harm compared with those without RLS (adjusted hazard ratio, 2.66; 95{\%} CI, 1.70-4.15), after adjusting for lifestyle factors (eg, alcohol and obesity), presence of chronic diseases (eg, depression, insomnia, diabetes, chronic kidney disease, peripheral neuropathy, iron-deficiency anemia, and Parkinson disease), and use of medications. Excluding those with depression, insomnia, obstructive sleep apnea, and other common chronic conditions, the significant association between RLS and suicide or self-harm persisted (adjusted hazard ratio, 4.14; 95{\%} CI, 2.17-7.92). Conclusions and Relevance: Restless legs syndrome was associated with a high risk of suicide and self-harm, and the risk was independent of most identified diseases and conditions.",
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Association of Restless Legs Syndrome With Risk of Suicide and Self-harm. / Zhuang, Sheng; Na, Muzi; Winkelman, John W.; Ba, Djibril; Liu, Chun Feng; Liu, Guodong; Gao, Xiang.

In: JAMA network open, Vol. 2, No. 8, 02.08.2019, p. e199966.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of Restless Legs Syndrome With Risk of Suicide and Self-harm

AU - Zhuang, Sheng

AU - Na, Muzi

AU - Winkelman, John W.

AU - Ba, Djibril

AU - Liu, Chun Feng

AU - Liu, Guodong

AU - Gao, Xiang

PY - 2019/8/2

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N2 - Importance: Restless legs syndrome (RLS) is a common neurologic disorder that has been previously found to be associated with higher odds of suicidal ideation. In the context of the increasing suicide rate in the United States, the evidence regarding the association between RLS and the risk of suicide and self-harm is limited. Objective: To investigate the association between RLS and risk of suicide and self-harm. Design, Setting, and Participants: This cohort study was performed using Truven Health MarketScan national claims data from 2006 to 2014; the baseline data were from 2006 to 2008, and the follow-up data covered 6 years (January 1, 2009, to December 31, 2014). Included were 24 179 nonpregnant participants with RLS and 145 194 age- and sex-matched participants without RLS at baseline (2006-2008), who were free of suicide, self-harm, cardiovascular disease, or cancer at study baseline. Data analysis was performed from February 1, 2018, to January 1, 2019. Exposure: Diagnosis of RLS, as identified by the International Classification of Diseases, Ninth Revision code. Main Outcomes and Measures: Incident suicide and self-harm event, identified by the International Classification of Diseases, Ninth Revision diagnosis code. Results: Among 169 373 participants in the current analysis, the mean (SD) age was 49.4 (9.1) years; 53 426 (31.5%) participants were men. During a mean (SD) follow-up duration of 5.2 (2.2) years, 119 incident suicide and self-harm cases were identified. Individuals with RLS had a higher risk of suicide or self-harm compared with those without RLS (adjusted hazard ratio, 2.66; 95% CI, 1.70-4.15), after adjusting for lifestyle factors (eg, alcohol and obesity), presence of chronic diseases (eg, depression, insomnia, diabetes, chronic kidney disease, peripheral neuropathy, iron-deficiency anemia, and Parkinson disease), and use of medications. Excluding those with depression, insomnia, obstructive sleep apnea, and other common chronic conditions, the significant association between RLS and suicide or self-harm persisted (adjusted hazard ratio, 4.14; 95% CI, 2.17-7.92). Conclusions and Relevance: Restless legs syndrome was associated with a high risk of suicide and self-harm, and the risk was independent of most identified diseases and conditions.

AB - Importance: Restless legs syndrome (RLS) is a common neurologic disorder that has been previously found to be associated with higher odds of suicidal ideation. In the context of the increasing suicide rate in the United States, the evidence regarding the association between RLS and the risk of suicide and self-harm is limited. Objective: To investigate the association between RLS and risk of suicide and self-harm. Design, Setting, and Participants: This cohort study was performed using Truven Health MarketScan national claims data from 2006 to 2014; the baseline data were from 2006 to 2008, and the follow-up data covered 6 years (January 1, 2009, to December 31, 2014). Included were 24 179 nonpregnant participants with RLS and 145 194 age- and sex-matched participants without RLS at baseline (2006-2008), who were free of suicide, self-harm, cardiovascular disease, or cancer at study baseline. Data analysis was performed from February 1, 2018, to January 1, 2019. Exposure: Diagnosis of RLS, as identified by the International Classification of Diseases, Ninth Revision code. Main Outcomes and Measures: Incident suicide and self-harm event, identified by the International Classification of Diseases, Ninth Revision diagnosis code. Results: Among 169 373 participants in the current analysis, the mean (SD) age was 49.4 (9.1) years; 53 426 (31.5%) participants were men. During a mean (SD) follow-up duration of 5.2 (2.2) years, 119 incident suicide and self-harm cases were identified. Individuals with RLS had a higher risk of suicide or self-harm compared with those without RLS (adjusted hazard ratio, 2.66; 95% CI, 1.70-4.15), after adjusting for lifestyle factors (eg, alcohol and obesity), presence of chronic diseases (eg, depression, insomnia, diabetes, chronic kidney disease, peripheral neuropathy, iron-deficiency anemia, and Parkinson disease), and use of medications. Excluding those with depression, insomnia, obstructive sleep apnea, and other common chronic conditions, the significant association between RLS and suicide or self-harm persisted (adjusted hazard ratio, 4.14; 95% CI, 2.17-7.92). Conclusions and Relevance: Restless legs syndrome was associated with a high risk of suicide and self-harm, and the risk was independent of most identified diseases and conditions.

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