The development of a predictive nomogram based on readily available information in electronic medical records (EMRs) to identify persons with multiple sclerosis (PwMS) at higher risk of suicidal ideation was explored in a recent study. The research highlighted the importance of behavioral risk factors in this population.

Researchers noted that PwMS face a higher risk of suicide, yet there is limited research on the factors that contribute to this risk. Detecting suicidal thoughts early on could help prevent self-harm, making personalized interventions crucial for PwMS experiencing suicidal ideation (SI). Researchers set out to create a predictive tool, using data found in EMRs or simpler patient-reported measures, to pinpoint PwMS who are most susceptible to SI. 

A retrospective, longitudinal cohort study was conducted on PwMS seeking long-term care at a tertiary academic MS center in Northeast Ohio between 2008 and 2015. Participants were required to be at least 18 years old at onset, Ohio residents, with a non-missing clinical course, and without any suicidal ideation at baseline and the following 3 months. 

Prior to each encounter, patients completed the EuroQoL 5D-3L (EQ5D; five 3-choice questions) and the Patient Health Questionnaire–9 (PHQ-9; nine 4-choice questions about depressive symptoms in the prior 2 weeks) electronically to assess their quality of life and depressive symptoms. The study defined suicidal ideation as the first endorsement of any SI measured by the PHQ-9. Multivariable Cox proportional hazards models were used to determine predictors of future suicidal ideation based on various demographic and clinical factors.

The study included 2166 PwMS with a mean age of 45.5 years and mean 3.6 years of observation, 72% of whom were female and 11.5% Black/African American. Sixteen percent reported suicidal ideation over time. Certain traits predicted suicidal ideation including identifying as male, Black/African American, a current smoker, single or divorced, having progressive MS, and endorsing specific items related to anxiety/depression, feeling down, appetite problems, and self-deprecation. 

These findings were used to create a nomogram to identify PwMS most vulnerable to suicidal ideation, showing the likelihood of reporting suicidal ideation in 1, 3, and 5 years for individuals with certain characteristics.

“An SI nomogram provides a concise, easy-to-use, visual risk stratification tool for SI in PwMS,” said researchers. “Our nomogram results highlight the importance of behavioral risk factors in SI among PwMS.” 

Reference 
Briggs F BS, Genuario I, Ontaneda D, et al. A nomogram for predicting suicidal ideation in multiple sclerosis; CMSC 2024; May 29-June 1, 2024; Nashville, TN; Abstract PSY06.