Restless Legs Syndrome an Independent Suicide Risk Factor?

Megan Brooks

June 08, 2018

BALTIMORE — People with severe restless legs syndrome (RLS) are more likely to plan and attempt suicide than people without RLS, even after controlling for depression, according to new research.

"Lifetime suicidal ideation and attempts are very prevalent among people with restless legs syndrome and seem to be independent of demographic factors and depression and seem to be associated with severity of restless legs," said Brian Koo, MD, director of the Yale Center for Restless Legs Syndrome, Yale University, New Haven, Connecticut.

The study was presented here at SLEEP 2018: 32nd Annual Meeting of the Associated Professional Sleep Societies.

Novel Study

RLS is associated with insomnia and depression, both suicide risk factors. But, until now, RLS and its potential relationship with suicide had not been studied.

The Yale team investigated the frequency of lifetime suicidal behavior in 198 patients with severe RLS and 164 controls. All participants completed the Suicidal Behavior Questionnaire-revised (SBQ-R) and the Brief Lifetime Depression Scale.

RLS and controls were similar in age (mean age, 51), income, and sex. Compared with controls, patients with RLS were more often white (96% vs 88%), less often had higher education (84% vs 96%), were more often married (72% vs 60%), and were less often employed or retired (80% vs 90%).

Significantly more patients with RLS than controls were at high suicide risk (SBQ-R score ≥ 7) and had lifetime suicidal thoughts or behavior, independent of depression history.

Table. Lifetime Suicidal Thoughts and Behavior in Study Participants

Suicidal Thought/Behavior Patients With RLS (%) Controls (%) P Value
Suicide plan 20.3 3.8 <.00001
Suicide attempt 6.8 3.2 .13
Suicide plan/attempt 27.1 7.0 <.00001
High suicide risk 30.7 10.1 <.00001


This relationship between suicidal behavior in patients with RLS "has not been previously investigated in any depth," John W. Winkelman, MD, PhD, from Harvard Medical School and Massachusetts General Hospital, Boston, noted in an interview with Medscape Medical News.

"Mood and anxiety disorders are highly comorbid in RLS patients. My feeling is that the suicidal ideation or even plan or intent and even some who have followed through is the same thing you see in patients with chronic pain," said Winkelman, who chaired the session where the results were presented.

"In many respects, RLS is a chronic pain disorder. And if you have chronic pain, for which you feel there is no appropriate treatment and your physician may not understand what you have, or may not know how to treat it appropriately, it can lead you to feel hopeless, and I think pain and hopeless can lead to those kinds of thoughts," said Winkelman.

"Given the fact that many patients with RLS have a mood disorder, doctors should ask them about depression symptoms, one of which are suicidal thoughts," he said.

The study had no funding. Koo and Winkelman have disclosed no relevant financial relationships.

SLEEP 2018: 32nd Annual Meeting of the Associated Professional Sleep Societies. Abstract 0661. Presented June 4, 2018.

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