Risk factors for suicidality in Huntington disease: An analysis of the 2CARE clinical trial.

Risk factors for suicidality in Huntington disease: An analysis of the 2CARE clinical trial.

Publication date: Mar 08, 2019

Most suicidality literature in Huntington disease (HD) is based on natural history studies or retrospective reviews, but reports on risk factors from clinical trials are limited.

We analyzed 609 participants from 2CARE, a randomized, double-blind, placebo-controlled clinical trial with up to 5 years of follow-up, for risk factors related to suicidality. The primary outcome variable was the time from randomization until the first occurrence of either suicidal ideation or attempt. We also considered time from randomization until the first suicide attempt as a secondary outcome variable.

Depression, anxiety, bipolar disorder, antidepressant or anxiolytic use, and prior suicide attempt at baseline were associated with time to ideation or attempt. Baseline employment status, marital status, CAG repeat length, tetrabenazine use, and treatment assignment (coenzyme Q or placebo) were not associated with suicidality. Time-dependent variables from the Unified Huntington’s Disease Rating Scale Behavioral Assessment were associated with time to suicidal ideation or attempt, driven mainly by items related to depressed mood, low self-esteem/guilt, anxiety, suicidal thoughts, irritability, and compulsions. Variables associated with time to suicide attempt alone were generally similar.

These data suggest psychiatric comorbidities in HD are predictive of suicidal behavior while participating in clinical trials, reinforcing the importance of clinical surveillance and treatment towards lessening risk during participation and perhaps beyond. Designing a composite algorithm for early prediction of suicide attempts in HD may be of value, particularly given anticipated trials aimed at disease modification are likely to be long-term.


McGarry, A., McDermott, M.P., Kieburtz, K., Alan Fung, W.L., McCusker, E., Peng, J., de Blieck, E.A., Cudkowicz, M., and Coordinators, Huntington Study. Group. 2CARE. Investigators. and. Risk factors for suicidality in Huntington disease: An analysis of the 2CARE clinical trial. 06391. 2019 Neurology.

Concepts Keywords
Algorithm Huntington’s disease
Antidepressant Tetrabenazine
Anxiety Design of experiments
Anxiolytic Suicide prevention
Bipolar Disorder RTT
Clinical Surveillance Depression
Clinical Trial Chemical compounds
Clinical Trials Health
Coenzyme Composite algorithm
Comorbidities Suicide crisis
Compulsions Antidepressant
Depressed Mood Major depressive disorder
Double Blind Suicidal ideation
Natural History
Suicidal Behavior
Suicidal Ideation
Suicidal Thoughts


Type Source Name
disease MESH comorbidities
drug DRUGBANK Tetrabenazine
disease MESH marital status
disease MESH employment status
disease DOID bipolar disorder
disease MESH bipolar disorder
disease DOID anxiety
disease MESH anxiety
disease MESH suicide
disease MESH Depression
disease MESH suicidal ideation
disease DOID Huntington disease
disease MESH Risk factors
disease MESH Huntington disease

Original Article

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