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Suicidal behaviour and suicide mortality in Parkinson’s disease: a nationwide register-based cohort study

Lindström, Sara LU orcid ; Wolfschlag, Mirjam LU ; Cedergren Weber, Gustav LU ; Ljung, Hanna LU ; Håkansson, Anders C LU orcid ; Odin, Per LU orcid and Berge, Jonas LU (2026) In BMJ Neurology Open 8(1).
Abstract
Background Previous population-based studies suggest an increased risk of suicide in Parkinson’s disease (PD), but findings have been inconsistent and often limited by residual confounding. We examined the association between incident PD and suicide-related outcomes using extensive confounding control, including both suicidal attempts and suicide.

Methods We conducted a nationwide matched cohort study using Swedish population registers. Individuals with incident PD (n=44 398) were matched 1:5 to population controls (n=2 23 292) by year of birth, sex and municipality. Baseline covariates were assessed during the 3 years before diagnosis and used to estimate propensity scores. Associations with (1) suicide death and (2) suicidal... (More)
Background Previous population-based studies suggest an increased risk of suicide in Parkinson’s disease (PD), but findings have been inconsistent and often limited by residual confounding. We examined the association between incident PD and suicide-related outcomes using extensive confounding control, including both suicidal attempts and suicide.

Methods We conducted a nationwide matched cohort study using Swedish population registers. Individuals with incident PD (n=44 398) were matched 1:5 to population controls (n=2 23 292) by year of birth, sex and municipality. Baseline covariates were assessed during the 3 years before diagnosis and used to estimate propensity scores. Associations with (1) suicide death and (2) suicidal behaviour (suicide attempt or suicide death) were analysed using Cox regression stratified by matching group. Additional confounding was addressed by inverse probability weighting by propensity scores. Analyses were further stratified by sex and age at diagnosis (<65/≥65 years).

Results There were 335 suicide deaths and 1083 suicidal behaviour events during follow-up. In matched analysis, PD was associated with suicide death (HR 1.35 (95% CI 1.03 to 1.76)), but this association attenuated after weighting (HR 1.08 (95% CI 0.81 to 1.45)). PD remained associated with suicidal behaviour after weighting (HR 1.46 (95% CI 1.27 to 1.69)). The association was strongest among individuals diagnosed before age 65 (weighted HR 1.86 (95% CI 1.47 to 2.36)).

Conclusions After extensive confounding adjustment, PD was not independently associated with suicide death overall but remained associated with increased risk of suicidal behaviour. Increased suicide death risk persisted among women and younger-onset PD. (Less)
Abstract (Swedish)
Background Previous population-based studies suggest an increased risk of suicide in Parkinson’s disease (PD), but findings have been inconsistent and often limited by residual confounding. We examined the association between incident PD and suicide-related outcomes using extensive confounding control, including both suicidal attempts and suicide.

Methods We conducted a nationwide matched cohort study using Swedish population registers. Individuals with incident PD (n=44 398) were matched 1:5 to population controls (n=2 23 292) by year of birth, sex and municipality. Baseline covariates were assessed during the 3 years before diagnosis and used to estimate propensity scores. Associations with (1) suicide death and (2) suicidal... (More)
Background Previous population-based studies suggest an increased risk of suicide in Parkinson’s disease (PD), but findings have been inconsistent and often limited by residual confounding. We examined the association between incident PD and suicide-related outcomes using extensive confounding control, including both suicidal attempts and suicide.

Methods We conducted a nationwide matched cohort study using Swedish population registers. Individuals with incident PD (n=44 398) were matched 1:5 to population controls (n=2 23 292) by year of birth, sex and municipality. Baseline covariates were assessed during the 3 years before diagnosis and used to estimate propensity scores. Associations with (1) suicide death and (2) suicidal behaviour (suicide attempt or suicide death) were analysed using Cox regression stratified by matching group. Additional confounding was addressed by inverse probability weighting by propensity scores. Analyses were further stratified by sex and age at diagnosis (<65/≥65 years).

Results There were 335 suicide deaths and 1083 suicidal behaviour events during follow-up. In matched analysis, PD was associated with suicide death (HR 1.35 (95% CI 1.03 to 1.76)), but this association attenuated after weighting (HR 1.08 (95% CI 0.81 to 1.45)). PD remained associated with suicidal behaviour after weighting (HR 1.46 (95% CI 1.27 to 1.69)). The association was strongest among individuals diagnosed before age 65 (weighted HR 1.86 (95% CI 1.47 to 2.36)).

Conclusions After extensive confounding adjustment, PD was not independently associated with suicide death overall but remained associated with increased risk of suicidal behaviour. Increased suicide death risk persisted among women and younger-onset PD. (Less)
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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BMJ Neurology Open
volume
8
issue
1
article number
e001618
ISSN
2632-6140
DOI
10.1136/bmjno-2026-001618
language
English
LU publication?
yes
id
901b8418-3eda-4d9a-99c5-44a83b32c9b6
date added to LUP
2026-05-04 09:41:31
date last changed
2026-05-04 12:42:04
@article{901b8418-3eda-4d9a-99c5-44a83b32c9b6,
  abstract     = {{Background Previous population-based studies suggest an increased risk of suicide in Parkinson’s disease (PD), but findings have been inconsistent and often limited by residual confounding. We examined the association between incident PD and suicide-related outcomes using extensive confounding control, including both suicidal attempts and suicide.<br/><br/>Methods We conducted a nationwide matched cohort study using Swedish population registers. Individuals with incident PD (n=44 398) were matched 1:5 to population controls (n=2 23 292) by year of birth, sex and municipality. Baseline covariates were assessed during the 3 years before diagnosis and used to estimate propensity scores. Associations with (1) suicide death and (2) suicidal behaviour (suicide attempt or suicide death) were analysed using Cox regression stratified by matching group. Additional confounding was addressed by inverse probability weighting by propensity scores. Analyses were further stratified by sex and age at diagnosis (&lt;65/≥65 years).<br/><br/>Results There were 335 suicide deaths and 1083 suicidal behaviour events during follow-up. In matched analysis, PD was associated with suicide death (HR 1.35 (95% CI 1.03 to 1.76)), but this association attenuated after weighting (HR 1.08 (95% CI 0.81 to 1.45)). PD remained associated with suicidal behaviour after weighting (HR 1.46 (95% CI 1.27 to 1.69)). The association was strongest among individuals diagnosed before age 65 (weighted HR 1.86 (95% CI 1.47 to 2.36)).<br/><br/>Conclusions After extensive confounding adjustment, PD was not independently associated with suicide death overall but remained associated with increased risk of suicidal behaviour. Increased suicide death risk persisted among women and younger-onset PD.}},
  author       = {{Lindström, Sara and Wolfschlag, Mirjam and Cedergren Weber, Gustav and Ljung, Hanna and Håkansson, Anders C and Odin, Per and Berge, Jonas}},
  issn         = {{2632-6140}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{1}},
  series       = {{BMJ Neurology Open}},
  title        = {{Suicidal behaviour and suicide mortality in Parkinson’s disease: a nationwide register-based cohort study}},
  url          = {{http://dx.doi.org/10.1136/bmjno-2026-001618}},
  doi          = {{10.1136/bmjno-2026-001618}},
  volume       = {{8}},
  year         = {{2026}},
}