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

      research-article
      , MD 1 , , PhD, MHS 2 , , MD, PhD 3 , 4 , , MPH 5 , , MD, PhD 1 , , PhD 5 , , MD, PhD 2 ,
      JAMA Network Open
      American Medical Association

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          Key Points

          Questions

          Is restless legs syndrome associated with a high risk of suicide and self-harm?

          Findings

          In a cohort study that included 169 373 participants, individuals with restless legs syndrome had a higher risk of suicide and self-harm compared with age- and sex-matched participants without restless legs syndrome, and the increased risk was independent of common diseases and conditions.

          Meaning

          Restless legs syndrome was associated with an increased risk of suicide and self-harm.

          Abstract

          This cohort study of commercially insured US individuals examines the association between restless legs syndrome and risk of suicide and self-harm.

          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.

          Related collections

          Most cited references41

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          Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health.

          Restless legs syndrome is a common yet frequently undiagnosed sensorimotor disorder. In 1995, the International Restless Legs Syndrome Study Group developed standardized criteria for the diagnosis of restless legs syndrome. Since that time, additional scientific scrutiny and clinical experience have led to a better understanding of the condition. Modification of the criteria is now necessary to better reflect that increased body of knowledge, as well as to clarify slight confusion with the wording of the original criteria. The restless legs syndrome diagnostic criteria and epidemiology workshop at the National Institutes of Health. Members of the International Restless Legs Syndrome Study Group and authorities on epidemiology and the design of questionnaires and scales. To modify the current criteria for the diagnosis of restless legs syndrome, to develop new criteria for the diagnosis of restless legs syndrome in the cognitively impaired elderly and in children, to create standardized criteria for the identification of augmentation, and to establish consistent questions for use in epidemiology studies. The essential diagnostic criteria for restless legs syndrome were developed and approved by workshop participants and the executive committee of the International Restless Legs Syndrome Study Group. Criteria were also developed and approved for the additional aforementioned groups.
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            Non-suicidal self-injury in United States adults: prevalence, sociodemographics, topography and functions.

            E. Klonsky (2011)
            Non-suicidal self-injury (NSSI) has received increased attention in the mental health literature and has been proposed as a diagnostic entity for DSM-5. However, data on NSSI in the United States adult population are lacking. The prevalence and nature of NSSI were examined in a random-digit dialing sample of 439 adults in the United States. Participants were recruited during July and August of 2008. Lifetime prevalence of NSSI was 5.9%, including 2.7% who had self-injured five or more times. The 12-month prevalence was 0.9%. Methods of NSSI reported included cutting/carving, burning, biting, scraping/scratching skin, hitting, interfering with wound healing and skin picking. Half of self-injurers reported multiple methods. The average age of onset was 16 years (median 14 years). Instances of NSSI infrequently co-occurred with suicidal thoughts and with use of alcohol or drugs and rarely required medical treatment. Most injurers reported that NSSI functioned to alleviate negative emotions. Fewer reported that they self-injured to punish themselves, to communicate with others/get attention or to escape a situation or responsibility. NSSI was associated with younger age, being unmarried and a history of mental health treatment, but not with gender, ethnicity, educational history or household income. Results are largely consistent with previous research in adolescent and young adult samples. Study limitations notwithstanding, this study provides the most definitive and detailed information to date regarding the prevalence and characteristics of NSSI in US adults. In the future, it will be important for large-scale epidemiological studies of psychopathology to include questions about NSSI.
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              • Article: not found

              Genome-wide association analyses of sleep disturbance traits identify new loci and highlight shared genetics with neuropsychiatric and metabolic traits

              Richa Saxena and colleagues report genome-wide association analyses of sleep disturbance traits in the UK Biobank cohort. They discover loci associated with insomnia symptoms and excessive daytime sleepiness and identify genetic correlations with several neuropsychiatric and metabolic traits.
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                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                23 August 2019
                August 2019
                23 August 2019
                : 2
                : 8
                : e199966
                Affiliations
                [1 ]Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
                [2 ]Department of Nutritional Sciences, Pennsylvania State University, State College, University Park
                [3 ]Department of Psychiatry, Massachusetts General Hospital, Boston
                [4 ]Department of Neurology, Massachusetts General Hospital, Boston
                [5 ]Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey
                Author notes
                Article Information
                Accepted for Publication: July 4, 2019.
                Published: August 23, 2019. doi:10.1001/jamanetworkopen.2019.9966
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Zhuang S et al. JAMA Network Open.
                Corresponding Author: Xiang Gao, MD, PhD, Department of Nutritional Sciences, Pennsylvania State University, 109 Chandlee Lab, University Park, PA 16802 ( xxg14@ 123456psu.edu ).
                Author Contributions: Drs G. Liu and Gao had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
                Concept and design: Ba, C.-F. Liu, G. Liu, Gao.
                Acquisition, analysis, or interpretation of data: All authors.
                Drafting of the manuscript: Zhuang, Na, C.-F. Liu.
                Critical revision of the manuscript for important intellectual content: All authors.
                Statistical analysis: Ba, G. Liu.
                Obtained funding: Gao.
                Administrative, technical, or material support: Na, C.-F. Liu, G. Liu.
                Supervision: Winkelman, G. Liu, Gao.
                Conflict of Interest Disclosures: Dr Winkelman reported receiving grants and personal fees from Luitpold Pharmaceuticals, royalties from UpToDate, speaker fees and travel support from Otsuka, and grants from the Restless Legs Syndrome Foundation, UCB Pharma, NeuroMetrix, National Institute of Mental Health, and Xenoport outside the submitted work and also reported serving as a consultant for Merck. No other disclosures were reported.
                Funding/Support: This research is supported by start-up grants from the College of Health and Human Development and the Department of Nutritional Sciences, Pennsylvania State University, and the Institute for CyberScience Seed Grant Program, Pennsylvania State University. Data from the IBM Truven Health Analytics (Market Scan) database were obtained through agreement with Pennsylvania State University.
                Role of the Funder/Sponsor: Pennsylvania State University had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
                Article
                zoi190394
                10.1001/jamanetworkopen.2019.9966
                6714009
                31441941
                374b1e40-2376-49da-847c-d377710b116c
                Copyright 2019 Zhuang S et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                History
                : 19 April 2019
                : 4 July 2019
                Categories
                Research
                Original Investigation
                Online Only
                Neurology

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