The recent tragic death by suicide of beloved actor and comedian, Robin Williams has brought the serious issue of suicide onto the American consciousness. His wife has revealed that he was recently diagnosed with early Parkinson's Disease, which is a neurodegenerative disorder that often results in tremor, rigidity, limited motion, and difficulty with balance. It is also associated with a variety of other non-motor symptoms such as decreased sense of smell, cognitive difficulties, and depression.
Some people have wondered if Mr. Williams' early Parkinsonism had anything to do with his suicide. What we do know is that suicide among patients with Parkinsonism is not greater than the rate among non-Parkinson's patients with similar demographics (Danish research by Stenager and colleagues). While patients with Parkinsonism have an increased rate of depression, it probably played only a minor role, if any, in the suicide of Mr. Williams. At most, having received news of this diagnosis may have made him more discouraged about his life.
Rather, his wife announced that he was diagnosed with Lewy Body Dementia, which likely led to his suicide. Lewy Body Dementia can be associated with Parkinson's Disease, and is the second most common form of dementia (Alzheimer's Disease is more common). We have also learned that he battled chronic depression and the disease of alcoholism and perhaps drug abuse. It is known that use of alcohol or drugs increases the risk of suicide.
Suicide is a common cause of death in the U. S. Overall, it is the 11th leading cause of death, but it is the 3rd leading cause among young people age 15-34. Among Native Americans in that age group it is the 2nd leading cause. There are about 33,000 suicides in the U. S. each year, which amounts to 91 suicides per day.
Risk factors include having prior attempts, a positive family history, alcohol/drug abuse, major mental illnesses such as bipolar disorder or schizophrenia, experiencing a significant loss, having a serious medical illness such as cancer or Huntington's Disease, feeling hopeless, and lacking social support, e.g., unmarried. Patients with borderline personality disorder or antisocial personality disorder have an increased incidence of suicide.
Caucasians have a higher incidence of suicide than African-Americans, Hispanics, and Asians. Experiencing physical, emotional or sexual abuse in childhood also increases the risk of suicide during adolescence and adulthood. Females attempt suicide more often than males, but males complete suicide more often because they tend to use more lethal means such as a firearm.
Anyone with suicidal thoughts should be taken seriously and seen urgently by a physician or mental health practitioner such as a psychologist. Such patients need capable treatment and protection against suicidal urges if possible. This may require hospitalization. However, many patients with suicidal thoughts can be treated on an outpatient basis. This depends on a careful assessment of the risks of the person acting on their thoughts.
The bottom line is that anyone with suicidal thoughts deserves to be evaluated in a timely manner by a professional. The overwhelming majority of suicidal patients are grateful that they did not act on their thought once they have received treatment.
Peter M. Hartmann, MD
Psychiatry and Family Medicine
[Updated on 8/17/22]
