Journal of Neurology

, Volume 265, Issue 11, pp 2548–2561 | Cite as

Risk factors of suicidal ideation in Huntington’s disease: literature review and data from Enroll-HD

  • Philipp Honrath
  • Imis Dogan
  • Olga Wudarczyk
  • Katharina S. Görlich
  • Mikhail Votinov
  • Cornelius J. Werner
  • Beate Schumann
  • Rena T. Overbeck
  • Jörg B. Schulz
  • Bernhard G. Landwehrmeyer
  • Raquel E. Gur
  • Ute Habel
  • Kathrin ReetzEmail author
  • the Enroll-HD investigators
Original Communication


Suicide is a leading cause of death in Huntington’s disease (HD), following pneumonia. Up to one-fifth of individuals with HD report suicidal ideation. Identifying the risk factors of suicidal ideation in this clinical population is thus pivotal. Here, we review the literature on prevalence rates and risk factors of suicidal ideation in premanifest and manifest patients and re-evaluate them using the largest currently existing clinical dataset from the ongoing observational study “Enroll-HD” (N = 5709). Large scale studies yielded important insights regarding suicidal ideation in HD. However, estimated prevalence rates vary among studies and risk factors are still poorly understood. According to the Enroll-HD data, pre- and manifest disease stages are associated with current (5.8–10%) and a history of suicidal ideation (18.6–30.9%). Throughout the course of HD, a history of suicidal ideation and the presence of depressive symptoms were strongly associated with current suicidal ideation. However, while for premanifest individuals, socio-demographics and activities of daily living appear to be important, in manifest patients, suicidal ideation is more closely linked to anxiety, irritability, psychosis, and apathy. These results highlight the importance of treating depressive symptoms in patients with HD and addressing potential suicidal ideation during clinical monitoring. The relevance of risk factors may differ among premanifest and manifest patients.


Huntington’s disease Depression Suicidal ideation Risk factors Enroll-HD 



This work was funded by the International Research Training Group, The Neuroscience of Modulating Aggression and Impulsivity in Psychopathology (IRTG-2150) of the German Research Foundation (DFG). KR was funded by the German Federal Ministry of Education and Research (BMBF 01GQ1402). ID was supported by the START-Program (08/16) of the Faculty of Medicine, RWTH Aachen. All authors contributed and approved the final manuscript. We thank Philippa Hüpen, Simon Koppers, and Andrei Puiu for comments on the manuscript. Enroll-HD is a longitudinal observational study for Huntington’s disease families intended to accelerate progress towards therapeutics; it is sponsored by CHDI Foundation, a non-profit biomedical research organization exclusively dedicated to developing therapeutics for HD. Enroll-HD would not be possible without the vital contribution of the research participants and their families.

Author contributions

Concept and design: PH, ID, KR, UH; acquisition of data: the Enroll-HD investigators; drafting of the manuscript: PH; critical revision of the manuscript: ID, KR, CJW, BS, RTO, OW, KSG, MV, REG, JBS, UH, BGL; statistical analyses: PH, ID.

Compliance with ethical standards

Conflicts of interest

We have read and understood the policy on declaration of conflict of interest and declare that we have no competing interests.

Patient consent


Ethics approval

The study design and protocol were approved by the local scientific committee (University Hospital RWTH Aachen) and were in accordance with the code of ethics of the World Medical association (Declaration of Helsinki, 1967).

Provenance and peer review

Not commissioned, externally reviewed.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologyRWTH Aachen University HospitalAachenGermany
  2. 2.Department of Neurology, Section Interdisciplinary GeriatricsRWTH Aachen UniversityAachenGermany
  3. 3.Department of Psychiatry, Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenGermany
  4. 4.JARA-BRAIN, Jülich-Aachen Research AllianceInstitute of Molecular Neuroscience and NeuroimagingAachenGermany
  5. 5.JARA-BRAIN, Jülich-Aachen Research AllianceInstitute of Brain Structure-Function RelationshipsAachenGermany
  6. 6.Department of NeurologyUniversity of UlmUlmGermany
  7. 7.Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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