Suicide in people with epilepsy: How great is the risk?

Gail S. Bell · Athanasios Gaitatzis · Catherine L Bell · Anthony L. Johnson · Josemir W. A. S. Sander

163 citations0/0 files storedEpilepsia

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Suicide and Self-Harm Studies Epilepsy research and treatment Homicide, Infanticide, and Child Abuse

Abstract

PURPOSE: Suicide is more common in populations with epilepsy, but estimates vary concerning the magnitude of the risk. We aimed to estimate the risk using meta-analysis. METHODS: A literature search identified 74 articles (76 cohorts of people with epilepsy) in whom the number of deaths by suicide in people with epilepsy and the number of person-years at risk could be estimated. Standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated for each cohort, for groups of cohorts, and for the total population. RESULTS: The overall SMR was 3.3 (95% CI 2.8-3.7) based on 190 observed deaths by suicide compared with 58.4 expected. The SMR was significantly increased in people with incident or newly diagnosed epilepsy in the community (SMR 2.1), in populations with mixed prevalence and incidence cases (SMR 3.6), in those with prevalent epilepsy (SMR 4.8), in people in institutions (SMR 4.6), in people seen in tertiary care clinics (SMR 2.28), in people with temporal lobe epilepsy (SMR 6.6), in those following temporal lobe excision (SMR 13.9), and following other forms of epilepsy surgery (SMR 6.4). The SMR was significantly low overall in two community-based studies of people with epilepsy and developmental disability. DISCUSSION: We confirm that the risk of suicide is increased in most populations of people with epilepsy. Psychiatric comorbidity has been demonstrated to be a risk factor for suicide in the general population and in people with epilepsy, and such comorbidity should thus be identified and treated.

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References

1997Suicide as an outcome for mental disorders 2007Epilepsy and risk of suicide: a population-based case–control study 2003Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy 2001Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study 2002Risk Factors for Suicide in Epilepsy: A Case Control Study

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