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Suicide risk in epilepsy: where do we stand?
| Content Provider | Semantic Scholar |
|---|---|
| Author | Bell, Gail S. Sander, Josemir W. |
| Copyright Year | 2007 |
| Abstract | 666 http://neurology.thelancet.com Vol 6 August 2007 Is it true that people with epilepsy are at greater risk of committing suicide than are people without epilepsy? And if so, why? A study in this issue reinforces the idea that the answer to the fi rst question is yes. Suicide has previously been suggested to cause around 10% of deaths in people with epilepsy, although this fi gure might be an overestimate owing to the use of inappropriate methods. The answer to the question of why this might be so is less clear. There are several diff erent ways of estimating the risk of suicide in epilepsy, and they all have their problems. Because suicide accounts for approximately 1·5% of all deaths worldwide and death occurs only once for each person, suicide would not be expected to occur frequently in a population of people with epilepsy, even if the rate of suicide were elevated. Thus, many personyears of follow-up would be needed to estimate the rate of suicide in people with epilepsy with any degree of certainty. Even studies with large numbers of patients and long follow-up periods do not always provide signifi cant standardised mortality ratios (SMRs) for suicide in people with epilepsy. A Swedish study that reported on over 50 000 person-years of patients who were once hospitalised for epilepsy, a study from the Netherlands that followed people newly diagnosed with epilepsy for over 30 000 person-years, and a Scottish study that followed adults with chronic epilepsy for 23 000 person-years calculated SMRs for suicide of 3·5, 1·7, and 2·1, respectively; only the fi rst of these ratios is signifi cant. A study from California that followed people with both learning disabilities and epilepsy for 65 000 person-years reported a low SMR (0·3) for suicide. However, this fi nding might be due to diff ering rates of suicide in people with learning disabilities: the SMR for people with learning disabilities but without epilepsy (650 000 person-years follow-up) was 0·2. Cohort studies frequently do not establish with certainty the cause of death, and death by suicide might be underrecorded, either because of uncertainty of intent or to avoid the stigma of suicide. Case–control studies of people with epilepsy who have died as a result of suicide can give useful information about risk factors. A Swedish study that used living individuals with epilepsy as controls reported that the major risk factors for suicide include a history of mental illness, use of antipsychotic drugs, and early onset of epilepsy. In the study from Denmark, Christensen and colleagues identifi ed more than 21 000 cases of suicide (492 with epilepsy) over a 17-year period. They used fi ve nationwide longitudinal registries and hospital data (predominantly inpatient data) to provide information on the diagnosis of epilepsy, cause of death, psychiatric diagnosis, and socioeconomics. Christensen and colleagues selected up to 20 people, matched for sex and age, and who were alive at the corresponding date of suicide, as controls for each person who committed suicide. They found that the rate ratio of suicide among people with epilepsy was high even after excluding people with psychiatric disease and adjusting for various socioeconomic factors. The risk of suicide in people with a history of psychiatric disease was, not surprisingly, far in excess of that in people who had no such history; the risk was even greater in people who also had a history of epilepsy. The risk of suicide decreased with time since epilepsy diagnosis, and was highest in patients with aff ective disorders. This study clearly confi rms that the risk of suicide in Denmark is greater in people with epilepsy than in people without, whether or not they have a history of psychiatric disease. However, this report does not provide all the answers. The rate of suicide varies around the world—for example, according the WHO Statistical Information System, the rate is much higher in Denmark Suicide risk in epilepsy: where do we stand? |
| Starting Page | 666 |
| Ending Page | 667 |
| Page Count | 2 |
| File Format | PDF HTM / HTML |
| DOI | 10.1016/S1474-4422(07)70182-5 |
| PubMed reference number | 17638606 |
| Journal | Medline |
| Volume Number | 6 |
| Alternate Webpage(s) | https://api.elsevier.com/content/article/pii/S1474442207701825 |
| Alternate Webpage(s) | https://www.sciencedirect.com/science/article/pii/S1474442207701825?dgcid=api_sd_search-api-endpoint |
| Alternate Webpage(s) | https://doi.org/10.1016/S1474-4422%2807%2970182-5 |
| Journal | The Lancet Neurology |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
