A Meta-Analysis of the Rates of Suicide Ideation, Attempts and Deaths in People with Epilepsy.

Nicholas Abraham,Roger C Ho,Giang Vu Thu,P Buvanaswari,Rahul Rathakrishnan,Long H Nguyen,Bach X Tran,Cyrus S Ho

doi:10.3390/ijerph16081451

Abstract

This meta-analysis aimed to evaluate the association between epilepsy and suicide. We systematically searched PubMed, PsycINFO, Embase and Web of Science for studies that reported the prevalence of suicidality in the form of suicide ideation, attempts and deaths among people with epilepsy (PWE). Studies were included if they reported the numbers of patients who died by suicide and concurrently suffered from epilepsy, assessed suicide ideation, or studied suicide attempts in PWE by validated instruments or diagnostic interviews. We used the random effects model to calculate the pooled odds ratios (OR) and standard mean differences (SMDs). We performed subgroup analyses. Seven case-control studies were included in the comparison of rates of suicide attempts between PWE and controls, with a total of 821,594 participants. Our analyses demonstrated a positive association between epilepsy and suicide attempts (pooled OR = 3.25, 95% confidence interval (CI): 2.69–3.92, p < 0.001), indicating that PWE have an elevated risk of suicide. The pooled prevalence for suicide ideation (24 studies) and suicide attempts (18 studies) were 23.2% (95% CI: 0.176–0.301) and 7.4% (95% CI: 0.031–0.169) respectively. The pooled rate of death due to suicide (10 studies) was 0.5% (95% CI: 0.002–0.016). Meta-regression showed that mean age and proportion of male gender were significant moderators for prevalence of suicide attempts and death due to suicide in PWE. Young PWE could be triggered by relationship problems and male PWE might use more lethal methods to attempt suicide. This meta-analysis provides the most up-to-date information on the prevalence of suicide among people with epilepsy and guidance on strategies to improve current psychiatric services provided for this population.

Highlights

IntroductionA recent meta-analysis found the median incidence of epilepsy per 100,000 people per year to be 45.0 in high income economies and 81.7 per 100,000 people in the rest of the world [1]
Epilepsy is a significant disease burden among the worldwide population
This meta-analysis was conducted to quantify the associations between epilepsy and suicidality, This was conducted to quantify the associations between epilepsy suicidality, globally, inmeta-analysis the forms of suicide ideation, suicide attempts, and death due to suicide

Summary

Introduction

A recent meta-analysis found the median incidence of epilepsy per 100,000 people per year to be 45.0 in high income economies and 81.7 per 100,000 people in the rest of the world [1]. Suicide is associated with symptoms of psychiatric illness [2], psychosomatic complaints of insomnia and headaches [3], reports of adverse life events [4], alcohol abuse and past medical or surgical treatment [5], but its association with epilepsy, globally, has not been quantified. The reported percentages of suicidality among people with epilepsy (PWE) vary amongst studies. The relationship between epilepsy and suicide is complex. Hesdorffer et al found that suicide attempts were associated with incident epilepsy in the absence of antiepileptic drugs in American patients [7]

Methods

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Discussion

Conclusion