Suicide in people with epilepsy: How great is the risk?
Article first published online: 12 MAY 2009
Wiley Periodicals, Inc. © 2009 International League Against Epilepsy
Volume 50, Issue 8, pages 1933–1942, August 2009
How to Cite
Bell, G. S., Gaitatzis, A., Bell, C. L., Johnson, A. L. and Sander, J. W. (2009), Suicide in people with epilepsy: How great is the risk?. Epilepsia, 50: 1933–1942. doi: 10.1111/j.1528-1167.2009.02106.x
- Issue published online: 29 JUL 2009
- Article first published online: 12 MAY 2009
- Accepted February 18, 2009; Early View publication May 12, 2009.
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.