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

Authors

  • Gail S Bell,

    1. Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, United Kingdom
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  • Athanasios Gaitatzis,

    1. Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, United Kingdom
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  • Catherine L Bell,

    1. Bristol Medical School, Bristol, United Kingdom
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  • Anthony L Johnson,

    1. MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, United Kingdom;
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  • Josemir W Sander

    1. Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, United Kingdom
    2. SEIN – Epilepsy Institutes in the Netherlands Foundation, Heemstede, The Netherlands
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Address correspondence to Prof. Ley Sander, Box 29, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, U.K. E-mail: lsander@ion.ucl.ac.uk

Summary

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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