Epilepsy and Associated Factors Among Adults Hospitalized for Attempted Suicide

Basma Akrout Brizard, MSc^a ; Philippe Courtet, MD, PhD^b,c ; Isabelle Jaussent, PhD^d ; Jorge Lopez-Castroman, MD, PhD^c,e ; Marion Leboyer, MD, PhD^f,g ; Carolina Baeza-Velasco, MSc, PhD^a,b,c

J Clin Psychiatry 2022;83(3):21m14207

ABSTRACT

Background: Suicidal behaviors are known to be increased in people with epilepsy compared to the general population. However, few studies have explored the frequency of epilepsy in a large sample of suicide attempters, and scarce data exist about differences and similarities between epileptic attempters (EA) and nonepileptic attempters (NEA). The aim of this study was to explore the frequency of epilepsy as well as psychopathological and somatic factors among suicide attempters.

Methods: In this multicenter cross-sectional study, 1,229 adults hospitalized for attempted suicide were included during the period between July 2001 and December 2015. They were assessed with the Mini-International Neuropsychiatric Interview for DSM-IV Axis I mental disorders. Data concerning sociodemographic and somatic diseases, including epilepsy, were collected.

Results: Sixty-five patients (5.3%) had epilepsy. EA had significantly fewer mean ± SD years of education compared with NEA (11.2 ± 3.2 vs 12.1 ± 2.9; P = .011) as well as increased rates of head trauma (29.2% for EA vs 16.2% for NEA; P = .007), antiepileptic use (35.4% for EA vs 23.8% for NEA; P = .036), and lifetime substance abuse and/or dependance (49.2% for EA vs 36.1% for NEA; P = .034). Multivariate analyses showed that years of education, head trauma, and panic disorder with agoraphobia predicted belonging to the EA group.

Conclusions: These results suggest that epilepsy is overrepresented among suicide attempters. Few psychopathological differences as well as differences in somatic comorbidities except head trauma were observed between EA and NEA in this sample. These results contribute to draw a clinical profile of people with epilepsy in the population of suicide attempters.

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References (50)

Courtet P, Jollant F, Castelnau D, et al. Suicidal behavior: relationship between phenotype and serotonergic genotype. Am J Med Genet C Semin Med Genet. 2005;133C(1):25–33. PubMed CrossRef
Nurtanti S, Handayani S, Ratnasari NY, et al. Characteristics, causality, and suicidal behavior: a qualitative study of family members with suicide history in Wonogiri, Indonesia. Front Nurs. 2020;7(2):169–178. CrossRef
Pompili M, Girardi P, Ruberto A, et al. Suicide in the epilepsies: a meta-analytic investigation of 29 cohorts. Epilepsy Behav. 2005;7(2):305–310. PubMed CrossRef
Pompili M, Girardi P, Tatarelli G, et al. Suicide after surgical treatment in patients with epilepsy: a meta-analytic investigation. Psychol Rep. 2006;98(2):323–338. PubMed CrossRef
Abraham N, Buvanaswari P, Rathakrishnan R, et al. A meta-analysis of the rates of suicide ideation, attempts and deaths in people with epilepsy. Int J Environ Res Public Health. 2019;16(8):1451. PubMed CrossRef
Christensen J, Vestergaard M, Mortensen PB, et al. Epilepsy and risk of suicide: a population-based case-control study. Lancet Neurol. 2007;6(8):693–698. PubMed CrossRef
Gorton HC, Webb RT, Carr MJ, et al. Risk of unnatural mortality in people with epilepsy. JAMA Neurol. 2018;75(8):929–938. PubMed CrossRef
Stefanello S, Marín-Léon L, Fernandes PT, et al. Psychiatric comorbidity and suicidal behavior in epilepsy: a community-based case-control study. Epilepsia. 2010;51(7):1120–1125. PubMed CrossRef
Xu KY, Rossi KC, Kim AM, et al. Risk of readmission for suicide attempt after epilepsy hospitalization. Epilepsy Behav. 2018;83:124–130. PubMed CrossRef
Lawson AA, Mitchell I. Patients with acute poisoning seen in a general medical unit (1960–1971). BMJ. 1972;4(5833):153–156. PubMed CrossRef
Mackay A. Self-poisoning: a complication of epilepsy. Br J Psychiatry. 1979;134(3):277–282. PubMed CrossRef
Hawton K, Fagg J, Marsack P. Association between epilepsy and attempted suicide. J Neurol Neurosurg Psychiatry. 1980;43(2):168–170. PubMed CrossRef
Mendez MF, Lanska DJ, Manon-Espaillat R, et al. Causative factors for suicide attempts by overdose in epileptics. Arch Neurol. 1989;46(10):1065–1068. PubMed CrossRef
Fiest KM, Sauro KM, Wiebe S, et al. Prevalence and incidence of epilepsy: a systematic review and meta-analysis of international studies. Neurology. 2017;88(3):296–303. PubMed CrossRef
Alejos M, Vázquez-Bourgon J, Santurtún M, et al. ¿Existe mayor riesgo de suicidio en pacientes diagnosticados de una enfermedad neurológica? Published online June 22, 2020. Neurologia. 2020. CrossRef
Brent DA. Overrepresentation of epileptics in a consecutive series of suicide attempters seen at a children’s hospital, 1978–1983. J Am Acad Child Psychiatry. 1986;25(2):242–246. PubMed CrossRef
Schommer L, Streltzov N, Andrew A, et al. Factors associated with suicidal ideation in an epilepsy center in Northern New England. Epilepsy Behav. 2021;121(Pt A):108009. PubMed CrossRef
Rymkiewicz P, Ravani P, Hemmelgarn BR, et al. Effects of longitudinal changes in Charlson comorbidity on prognostic survival model performance among newly diagnosed patients with hypertension. BMC Health Serv Res. 2016;16(1):671. PubMed CrossRef
Torvik FA, Rosenström TH, Ystrom E, et al. Stability and change in etiological factors for alcohol use disorder and major depression. J Abnorm Psychol. 2017;126(6):812–822. PubMed CrossRef
Friedman D, Spruill TM, Liu H, et al. Depressive symptoms and suicidality among individuals with epilepsy enrolled in self-management studies: results from the US Centers for Disease Control and Prevention Managing Epilepsy Well (MEW) Network. Epilepsy Behav. 2018;87:235–240. PubMed CrossRef
Courtet P, Jollant F, Buresi C, et al. The monoamine oxidase A gene may influence the means used in suicide attempts. Psychiatr Genet. 2005;15(3):189–193. PubMed CrossRef
Jollant F, Guillaume S, Jaussent I, et al. Psychiatric diagnoses and personality traits associated with disadvantageous decision-making. Eur Psychiatry. 2007;22(7):455–461. PubMed CrossRef
Mann JJ, Waternaux C, Haas GL, et al. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry. 1999;156(2):181–189. PubMed
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(suppl 20):22–33, quiz 34–57. PubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. APA; 1994.
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization; 1993.
WHO Collaborating Centre for Drug Statistics Methodology. ATC Classification Index with DDDs. World Health Organization; 2021.
Corp IBM. IBM SPSS Statistics for Windows, Version 27.0. IBM Corp; 2020.
World Health Organization. World Health Statistics 2019: Monitoring Health for the SDGs : Sustainable Development Goals. World Health Organization; 2019.
Yule W. Educational achievement. In: Epilepsy and Behavior. Swets and Zeittuyer; 1980.
Heaney DC, MacDonald BK, Everitt A, et al. Socioeconomic variation in incidence of epilepsy: prospective community based study in south east England. BMJ. 2002;325(7371):1013–1016. PubMed CrossRef
Rodin E, Rennick P, Dennerll R, et al. Vocational and educational problems of epileptic patients. Epilepsia. 1972;13(1):149–160. PubMed CrossRef
Syvertsen M, Vasantharajan S, Moth T, et al. Predictors of high school dropout, anxiety, and depression in genetic generalized epilepsy. Epilepsia Open. 2020;5(4):611–615. PubMed CrossRef
Sörberg Wallin A, Sorjonen K, Lager A, et al. Academic performance, subsequent socioeconomic status and suicide attempt in adulthood: path analyses on Swedish cohort data. J Epidemiol Community Health. 2020;74(12):1002–1007. PubMed
Benardo LS. Prevention of epilepsy after head trauma: do we need new drugs or a new approach? Epilepsia. 2003;44(s10):27–33. PubMed CrossRef
Zwimpfer TJ, Brown J, Sullivan I, et al. Head injuries due to falls caused by seizures: a group at high risk for traumatic intracranial hematomas. J Neurosurg. 1997;86(3):433–437. PubMed CrossRef
Coetzer B, Rydon-Grange M, Roberts C, et al. Cognitive function, self-awareness, and neuroimaging findings in obsessive-compulsive presentations after traumatic brain injury. Panam J Neuropsychol. 2019;13(2):15–28.
Hilton G. Behavioral and cognitive sequelae of head trauma. Orthop Nurs. 1994;13(4):25–32. PubMed CrossRef
Peters EM, Balbuena L, Marwaha S, et al. Mood instability and impulsivity as trait predictors of suicidal thoughts. Psychol Psychother. 2016;89(4):435–444. PubMed CrossRef
Harcourt S. The neuropsychology of epilepsy and suicide: a review. Aggress Violent Behav. 2020;54:101411. CrossRef
Ettinger AB, Argoff CE. Use of antiepileptic drugs for nonepileptic conditions: psychiatric disorders and chronic pain. Neurotherapeutics. 2007;4(1):75–83. PubMed CrossRef
Too LS, Spittal MJ, Bugeja L, et al. The association between mental disorders and suicide: a systematic review and meta-analysis of record linkage studies. J Affect Disord. 2019;259:302–313. PubMed CrossRef
Nock MK, Hwang I, Sampson NA, et al. Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15(8):868–876. PubMed CrossRef
Bakken IJ, Revdal E, Nesvåg R, et al. Substance use disorders and psychotic disorders in epilepsy: a population-based registry study. Epilepsy Res. 2014;108(8):1435–1443. PubMed CrossRef
Thompson SA, Duncan JS, Smith SJM. Partial seizures presenting as panic attacks. BMJ. 2000;321(7267):1002–1003. PubMed CrossRef
Hingray C, McGonigal A, Kotwas I, et al. The relationship between epilepsy and anxiety disorders. Curr Psychiatry Rep. 2019;21(6):40. PubMed CrossRef
Harter C, Brandt C, Angenendt J. Agoraphobia with panic disorder or epilepsy? differential diagnostic considerations in a case. Psychiatr Prax. 2000;27(5):252–254. PubMed
Téllez-Zenteno JF, Matijevic S, Wiebe S. Somatic comorbidity of epilepsy in the general population in Canada. Epilepsia. 2005;46(12):1955–1962. PubMed CrossRef
Selassie AW, Wilson DA, Martz GU, et al. Epilepsy beyond seizure: a population-based study of comorbidities. Epilepsy Res. 2014;108(2):305–315. PubMed CrossRef
Hesdorffer DC, Ishihara L, Webb DJ, et al. Occurrence and recurrence of attempted suicide among people with epilepsy. JAMA Psychiatry. 2016;73(1):80–86. PubMed CrossRef