Suicide is one of the leading causes of death and has steadily increased throughout the past 2 decades. 1 Religious affiliation may be associated with a lower risk for both suicide attempt and death through multiple mechanisms, including the promotion of social support, personal empowerment, healthy lifestyle, and commitment to religious life-preserving morals. 2 In the US, Muslim individuals represent a religious minority group who are vulnerable to religious discrimination but may access mental health services more infrequently than other groups. We compare the prevalence of suicide attempts among Muslim adults compared with adults of other faith communities in the US. Methods | Participants completed the 2019 Institute for SocialPolicy and Understanding national community-based survey 3 conducted over landline, cell phone, and online by Social Science Research Solutions during January 2019. Muslim and Jewish participants were oversampled, and other religious groups were weighted to provide nationally representative and projectable estimates of the US adult population 18 years and older. The eMethods in the Supplement include a description of sample design, survey administration, and weighting procedures. The Stanford University institutional review board exempted the study from ethical review because it was an analysis of deidentified poll data.Participant demographics were collected using selfreported items. Participants were asked to self-identify their religion from the following categories: agnostic, atheist, Buddhist, Catholic, Christian, do not know, Hindu, Jewish, Mormon, Muslim, no religion, Orthodox, Protestant, something else, or Unitarian (Universalist). Participants were also asked to self-identify their race and ethnicity using the following categories: African American, Arab, Asian/Chinese/ Japanese/Indian/Pakistani, Native American/American Indian/ Alaska Native, Native Hawaiian/Pacific Islander, mixed, Hispanic, White, or other. Lifetime suicide attempt was assessed with a question adapted from the Columbia-Suicide Severity Rating Scale: "Have you ever tried to do anything to try to kill yourself or make yourself not alive anymore?" 4 Descriptive statistics and cross-tabulations were used to categorize and compare the frequency of the chosen study characteristics of participants. Univariate and multivariate logistic regression analyses were performed using Stata version 15 (StataCorp) to calculate unadjusted and adjusted odds ratios. Demographic factors were coded as categorical variables in the adjusted analyses. Individuals who refused to identify with a religious group or other demographic variable were coded as missing and excluded. Two-sided P values were statistically significant at .05. Analysis took place from March to December 2020.

Background: Functional neurological disorders (FNDs) are neurological symptoms that cannot be explained by an underlying neurological lesion or other medical illness and that do not have clear neuropathological correlates. Psychogenic non-epileptic seizures (PNES) are a common and highly disabling form of FND, characterized by paroxysmal episodes of involuntary movements and altered consciousness that can appear clinically similar to epileptic seizures. PNES are unique among FNDs in that they are diagnosed by video electroencephalographic (VEEG), a well-established biomarker for the disorder. The course of illness and response to treatment of PNES remain controversial. This study aims to describe the epidemiology of PNES in the Department of Veterans Affairs Healthcare System (VA), evaluate outcomes of veterans offered different treatments, and compare models of care for PNES. Methods: This electronic health record (EHR) cohort study utilizes an informatics search tool and a natural language processing algorithm to identify cases of PNES nationally. We will use VA inpatient, outpatient, pharmacy, and chart abstraction data across all 170 medical centers to identify cases in fiscal years 2002-2018. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and the utilization of psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care. Discussion: This study will describe the risk factors and course of treatment of a large cohort of people with PNES. Since PNES are cared for by a variety of different modalities, treatment orientations, and models of care, effectiveness outcomes such as seizure outcomes and utilization of emergency visits for seizures will be assessed. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care.

Background:The increased rate of suicide associated with epilepsy has been described, but no studies have reported the rates of suicide and suicide related behavior (SRB) associated with psychogenic non-epileptic seizures (PNES).Methods:This retrospective cohort study analyzed data from October 2002 to October 2017 within Veterans Health Administration (VHA) services. Of 801,734 veterans, 0.09% had PNES, 1.37% had epilepsy, and 98.5% had no documented seizures. Veterans coded for completed suicide, suicide attempts, and suicidal ideation were identified from electronic health records (EHR). The primary measure was the suicide-specific standardized mortality ratio (SMR) based on the number of suicide deaths and CDC national suicide mortality database. A Poisson regression was used to calculate the relative risk of suicide across groups.Results:A total of 1,870 veterans (mean age [SD] 33.76 [7.81] years) completed suicide. Veterans with PNES (RR = 1.75, 95% CI 0.84-4.24) and veterans with epilepsy (RR = 2.19, 95% CI 2.10-2.28) had higher risk for suicide compared to general veteran population. Veterans with PNES or epilepsy had higher risk of suicide and SRB if they had comorbid alcohol abuse, illicit drug abuse, major depression, post-traumatic stress disorder (PTSD), and use of psychotropic medications. Conversely, those who were married or attained higher education were at decreased risk. The SMR for completed suicide for PNES, epilepsy, and the comparison group was 2.65 (95% CI 1.95-5.52), 2.04 (95% CI 1.60 - 2.55), and 0.70 (95% CI 0.67 - 0.74), respectively.Conclusions:Veterans with seizures (both psychogenic and epileptic) are at an increased risk for death by suicide and SRB than the comparison group. These findings suggest that while the pathophysiology of PNES and epilepsy are different, the negative impact of seizures is evident in the psychosocial outcomes in both groups.