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.

Introduction Worldwide, COVID-19 clusters have emerged within communities of international migrant workers operating in high-density work and living environments. Despite their increased vulnerability, no study has documented the mental health burden of COVID-19 amongst these groups. To address this gap, we conducted a survey of migrant workers involved in large-scale dormitory outbreaks within Singapore. Methods Between 22 June to 11 October 2020, questionnaires were distributed to 1011 migrant workers undergoing extended movement restrictions. Mental health symptoms were measured using the 21-item Depression, Anxiety and Stress Scale (DASS-21). As covariates, we assessed participants’ socio-demographics, quarantine status, COVID-19 health concerns, financial stability, and exposure to news and misinformation. Linear regression models were fitted to identify factors associated with DASS-21 scores. Results Complete movement restrictions were associated with increased depression and stress symptoms, while being diagnosed with COVID-19 was associated with increased anxiety. Participants who harboured fears about their health or job, perceived their health to be poorer, or had greater exposure to COVID-19 rumours reported higher depression, anxiety, and stress levels. Across the cohort, rates of severe or extremely severe depression (3.1%, 95% CI: 2.1-4.3%), anxiety (4.1%, 95% CI: 2.9-5.5%), and stress (1.3%, 95% CI: 0.7-2.2%) were similar to those observed in the general population for the host country (Singapore). Conclusions As the first mental health survey of low-waged migrant workers during the pandemic, our findings provide a basis to identify and support at-risk individuals. This is critical as migrant workers often have limited access to healthcare services. At the same time, we documented resilience within the cohort as a whole.

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SummaryBackgroundIn the COVID-19 pandemic, international migrant workers have faced increased vulnerability on account of their status. This study examined the mental health burden of COVID-19 amongst low-waged migrant workers involved in large-scale dormitory outbreaks within Singapore.MethodsBetween 22 June to 11 October 2020, questionnaires were distributed in-person and online to 1011 migrant workers undergoing movement restrictions. Mental health symptoms were measured using the 21-item Depression, Anxiety and Stress Scale (DASS-21). As covariates, we assessed participants’ socio-demographics, quarantine status, COVID-19 health concerns, financial stability, and exposure to news and misinformation. Linear regression models were fitted to identify factors associated with each DASS-21 subscale.FindingsComplete movement restrictions were associated with increased depression and stress symptoms, while being diagnosed with COVID-19 was associated with increased anxiety. Participants who harboured fears about their health or job, perceived their health to be poorer, or had greater exposure to COVID-19 rumours reported higher depression, anxiety, and stress levels. Across the cohort, rates of severe or extremely severe depression (3.1%, 95% CI: 2.1-4.3%), anxiety (4.1%, 95% CI: 2.9-5.5%), and stress (1.3%, 95% CI: 0.7-2.2%) were similar to those observed in the general population for the host country (Singapore).InterpretationThe risk factors identified underscore how the ongoing pandemic may impact the mental health of migrant workers. At the same time, we observed resilience within the cohort, with no evidence of increased symptomology (relative to the general population).FundingJY Pillay Global Asia GrantResearch in ContextEvidence before this studyWe searched PubMed and Google Scholar for articles published in English between Jan 1, 2020 and Feb 20, 2021 using the following keywords: (“COVID*” OR “coronavirus”) AND (“mental*” OR “psychiatr*”) AND (“labo*r migra*” OR “migrant work” OR “foreign-work” OR “immigrant work” OR “economic migra*” OR “economic immigra*”). Focusing on international migrant workers employed in low-wage manual labour positions, we identified commentaries and interview-based studies describing the stressors faced by workers during the COVID-19 pandemic. However, we found no study documenting mental health symptoms within this group.Added value of this studyTo our knowledge, this is the first mental health survey of low-wage migrant workers during the COVID-19 pandemic. We observed that the mental health burden was highest amongst participants who encountered pandemic-related adversities (complete movement restrictions, testing positive for COVID-19), perceived the situation negatively (being fearful of their health or job, or judging their health to be poorer), or had higher exposure to COVID-19 rumours.Implications of the available evidenceOur findings provide a basis to identify and support at-risk migrant workers during the pandemic. Although we did not observe elevated rates of depression, anxiety, and stress symptoms within the migrant worker cohort, individual workers who experience poor mental health may find it harder to access health-care services (relative to the general population). Correspondingly, targeted support for at-risk migrant workers may serve to reduce mental health inequalities.

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