Predictors of Suicidal Ideation in People with Epilepsy Living in Korea

Abstract

Background and PurposeThe risk of suicide or suicide attempts is reported higher in people with epilepsy (PWE) than in the general population. Although epileptic, psychiatric, and psychosocial factors are known risk factors for suicide or suicide attempt, no studies have evaluated the predictors of the severity of suicidal ideation-which is a warning sign for suicide attempts-in PWE. Therefore, we measured the severity of suicidal ideation and its risk factors.MethodsConsecutive PWE who were medicated with antiepileptic drugs (AEDs) and attended epilepsy clinic were included in the study. The subjects completed self-reported questionnaires, which included the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Checklist-90-Revised (SCL-90-R), and Scale for Suicide Ideation-Beck (SSI-Beck). We compared the patients' demographic and clinical variables, and BDI, BAI, and SCL-90-R scores with their SSI-Beck score, and used our findings to determine the predictors for suicidal ideation.ResultsIn total, 257 PWE were enrolled in the study. SSI-Beck scores correlated strongly with several seizure-related variables, duration of education, IQ, BDI and BAI scores, and nine domains of the SCL-90-R questionnaire. However, the strongest predictor for suicidal ideation was BDI score (β=0.41, p<0.001), followed by several SCL-90-R domains, such as obsessive-compulsive (β=-0.39, p<0.001), depression (β=0.38, p<0.001), hostility (β=0.22, p=0.002), paranoid ideation (β=0.17, p=0.01), and IQ (β=-0.10, p=0.017). These variables explained 59% of the variance in the SSI-Beck score. The seizure-related variables that influenced the BDI score were seizure frequency, duration of education, MRI abnormality, and number of AEDs. However, these variables explained only 18% of the variance in the BDI score.ConclusionsMajor risk factors for suicidal ideation in PWE were depressive and psychiatric symptoms rather than seizure-related variables. Therefore, clinicians should focus on screening for depression and other psychiatric problems and treat them appropriately in order to reduce suicidal behavior in PWE. Since seizure-related variables also exhibited a minor role in determining depressive symptoms, stronger seizure-related risk factors for depression should be sought, such as seizure severity or psychosocial factors, to minimize suicidal behavior.

Frequency of affective symptoms and their psychosocial impact in Korean people with epilepsy: A survey at two tertiary care hospitals

“…In a multicenter study conducted in tertiary outpatient epilepsy centers associated with five universities in the US, the rate of current suicidal ideation was 12.2% and was associated with depression and anxiety [19]. Major risk factors for suicidal ideation were depression and other psychiatric symptoms rather than seizure-related variables [43]. We also found that suicidal ideation was more frequent among PWE with depressive and/or anxiety symptoms than among those without these symptoms.…”

The relationship between sleep quality, depression, and anxiety in patients with epilepsy and suicidal ideation

“…Sleep disturbance has also been reported as an important predictor of passive suicidal ideation in the psychiatric literature 22,23 . The presence of anxiety and depression was a risk factor for the occurrence of suicidal ideation among the studied patients, and has been found in several studies 1,2,3,6,7,8,9 . The "suicidal ideators" had the worst rates for quality of sleep (PSQI), sleep alterations (PSQI), global score (PSQI), anxiety (BAI), and depression (BDI), which allows us to suggest a strong association between anxiety and depression and sleep.…”

“…We must be cautious in the study of comorbidity. Prevalence rates of psychiatric comorbidities require more studies and more appropriate therapeutic 1,2,3,4,5,6,7,8,9 . However, knowledge concerning suicide and its ideation in PWE is still limited.…”

EEG (Electroencephalography) Abnormality in First Episode Mania: Is It Trait or State?

“…Another relation between suicide attempt, BD and abnormal EEG findings may be established through childhood traumas. In many studies, suicide attempt occurs at higher rates in bipolar cases with childhood trauma (Lim, Song, Hwang, Lee, Suh, Park, & Kwon, 2010). Drawing upon these findings, it can be suggested that in psychiatric disorders in general and in BPD in particular, the mediator between suicide and epilepsy is childhood trauma.…”