TY - JOUR
T1 - Suicide and Seizures
T2 - A National Cohort Study in Veterans
AU - Bornovski, Yarden
AU - Jackson-Shaheed, Ebony
AU - Argraves, Stephanie
AU - Hitchins, Adrianna
AU - Tolchin, Benjamin
AU - Galluzzo, Daniela
AU - Cheung, Kei Hoi
AU - Goulet, Joseph
AU - Skanderson, Melissa
AU - Brandt, Cynthia A.
AU - Pugh, Mary Jo
AU - Altalib, Hamada
N1 - Funding Information:
Y. Bornovski's salary was paid by a grant from the US Department of Defense CDRMP (EP1600449). E. Jackson-Shaheed, S. Argraves, and A. Hitchins report no disclosures relevant to the manuscript. B. Tolchin received research funding from a US Veteran Administration (VA) VISN1 Career Development Award, the VA Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, and the C.G. Swebilius Trust; he has received honoraria from the Columbia University Medical Center, the International League against Epilepsy, and the American Academy of Neurology. D. Galluzzo, K.-H. Cheung, J. Goulet, M. Skanderson, C.A. Brandt, and M.J. Pugh report no disclosures relevant to the manuscript. H. Altalib is on the scientific advisory board for Eisai; has received commercial research support from Eisai Medical Research, Engage Therapeutics, Pfizer, Sunovion, and UCB; and has received government research support from the Department of Defense Congressionally Directed Medical Research Programs Epilepsy Research Program (DOD CDMRP ERP) #EP160049, DOD CDMRP ERP #EP150013, Department of Veterans Affairs Health Service Research & Development Center of Innovation # CIN 13-407 COIN, and US Department of Defense Office of Naval Research #N66001-08-C-2005. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp .
Publisher Copyright:
© 2022 American Academy of Neurology.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - ObjectiveThe 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 nonepileptic seizures (PNESs).MethodsThis retrospective cohort study analyzed data from October 2002 to October 2017 within Veterans Health Administration 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. 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 (RR) of suicide across groups.ResultsA total of 1,870 veterans (mean age [SD] 33.76 [7.81] years) completed suicide. Veterans with PNES (RR = 1.75, 95% confidence interval [CI] 0.84-4.24) and veterans with epilepsy (RR = 2.19, 95% CI 2.10-2.28) had a higher risk of suicide compared with the general veteran population. Veterans with PNES or epilepsy had a higher risk of suicide and SRB if they had comorbid alcohol abuse, illicit drug abuse, major depression, posttraumatic stress disorder, and use of psychotropic medications. Conversely, those who were married or attained higher education were at a 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.ConclusionsVeterans with seizures (both psychogenic and epileptic) are at a greater risk of death by suicide and SRB than the comparison group. These findings suggest that although the pathophysiology of PNES and epilepsy is different, the negative impact of seizures is evident in the psychosocial outcomes in both groups.
AB - ObjectiveThe 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 nonepileptic seizures (PNESs).MethodsThis retrospective cohort study analyzed data from October 2002 to October 2017 within Veterans Health Administration 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. 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 (RR) of suicide across groups.ResultsA total of 1,870 veterans (mean age [SD] 33.76 [7.81] years) completed suicide. Veterans with PNES (RR = 1.75, 95% confidence interval [CI] 0.84-4.24) and veterans with epilepsy (RR = 2.19, 95% CI 2.10-2.28) had a higher risk of suicide compared with the general veteran population. Veterans with PNES or epilepsy had a higher risk of suicide and SRB if they had comorbid alcohol abuse, illicit drug abuse, major depression, posttraumatic stress disorder, and use of psychotropic medications. Conversely, those who were married or attained higher education were at a 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.ConclusionsVeterans with seizures (both psychogenic and epileptic) are at a greater risk of death by suicide and SRB than the comparison group. These findings suggest that although the pathophysiology of PNES and epilepsy is different, the negative impact of seizures is evident in the psychosocial outcomes in both groups.
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U2 - 10.1212/CPJ.0000000000001070
DO - 10.1212/CPJ.0000000000001070
M3 - Article
AN - SCOPUS:85131211896
VL - 11
SP - 372
EP - 376
JO - Neurology: Clinical Practice
JF - Neurology: Clinical Practice
SN - 2163-0402
IS - 5
ER -