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Zhang Y, Wang H, Liu L. Risk factors of suicide-related events in patients with epilepsy: A systematic review and meta-analysis. Seizure 2024; 120:72-82. [PMID: 38908144 DOI: 10.1016/j.seizure.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024] Open
Abstract
PURPOSE This systematic review and meta-analysis examined the risk factors for suicide-related events (SRE) in patients with epilepsy (PWE). METHODS The PubMed, Embase, Cochrane Online Library, and ClinicalTrials.gov databases were searched for relevant articles published from 1946 to August 30, 2022. The quality of the extracted articles was assessed using the Newcastle-Ottawa scale. Subsequently, a meta-analysis of PWE was performed to calculate the random-effects pooled odds ratios (ORs) for studies investigating the association between suicide and its associated risk factors. All statistical analyses were performed using R version 4.1.0. RESULTS A total of 2,803 studies were screened, of which 23 articles comprising 6,723 PWE were included in our meta-analysis. Female sex (odds ratio [OR]=1.24, 95 % confidence interval [CI]: 1.08-1.43), low quality of life (QOL) scores (standardized mean difference [SMD]= -0.89, CI: -1.17 - -0.61), poor social support (OR=3.44, CI: 1.83-6.46), unemployment (OR=1.82, CI: 1.40-2.38), unmarried status (OR=1.48, CI: 1.12-1.97), low income (OR=1.37, CI: 1.07-1.76), low education (OR=1.33, CI: 1.04-1.68), use of antidepressant drugs (OR=7.77, CI: 3.17-19.03), uncontrolled seizures (OR=2.28, CI: 1.63-3.18), use of multiple antiepileptic drugs (OR=1.70, CI: 1.33-2.18), early age at onset of epilepsy (SMD= -0.15, CI: -0.30 - -0.0002), depression (OR=6.85, CI: 4.88-9.62), and anxiety (OR=3.76, CI: 2.92-4.84) were identified as significant risk factors of SRE. SIGNIFICANCE There are many risk factors for SRE in PWE, as outlined above. Interventions targeting these risk factors may help reduce the risk of SRE in PWE.
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Affiliation(s)
- Yu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu 610041, Sichuan, PR China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Shang Jin Road 253 Chengdu 610000, Sichuan, PR China
| | - Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu 610041, Sichuan, PR China; Department of Neurology, Third Xiangya Hospital, Central South University, No.138 Tong Zipo Road, Yuelu District, Changsha City, PR China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu 610041, Sichuan, PR China.
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Gillespie DC, Flewitt BI, Sacripante R, Burns V, Young L, Chin RF, Duncan SE. Questionnaire-based screening for mental distress in epilepsy: Outline and feasibility of an outpatient screening and intervention pathway. Epilepsy Behav 2023; 142:109085. [PMID: 36801165 DOI: 10.1016/j.yebeh.2023.109085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/19/2022] [Accepted: 01/01/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Mental distress is present in a significant proportion of people with epilepsy (PWE), with a negative impact across life domains. It is underdiagnosed and under-treated despite guidelines recommending screening for its presence (e.g., SIGN, 2015). We describe a tertiary-care epilepsy mental distress screening and treatment pathway, with a preliminary investigation of its feasibility. METHODS We selected psychometric screening instruments for depression, anxiety, quality of life (QOL), and suicidality, establishing treatment options matched to instrument scores on the Patient Health Questionnaire 9 (PHQ-9), along 'traffic light' lines. We determined feasibility outcomes including recruitment and retention rates, resources required to run the pathway, and level of psychological need. We undertook a preliminary investigation of change in distress scores over a 9-month interval and determined PWE engagement and the perceived usefulness of pathway treatment options. RESULTS Two-thirds of eligible PWE were included in the pathway with an 88% retention rate. At the initial screen, 45.8% of PWE required either an 'Amber-2' intervention (for moderate distress) or a 'Red' one (for severe distress). The equivalent figure at the 9-month re-screen was 36.8%, reflective of an improvement in depression and QOL scores. Online charity-delivered well-being sessions and neuropsychology were rated highly for engagement and perceived usefulness, but computerized cognitive behavioral therapy was not. The resources required to run the pathway were modest. CONCLUSION Outpatient mental distress screening and intervention are feasible in PWE. The challenge is to optimize methods for screening in busy clinics and to determine the best (and most acceptable) interventions for screening positive PWE.
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Affiliation(s)
- David C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Bethany Iona Flewitt
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK
| | - Riccardo Sacripante
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK; Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | | | | | - Richard F Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Royal Hospital for Children and Young People, Edinburgh, UK
| | - Susan E Duncan
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Puteikis K, Mameniškienė R. Psychometric properties of the Lithuanian version of the NDDI-E in persons with epilepsy and suicidal ideation. Epilepsy Behav 2022; 136:108913. [PMID: 36155364 DOI: 10.1016/j.yebeh.2022.108913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Suicidality and depression are associated with worse epilepsy outcomes, but their screening in routine clinical practice remains insufficient and may improve with the validation of brief and accessible psychometric tools. We explored the psychometric properties of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) in the Lithuanian population, which has one of the highest suicide rates globally. METHODS We conducted a cross-sectional anonymous survey among adult outpatients visiting a tertiary epilepsy clinic in Vilnius, Lithuania. People with epilepsy (PWE) provided demographic and clinical information and completed the Geriatric depression scale (GDS), the Hospital anxiety and depression scale (HADS), the Beck depression inventory (BDI), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the Generalized anxiety scale-7 (GAD-7). Suicidal ideation was defined as a non-zero score on the suicide item of the BDI and clinically relevant levels of depression - as a total BDI score of >16. Psychometric properties of the NDDI-E were evaluated by measuring its internal consistency, dimensionality, correlation with other depression scales, and by conducting receiver operating characteristic analysis for the detection of suicidal ideation and symptoms of depression. RESULTS The study sample consisted of 246 PWE (average age 39.9 ± 16.3 years, 101 [41.1%] male), of them 31 (12.6%) and 41 (19.5% of those who completed the BDI) were identified with suicidal ideation or significant symptoms of depression, respectively. On average, PWE scored 10.4 ± 4.2 points on the NDDI-E. The instrument had good internal consistency (Cronbach's alpha = 0.863, n = 235), item-item and item-total correlation (>0.30). In factor analysis, its items comprised a single factor distinct from the GAD-7. The NDDI-E strongly correlated with other depression scales (r = 0.657 [GDS, n = 201], r = 0.657 [BDI, n = 201], r = 0.623 [HADS-D, n = 231], p < 0.001 for all). The NDDI-E had good diagnostic properties in discerning suicidal ideation (AUC = 0.858, 95%CI = 0.791-0.925). The isolated suicide item of the NDDI-E had acceptable properties in detecting suicidal ideation (AUC = 0.821, 95%CI = 0.724-0.918) as well. CONCLUSION The Lithuanian NDDI-E was shown to have good psychometric properties comparable to other versions of this scale. The NDDI-E is endorsed as a short and accessible instrument for estimating suicidal ideation among Lithuanian PWE.
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Affiliation(s)
| | - Rūta Mameniškienė
- Centre for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
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Nemesure MD, Streltzov N, Schommer LM, Lekkas D, Jacobson NC, Bujarski KA. Predictive modeling of suicidal ideation in patients with epilepsy. Epilepsia 2022; 63:2269-2278. [PMID: 35689808 PMCID: PMC10129274 DOI: 10.1111/epi.17324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The prevalence of suicide in the United States has seen an increasing trend and is responsible for 1.6% of all mortality nationwide. Although suicide has the potential to broadly impact the entire population, it has a substantially increased prevalence in persons with epilepsy (PWE), despite many of these individuals consistently seeing a health care provider. The goal of this work is to predict the development of suicidal ideation (SI) in PWE using machine learning methodology such that providers can be better prepared to address suicidality at visits where it is likely to be prominent. METHODS The current study leverages data collected at an epilepsy clinic during patient visits to predict whether an individual will exhibit SI at their next visit. The data used for prediction consisted of patient responses to questions about the severity of their epilepsy, issues with memory/concentration, somatic problems, markers for mental health, and demographic information. A machine learning approach was then applied to predict whether an individual would display SI at their following visit using only data collected at the prior visit. RESULTS The modeling approach allowed for the successful prediction of an individual's passive and active SI severity at the following visit (r = .42, r = .39) as well as the presence of SI regardless of severity (area under the curve [AUC] = .82, AUC = .8). This shows that the model was successfully able to synthesize the unique combination of an individual's responses to important questions during a clinical visit and utilize that information to indicate whether that individual will exhibit SI at their next visit. SIGNIFICANCE The results of this modeling approach allow the health care team to be prepared, in advance of a clinical visit, for the potential reporting of SI. By allowing the necessary support to be prepared ahead of time, it can be better integrated at the point of care, where patients are most likely to follow up on potential referrals or treatment.
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Affiliation(s)
- Matthew D Nemesure
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA.,Quantitative Biomedical Sciences Program, Dartmouth College, Lebanon, New Hampshire, USA
| | - Nicholas Streltzov
- Dartmouth-Hitchcock Medical Center Epilepsy Clinic, Lebanon, New Hampshire, USA
| | - Lindsay M Schommer
- Dartmouth-Hitchcock Medical Center Epilepsy Clinic, Lebanon, New Hampshire, USA
| | - Damien Lekkas
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA.,Quantitative Biomedical Sciences Program, Dartmouth College, Lebanon, New Hampshire, USA
| | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA.,Quantitative Biomedical Sciences Program, Dartmouth College, Lebanon, New Hampshire, USA.,Department of Biomedical Data Science, Geisel School of Medicine, Lebanon, New Hampshire, USA
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Guo Y, Xu ZYR, Cai MT, Gong WX, Shen CH. Epilepsy With Suicide: A Bibliometrics Study and Visualization Analysis via CiteSpace. Front Neurol 2022; 12:823474. [PMID: 35111131 PMCID: PMC8802777 DOI: 10.3389/fneur.2021.823474] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/22/2021] [Indexed: 01/09/2023] Open
Abstract
Objective:The purpose of this study was to analyze the research status of epilepsy with suicide and to determine the hotspots and frontiers via CiteSpace.Method:We searched the Web of Science Core Collection (WoSCC) for studies related to epilepsy and suicide from inception to September 30, 2021. We used CiteSpace to generate online maps of collaboration between countries, institutions, and authors, and revealed hot spots and frontiers in epilepsy with suicide.Results:A total of 631 publications related to epilepsy with suicide were retrieved from the WoSCC. Andres M. Kanner was the most published author (25 papers). The USA and Columbia University were the leading country and institution in this field, with 275 and 25 papers, respectively. There were active cooperation between institutions, countries, and authors. Hot topics focused on depression, antiseizure medications, pediatric epilepsy, and risk factors of suicide in patients with epilepsy (PWEs).Conclusions:Based on the CiteSpace findings, this study detected active collaboration among countries, institutions and authors. The main current research trends include suicide caused by depression, suicide caused by the use of antiseizure medications, suicide in children with epilepsy, and risk factors for suicide in PWEs. Thus, more attention should be paid to the psychiatric comorbidity of PWEs (especially pediatric epilepsy), the suicidal tendency of PWEs, and the rational use of antiseizure medications in the future.
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Affiliation(s)
- Yi Guo
- Department of General Practice and International Medicine, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
- Department of Neurology, Epilepsy Center, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Yi Guo
| | - Zheng-Yan-Ran Xu
- Department of Neurology, Epilepsy Center, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meng-Ting Cai
- Department of Neurology, Epilepsy Center, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wen-Xin Gong
- Department of General Practice and International Medicine, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chun-Hong Shen
- Department of Neurology, Epilepsy Center, School of Medicine, Zhejiang University, Hangzhou, China
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