Suicidal Thoughts Plague Young and Old with Epilepsy

PHILADELPHIA -- Patients with epilepsy are more likely to commit suicide than the general population, new CDC data showed.An analysis of data from the CDC's National Violent Death Reporting System (NVDRS) found that the annual suicide mortality rate among those with epilepsy was about 16% higher than that seen in the general population, according to Niu Tian, MD, PhD, of the CDC in Atlanta, and colleagues.But according to a separate study, a simple screening test may prevent self-harm in the youngest epilepsy patients. An electronic health record (EHR)-based questionnaire prevented 13 suicides among some 400 children with epilepsy, said Tatiana Falcone, MD, of the Cleveland Clinic, and colleagues.Both groups reported their findings during a poster session at the American Epilepsy Society meeting."Routine screening at least every 6 months for mood disorders and suicidal ideation could aid in early referral and appropriate treatment and potentially save lives," Falcone and colleagues wrote.NVDRS Data in AdultsIt's been known that patients with epilepsy are at increased risk for mental health issues, including depression and suicidal ideation, and the lifetime prevalence of suicide attempts in this group is around 20%, according to earlier estimates.To get a better handle on those numbers, Tian and colleagues mined the NVDRS data on people with epilepsy 10 years or older, which is collected by 17 states, from 2003 to 2011.They found 972 suicides among those with epilepsy and 81,529 in the general population, which ultimately translated to a 16% higher annual suicide mortality rate among those with the condition, at 16.03 per 100,000 people.Epilepsy patients were more likely to commit suicide in their homes or in residential institutions than those in the general population (81% versus 76%) and they were were twice as likely to poison themselves (38% versus 17%, P<0.01).Physicians should be especially vigilant among those ages 40 to 49, with epilepsy patients in this age group having a significantly higher suicide rate than the general population (29% versus 22%, P<0.01)."Preventing suicide among people with epilepsy should focus on those ages 40 to 49 and on reducing availability or exposure to poisons, especially at home," Tian and colleagues wrote.

Kids with EpilepsyThe picture of suicide in children with epilepsy is less clear, with some studies showing rates of suicidal ideation as high as 37%, Falcone and colleagues noted.They conducted 5,303 mental health screenings among 400 children with epilepsy who were treated at the Cleveland Clinic from 2008 to 2015.Their EHR enables them to launch a screening program that starts off with the Patient Health Questionnaire (PHQ-2), and an algorithm subsequently determines whether the patient needs further mental health screening with the CES-DC, a childhood depression screen.Depending on those results, the patient either receives literature on mental health or is referred for a suicide screen, the latter of which ends up either with a referral to the emergency department (ED) or to a social worker.About a quarter of their young patients (26.5%) screened positive for suicide, they reported.Overall, 13 suicides were prevented in nine girls and four boys who ranged in age from 9 to 18. There were 12 suicide attempts, all of whom had been referred to the ED, they said.All of these children had been taking selective serotonin reuptake inhibitors (SSRIs), they noted.In addition, the overall mean score for Screen for Child Anxiety Related Disorders(SCARED) was 47.69, which was significant for clinical anxiety. The overall mean score for Children Depression Inventory (CDI) was 88.3, significant for depression, the authors noted.Finally, the mean score of exposure to emotional trauma according to the Adverse Childhood Experiences (ACE) scale was 2.They concluded that routine semiannual screening for mood disorders and suicidal ideation could aid in early referral and appropriate treatment and potentially save lives.

Tian and Falcone disclosed no relevant relationships with industry.

• Primary Source

  American Epilepsy Society

  Source Reference: Falcone T, et al "Screening for suicidal ideation and behavior among youth with epilepsy can save lives" AES 2015; Abstract 1.009.

• Secondary Source

  American Epilepsy Society

  Source Reference: Tian N, et al "Suicide among people with epilepsy: A population-based study from 17 U.S. states, 2003-2011" AES 2015; Abstract 1.366.

• Article originally appeared at http://www.medpagetoday.com/MeetingCoverage/AES/55048