In patients with epilepsy who live in western societies, suicide rates are increasing. Does culture play a role? Here's a study of Asian populations.
Is the increased suicide risk in patients with epilepsy related to coexisting psychiatric illness or to epilepsy alone? What (if any) cultural and ethnic factors are at play?
About 5% of patients with epilepsy may die from suicide.1 Moreover, people with epilepsy often have coexisting psychiatric illness. Is the increased suicide risk related to psychiatric illness or to epilepsy alone?
Most studies of suicide rate in people with epilepsy have been done in Western countries. However, these studies may have drawbacks: cultural/ethnic differences may affect suicide risk. The goal of the study undertaken by Bell and colleagues1 was to ascertain the suicide risk in epilepsy in Asian countries.
Harnod and colleagues2 used data from National Health Insurance Research Database (NHIRD) from Taiwan in their study to understand the relationship between epilepsy and suicide. The study comprised 68,543 adult inpatients who had a diagnosis of epilepsy between 2000 and 2011 and 68,543 controls without epilepsy. The researchers evaluated suicide attempts, completed suicides, and role of comorbid psychiatric illness.
Compared with controls, patients who had epilepsy had 2 times higher risk of attempted suicide (aHR 2.06, 95% CI = 1.65-2.56); and 66% higher risk of death from suicide (aHR = 1.66, 95% CI = 1.02–2.69). Data were adjusted for age, monthly income, urbanization, occupation, and psychiatric comorbidities.
Except for depression, which was linked to 11-fold greater risk of suicide (aHR 11.1, P < .001), the results show that there was no significant difference in incidence of attempted suicide with or without psychiatric comorbidity. Schizophrenia, alcohol-related illness, anxiety, and insomnia were not significantly linked to increased risk of suicide attempt. And, there were no significant differences in attempted suicide between women and men.
Only inpatient claims for epilepsy and suicide were included, which would have missed outpatient suicides attempted or completed. The study design did not include the possible effects of antiepileptic drugs, which have been linked to suicide (although this is controversial3), nor did it evaluate social support and other coping mechanisms.
• Epilepsy found to be is an independent and predisposing factor for attempted suicide
• Epilepsy linked to 2-fold increased risk of attempted suicide; 66% increased risk of death from suicide
• Depression linked to significantly increased risk of suicide, but schizophrenia, alcohol-related illness, anxiety, and insomnia were not.
1. Bell GS, Gaitatzis A, Bell CL, et al. Suicide in people with epilepsy: how great is the risk? Epilepsia. 2009;50:1933-1942.
2. Harnod T, Lin CL, Kao CH, et al. Evaluating clinical risk factors for suicide attempts in patients with epilepsy. J Affect Disord. December 2017; Epub ahead of print.
3. Fountoulakis K, Gonda X, Samara M, et al. Antiepileptic drugs and suicidality. JPsychopharm. 2012;26:1401-1407.