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. 2024 Apr 19;27(1):e300957.
doi: 10.1136/bmjment-2023-300957.

Sociodemographic and clinical risk factors for suicidal ideation and suicide attempt in functional/dissociative seizures and epilepsy: a large cohort study

Irene Faiman  1 , John Hodsoll  2 , Iman Jasani  2 , Allan H Young  2   3 , Paul Shotbolt  2
Affiliations

Sociodemographic and clinical risk factors for suicidal ideation and suicide attempt in functional/dissociative seizures and epilepsy: a large cohort study

Irene Faiman et al. BMJ Ment Health. .

Abstract

Background: People with functional/dissociative seizures (FDS) are at elevated suicidality risk.

Objective: To identify risk factors for suicidality in FDS or epilepsy.

Methods: Retrospective cohort study from the UK's largest tertiary mental healthcare provider, with linked national admission data from the Hospital Episode Statistics. Participants were 2383 people with a primary or secondary diagnosis of FDS or epilepsy attending between 01 January 2007 and 18 June 2021. Outcomes were a first report of suicidal ideation and a first hospital admission for suicide attempt (International Classification of Diseases, version 10: X60-X84). Demographic and clinical risk factors were assessed using multivariable bias-reduced binomial-response generalised linear models.

Findings: In both groups, ethnic minorities had significantly reduced odds of hospitalisation following suicide attempt (OR: 0.45-0.49). Disorder-specific risk factors were gender, age and comorbidity profile. In FDS, both genders had similar suicidality risk; younger age was a risk factor for both outcomes (OR: 0.16-1.91). A diagnosis of depression or personality disorders was associated with higher odds of suicidal ideation (OR: 1.91-3.01). In epilepsy, females had higher odds of suicide attempt-related hospitalisation (OR: 1.64). Age had a quadratic association with both outcomes (OR: 0.88-1.06). A substance abuse disorder was associated with higher suicidal ideation (OR: 2.67). Developmental disorders lowered the risk (OR: 0.16-0.24).

Conclusions: This is the first study systematically reporting risk factors for suicidality in people with FDS. Results for the large epilepsy cohort complement previous studies and will be useful in future meta-analyses.

Clinical implications: Risk factors identified will help identify higher-risk groups in clinical settings.

Keywords: Anxiety disorders; Depression & mood disorders; Personality disorders; Substance misuse; Suicide & self-harm.

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Conflict of interest statement

Competing interests: IF, JH, IJ and PS—none to declare. AY—employed by King’s College London; honorary consultant of SLaM (NHS UK); deputy editor of BJPsych Open; paid lectures and advisory boards for the following companies with drugs used in affective and related disorders: AstraZeneca, Eli Lilly, Lundbeck, Sunovion, Servier, LivaNova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS, Sage and Novartis; consultant to Johnson & Johnson and LivaNova; received honoraria for attending advisory boards and presenting talks at meetings organised by LivaNova; principal investigator in the Restore-Life VNS registry study funded by LivaNova; principal investigator on ESKETINTRD3004: ‘An Open-label, Long-term, Safety and Efficacy Study of Intranasal Esketamine in Treatment-resistant Depression’; principal investigator on ‘The Effects of Psilocybin on Cognitive Function in Healthy Participants’; principal investigator on ‘The Safety and Efficacy of Psilocybin in Participants with Treatment-Resistant Depression (P-TRD)’; UK chief investigator for Novartis MDD Study MIJ821A12201; grant funding (past and present): NIMH (USA), CIHR (Canada), NARSAD (USA), Stanley Medical Research Institute (USA), MRC (UK), Wellcome Trust (UK), Royal College of Physicians (Edin), BMA (UK), UBC-VGH Foundation (Canada), WEDC (Canada), CCS Depression Research Fund (Canada), MSFHR (Canada), NIHR (UK) and Janssen (UK); no shareholdings in pharmaceutical companies.

Figures

Figure 1
Figure 1
Loess smoothed (local non-linear regression) curves showing probability of suicidal ideation and suicide attempt-related hospitalisation by age per each diagnostic group. (Top left) Probability of suicidal ideation by age in epilepsy; (bottom left) probability of suicide attempt-related admission by age in epilepsy; (top right) probability of suicidal ideation by age in FDS; (bottom right) probability of suicide attempt-related admission by age in FDS. On the negative side of the y axis are depicted the age distributions (number of cases) stratified by presence of outcome (blue: suicidal ideation/suicide attempt present; yellow: suicidal ideation/suicide attempt absent). FDS, functional/dissociative seizures.
Figure 2
Figure 2
Summary of main findings on risk factors for suicidality in people with FDS. FDS, functional/dissociative seizures.
See this image and copyright information in PMC

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