Which of the Mood and Anxiety Disorders are the Strongest Predictors of Suicidality in Newly Diagnosed Non-Lesional Focal Epilepsy?
December 07, 2020
Andres Kanner, University of Miami, Miller School of Medicine; Dong Hee Kim - University of Miami, Miller School of Medicine; Seixas Anita - Iniversity of Miami, Miller School of Medicine; John Barry - Stanford University; Hamada Hamid - Yale University,
Mood and anxiety disorders have been associated with an increased suicidality risk in patients with epilepsy. Which of the mood and anxiety disorders are the stronger predictors of suicidality is yet to be established. The aim of this study is to answer this question in patients with newly diagnosed non-lesional focal epilepsy.
Data from the Human Epilepsy Project obtained from 28 Epilepsy Centers was used. A total of 367 consecutive patients with newly-diagnosed non-lesional focal epilepsy were included. Baseline psychiatric data, obtained at the time of enrollment included every mood and anxiety disorder identified in the MINI International Neuropsychiatric Interview. Suicidality data were identified with the Columbia Suicide Severity Rating Scale (CSSRS). Suicidality variables included: (i) any suicidality form; (ii) Lifetime active and passive suicidal ideation. (iii) Current (last 6 months) active and passive suicidal ideation. (iiii) Lifetime suicidal attempts._x000D_
Psychiatric disorders significantly associated with any of the suicidality variables on univariate analysis (p value set at 0.009) were submitted to a logistic regression analysis.
Among the 367 subjects, 162 (44%) had a mood and /or anxiety and /or suicidality identified. Suicidality was identified in 82 (22%) subjects: 52 had a lifetime active and 30 passive suicidal ideation, while 18 had current active and 12 passive suicidal ideation. 17 subjects reported lifetime suicidal attempts. 100 subjects experienced one or more than one anxiety disorder, 93 one or more than one mood disorder and 50 experienced comorbid mood+ anxiety disorders. 63 of the 82 subjects with suicidality experienced a mood and /or anxiety disorder._x000D_
Every mood (except for hypomania and dysthymia) and anxiety disorder were significantly associated with the four suicidality forms (p< 0.0001 for each) when all 367 subjects were included in the analyses. Accordingly, we conducted a second analysis including only the 162 symptomatic subjects to identify the variables with the strongest risk of suicidality._x000D_
In univariate analysis, the variables significantly associated with suicidality included bipolar disorders (types I and II), bipolar + anxiety disorders, panic disorder, panic + bipolar disorders and having more than one type of anxiety disorder. Hypomania was significantly associated with a lower risk of having suicidality._x000D_
Logistic regression analysis identified the following predictors of suicidality:_x000D_
1) Bipolar + anxiety disorders predicted any form of suicidality, lifetime and current active suicidal ideation and suicidal attempts._x000D_
2) Panic disorder predicted lifetime and current active suicidal ideation and, when occurring together with bipolar disorder, lifetime suicidal attempts._x000D_
3) Hypomania alone predicted a lower risk of any form of suicidality and of lifetime active suicidal ideation.
Bipolar + anxiety disorders occurring together appear to be the strongest predictors of suicidality in patients with newly diagnosed non-lesional focal epilepsy.
:The HEP study is supported by the Epilepsy Study Consortium (ESCI), a non-profit organization dedicated to accelerating the development of new therapies in epilepsy to improve patient care. The funding provided to ESCI to support HEP comes from industry, philanthropy and foundations (UCB Pharma, Eisai, Pfizer, Lundbeck, Sunovion, The Andrews Foundation, The Vogelstein Foundation, Finding A Cure for Epilepsy and Seizures (FACES), Friends of Faces and others).