Suicidality in epilepsy: epidemiology and clinical risk factors

Zinchuk M.S.; Rider F.K.; Kustov G.V.; Pashnin E.V.; Akzhigitov R.G.; Gudkova A.A.; Guekht A.B.

doi:https://doi.org/10.17116/jnevro201811810245

Close metadata

Recommended articles:

Epidemiology of suicidal behavior in children and adolescents worldwide. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11-2):16-26

Non-suicidal self-injury and eating disorders: clinical and dynamic patterns in adolescence, young and middle age. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11-2):43-50

Personality profile caused by epilepsy according to the «Big Five» model. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(10):16-21

Brain microstructural abnormalities assessed by diffusion kurtosis MRI in patients with focal temporal lobe epilepsy. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11):171-177

Ototoxicity caused by anti-epileptic drugs. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(12):14-19

Absence status epilepticus in adults. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(12):47-56

Comorbid anxiety disorders in patients with neurological pathology: current state of the problem and the role of etifoxine in treatment strategy. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(12):126-136

Autonomic cardiovascular disorders in patients with epileptic and psychogenic non-epileptic seizures: a pilot study. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(2):13-20

Adolescent suicide risk assessment using the Suicide Risk Rapid Survey. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(3):86-93

A personalized approach to the diagnosis of epilepsy in obese children. Laboratory Service. 2025;(1):5-12

Abstract:

The results of studies on the prevalence of suicidal behavior in patients with epilepsy are discussed in the article. The reasons for the high incidence of suicides among patients with epilepsy are given, with special attention paid to social, demographic, clinical and pathopsychological risk factors. Existing gaps in our knowledge about suicidal behavior in patients with epilepsy are analyzed.

Keywords:

suicide

epilepsy

suicidal risk factors

suicidogenesis

nonsuicidal self-injury

Authors:

Zinchuk M.S.

Solov’ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia

ORCID: 0000-0002-2538-3314

Rider F.K.

Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia

Kustov G.V.

Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia

Pashnin E.V.

Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia

Akzhigitov R.G.

Serbsky Federal Medical Research Centre for Psychiatry and Narcology;
Soloviev Scientific and Practical Center of Psychoneurology

SPIN RSCI: 7335-7359
Scopus AuthorID: 12765937300
ResearcherID: K-2282-2018
ORCID: 0000-0001-7777-2920

Gudkova A.A.

Kafedra nevrologii i neĭrokhirurgii lechebnogo fakul'teta Rossiĭskogo gosudarstvennogo meditsinskogo universiteta, Moskva

Guekht A.B.

Moscow Research and Clinical Centre for Neuropsychiatry;
Pirogov Russian National Research Medical University

SPIN RSCI: 7691-3288
Scopus AuthorID: 7003326363
ResearcherID: Y-6725-2018
ORCID: 0000-0002-1170-6127

Close metadata

References:

DiLuca M, Olesen J. The Cost of Brain Diseases: A Burden or a Challenge? Neuron. 2014;82(6):1205-1208. https://doi.org/10.1016/j.neuron.2014.05.044
Guekht A. Quality of Life and the Stigma of Epilepsy. Krishamoorthy ES, Shorvon S, Schacter S, ed. Epilepsy. Cambridg: Cambridge University Press; 2017. https://doi.org/10.1017/9781139547918.008
Parfenova EV, Rider FK, Gersamia AG. Sociocultural aspects and different types of stigmatization in epilepsy. Nevrologiya, Neiropsikhiatriya, Psikhosomatika. 2018;(Special Issue 1):89-95. (In Russ.) https://doi.org/ 10.14412/2074-2711-2018-1S-89-95
Beghi E, Giussani G. Aging and the Epidemiology of Epilepsy. Neuroepidemiology. 2018:216-223. https://doi.org/10.1159/000493484
Zinchuk MS, Avedisova AS, Zhabin MO, Guekht AB. Suicidality in the elderly: socio-cultural and clinical risk factors. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2018;118(7):104-111. (In Russ.) https://doi.org/10.17116/jnevro201811871104
Fiest K, Sauro K, Wiebe S, Patten S, Kwon C, Dykeman J, Pringsheim T, Lorenzetti D, Jetté N. Prevalence and incidence of epilepsy. Neurology. 2016;88(3):296-303. https://doi.org/10.1212/wnl.0000000000003509
Forsgren L, Hauser W, Olafsson E, Sander J, Sillanpaa M, Tomson T. Mortality of Epilepsy in Developed Countries: A Review. Epilepsia. 2005;46(11):18-27. https://doi.org/10.1111/j.1528-1167.2005.00403.x
Nevalainen O, Ansakorpi H, Simola M, Raitanen J, Isojarvi J, Artama M, Auvinen A. Epilepsy-related clinical characteristics and mortality: A systematic review and meta-analysis. Neurology. 2014;83(21):1968-1977. https://doi.org/10.1212/wnl.0000000000001005
Levira F, Thurman D, Sander J, Hauser W, Hesdorffer D, Masanja H, Odermatt P, Logroscino G, Newton C. Premature mortality of epilepsy in low- and middle-income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy. Epilepsia. 2016;58(1):6-16. https://doi.org/10.1111/epi.13603
Devinsky O, Abramson H, Alper K, FitzGerald L, Perrine K, Calderon J, Luciano D. Postictal psychosis: A case control series of 20 patients and 150 controls. Epilepsy Res. 1995;20(3):247-253. https://doi.org/10.1016/0920-1211(94)00085-b
Christensen J, Vestergaard M, Mortensen P, Sidenius P, Agerbo E. Epilepsy and risk of suicide: a population-based case — control study. The Lancet Neurology. 2007;6(8):693-698. https://doi.org/10.1016/s1474-4422(07)70175-8
Fazel S, Wolf A, Långström N, Newton C, Lichtenstein P. Premature mortality in epilepsy and the role of psychiatric comorbidity: a total population study. The Lancet. 2013;382(9905):1646-1654. https://doi.org/10.1016/s0140-6736(13)60899-5
Hesdorffer D, Ishihara L, Webb D, Mynepalli L, Galwey N, Hauser W. Occurrence and Recurrence of Attempted Suicide Among People With Epilepsy. JAMA Psychiatry. 2016;73(1):80. https://doi.org/10.1001/jamapsychiatry.2015.2516
Thurman D, Logroscino G, Beghi E, Hauser W, Hesdorffer D, Newton C, Scorza F, Sander J, Tomson T. The burden of premature mortality of epilepsy in high-income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy. Epilepsia. 2016;58(1):17-26. https://doi.org/10.1111/epi.13604
Nevalainen O, Simola M, Ansakorpi H, Raitanen J, Artama M, Isojärvi J, Auvinen A. Epilepsy, excess deaths and years of life lost from external causes. Eur J Epidemiol. 2015;31(5):445-453. https://doi.org/10.1007/s10654-015-0095-5
Prudhomme C. Epilepsy And Suicide. J NervMent Dis. 1941;94(6):722-731. https://doi.org/10.1097/00005053-194112000-00006
Krohn W. Causes of Death among Epileptics. Epilepsia. 1963;4(1-4):315-321. https://doi.org/10.1111/j.1528-1157.1963.tb05228.x
Hauser W, Annegers J, Elveback L. Mortality in Patients with Epilepsy. Epilepsia. 1980;21(4):399-412. https://doi.org/10.1111/j.1528-1157.1980.tb04088.x
Blumer D, Montouris G, Davies K, Wyler A, Phillips B, Hermann B. Suicide in epilepsy: psychopathology, pathogenesis, and prevention. Epilepsy & Behavior. 2002;3(3):232-241. https://doi.org/10.1016/s1525-5050(02)00006-9
Jones J, Hermann B, Barry J, Gilliam F, Kanner A, Meador K. Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy. Epilepsy & Behavior. 2003;4:31-38. https://doi.org/10.1016/j.yebeh.2003.08.019
Pompili M, Girardi P, Tatarelli R. Death from suicide versus mortality from epilepsy in the epilepsies: A meta-analysis. Epilepsy & Behavior. 2006;9(4):641-648. https://doi.org/10.1016/j.yebeh.2006.06.019
Bell G, Gaitatzis A, Bell C, Johnson A, Sander J. Suicide in people with epilepsy: How great is the risk? Epilepsia. 2009;50(8):1933-1942. https://doi.org/10.1111/j.1528-1167.2009.02106.x
Tian N, Cui W, Zack M, Kobau R, Fowler K, Hesdorffer D. Suicide among people with epilepsy: A population-based analysis of data from the U.S. National Violent Death Reporting System, 17 states, 2003—2011. Epilepsy & Behavior. 2016;61:210-217. https://doi.org/10.1016/j.yebeh.2016.05.028
Scott KM, Hwang I, Chiu W-T, Kessler RC, Sampson NA, Angermeyer M, Beautrais A, Borges G, Bruffaerts R, de Graaf R, Florescu S, Fukao A, Haro MJ, Hu Ch, Kovess V, Levinson D, Posada-Villa J, Scocco P, Nock MK. Chronic Physical Conditions and Their Association With First Onset of Suicidal Behavior in the World Mental Health Surveys. Psychosom Med. 2010;72(7):712-719. https://doi.org/10.1097/psy.0b013e3181e3333d
Tellez-Zenteno J, Patten S, Jetté N, Williams J, Wiebe S. Psychiatric Comorbidity in Epilepsy: A Population-Based Analysis. Epilepsia. 2007;48(12):2197-2386. https://doi.org/10.1111/j.1528-1167.2007.01222.x
Gorton H, Webb R, Carr M, DelPozo-Banos M, John A, Ashcroft D. Risk of Unnatural Mortality in People With Epilepsy. JAMA Neurol. 2018;75(8): 929. https://doi.org/10.1001/jamaneurol.2018.0333
Harnod T, Lin C, Kao C. Evaluating clinical risk factors for suicide attempts in patients with epilepsy. J Affect Disord. 2018;229:79-84. https://doi.org/10.1016/j.jad.2017.12.048
Rai D, Kerr M, McManus S, Jordanova V, Lewis G, Brugha T. Epilepsy and psychiatric comorbidity: A nationally representative population-based study. Epilepsia. 2012;53(6):1095-1103. https://doi.org/10.1111/j.1528-1167.2012.03500.x
Whitlock J, Muehlenkamp J, Eckenrode J, Purington A, Baral Abrams G, Barreira P, Kress V. Nonsuicidal Self-Injury as a Gateway to Suicide in Young Adults. Journal of Adolescent Health. 2013;52(4):486-492. https://doi.org/10.1016/j.jadohealth.2012.09.010
Bryan C, Rudd M, Wertenberger E, Young-McCaughon S, Peterson A. Nonsuicidal self-injury as a prospective predictor of suicide attempts in a clinical sample of military personnel. Compr Psychiatry. 2015;59:1-7. https://doi.org/10.1016/j.comppsych.2014.07.009
Willoughby T, Heffer T, Hamza C. The link between nonsuicidal self-injury and acquired capability for suicide: A longitudinal study. J Abnorm Psychol. 2015;124(4):1110-1115. https://doi.org/10.1037/abn0000104
Meyer N, Voysey M, Holmes J, Casey D, Hawton K. Self-harm in people with epilepsy: A retrospective cohort study. Epilepsia. 2014;55(9):1355-1365. https://doi.org/10.1111/epi.12723
Hesdorffer D, French J, Posner K, DiVentura B, Pollard J, Sperling M, Harden C, Krauss G, Kanner A. Suicidal ideation and behavior screening in intractable focal epilepsy eligible for drug trials. Epilepsia. 2013;54(5):879-887. https://doi.org/10.1111/epi.12128
Xu K, Rossi K, Kim A, Jetté N, Yoo J, Hung K, Dhamoon M. Risk of readmission for suicide attempt after epilepsy hospitalization. Epilepsy & Behavior. 2018;83:124-130. https://doi.org/10.1016/j.yebeh.2018.03.037
Kobau R, Gilliam F, Thurman D. Prevalence of Self-Reported Epilepsy or Seizure Disorder and Its Associations with Self-Reported Depression and Anxiety: Results from the 2004 Healthstyles Survey. Epilepsia. 2006;47(11):1915-1921. https://doi.org/10.1111/j.1528-1167.2006.00612.x
Lim H, Song H, Hwang Y, Lee H, Suh C, Park S, Kwon S. Predictors of Suicidal Ideation in People with Epilepsy Living in Korea. Journal of Clinical Neurology. 2010;6(2):81. https://doi.org/10.3988/jcn.2010.6.2.81
Hamed S. Risks of suicidality in adult patients with epilepsy. World J Psychiatry. 2012;2(2):33. https://doi.org/10.5498/wjp.v2.i2.33
Gandy M, Sharpe L, Perry K, Miller L, Thayer Z, Boserio J, Mohamed A. The psychosocial correlates of depressive disorders and suicide risk in people with epilepsy. J Psychosom Res. 2013;74(3):227-232. https://doi.org/10.1016/j.jpsychores.2012.11.001
Andrade-Machado R, Ochoa-Urrea M, Garcia-Espinosa A, Benjumea-Cuartas V, Santos-Santos A. Suicidal risk, affective dysphoric disorders, and quality-of-life perception in patients with focal refractory epilepsy. Epilepsy & Behavior. 2015;45:254-260. https://doi.org/10.1016/j.yebeh.2015.01.005
Fukuchi T, Kanemoto K, Kato M, Ishida S, Yuasa S, Kawasaki J, Suzuki S, Onuma T. Death in epilepsy with special attention to suicide cases. Epilepsy Res. 2002;51(3):233-236. https://doi.org/10.1016/s0920-1211(02)00151-1
Nilsson L, Ahlbom A, Farahmand B, Åsberg M, Tomson T. Risk Factors for Suicide in Epilepsy: A Case Control Study. Epilepsia. 2002;43(6):644-651. https://doi.org/10.1046/j.1528-1157.2002.40001.x
Adelow C, Andersson T, Ahlbom A, Tomson T. Hospitalization for psychiatric disorders before and after onset of unprovoked seizures/epilepsy. Neurology. 2012;78(6):396-401. https://doi.org/10.1212/wnl.0b013e318245f461
Ding D, Wang W, Wu J, Yang H, Li S, Dai X, Yang B, Wang T, Yuan C, Ma G, Bell G, Kwan P, de Boer H, Hong Z., Sander J. Premature mortality risk in people with convulsive epilepsy: Long follow-up of a cohort in rural China. Epilepsia. 2012;54(3):512-517. https://doi.org/10.1111/epi.12048
Nevalainen O, Raitanen J, Ansakorpi H, Artama M, Isojärvi J, Auvinen A. Long-term mortality risk by cause of death in newly diagnosed patients with epilepsy in Finland: a nationwide register-based study. Eur J Epidemiol. 2013;28(12):981-990. https://doi.org/10.1007/s10654-013-9848-1
World Health Organization. Atlas: epilepsy care in the world. Geneva: WHO; 2015. Accessed October 7, 2018. https://www.who.int/mental_health/neurology/Epilepsy_atlas_r1.pdf
de Oliveira G, Kummer A, Salgado J, Filho G, David A, Teixeira A. Suicidality in temporal lobe epilepsy: Measuring the weight of impulsivity and depression. Epilepsy & Behavior. 2011;22(4):745-749. https://doi.org/10.1016/j.yebeh.2011.09.004
Kalinin V, Polyanskiy D. Gender differences in risk factors of suicidal behavior in epilepsy. Epilepsy & Behavior. 2005;6(3):424-429. https://doi.org/10.1016/j.yebeh.2005.02.003
Nuhu F, Lasisi M, Yusuf A, Aremu S. Suicide risk among adults with epilepsy in Kaduna, Nigeria. Gen Hosp Psychiatry. 2013;35(5):517-520. https://doi.org/10.1016/j.genhosppsych.2013.04.012
Ryan H. Increase in Suicidal Thoughts and Tendencies. JAMA. 1968;203(13): 1137. https://doi.org/10.1001/jama.1968.03140130049015
Abraham G. Topiramate-Induced Suicidality. The Canadian Journal of Psychiatry. 2003;48(2):127-128. https://doi.org/10.1177/070674370304800214
Kalinin V. Suicidality and Antiepileptic Drugs. Drug Saf. 2007;30(2):123-142. https://doi.org/10.2165/00002018-200730020-00003
Mula M. Do anti-epileptic drugs increase suicide in epilepsy? 10 years after the FDA alert. Expert Rev Neurother. 2018;18(3):177-178. https://doi.org/10.1080/14737175.2018.1427067
Rudzinski L, Meador K. Epilepsy and Neuropsychological Comorbidities. CONTINUUM: Lifelong Learning in Neurology. 2013;19:682-696. https://doi.org/10.1212/01.con.0000431382.06438.cd
Fountoulakis K, Gonda X, Baghai T, Baldwin D, Bauer M, Blier P, Gattaz W, Hasler G, Möller H, Tandon R, Vieta E, Kasper S. Report of the WPA section of pharmacopsychiatry on the relationship of antiepileptic drugs with suicidality in epilepsy. Int J Psychiatry Clin Pract. 2015;19(3):158-167. https://doi.org/10.3109/13651501.2014.1000930
Grimaldi-Bensouda L, Nordon C, Rossignol M, Jardon V, Boss V, Warembourg F, Reynolds R, Kurz X, Rouillon F, Abenhaim L. Antiepileptic drugs and risk of suicide attempts: a case-control study exploring the impact of underlying medical conditions. Pharmacoepidemiol Drug Saf. 2017;26(3):239-247. https://doi.org/10.1002/pds.4160
Jensen I. Temporal Lobe Epilepsy Late Mortality in Patients Treated with Unilateral Temporal Lobe Resections. Acta Neurol Scand. 1975;52(5):374-380. https://doi.org/10.1111/j.1600-0404.1975.tb05832.x
Jensen I, Larsen J. Mental aspects of temporal lobe epilepsy. Follow-up of 74 patients after resection of a temporal lobe. Journal of Neurology, Neurosurgery & Psychiatry. 1979;42(3):256-265. https://doi.org/10.1136/jnnp.42.3.256
Bladin P. Psychosocial Difficulties and Outcome After Temporal Lobectomy. Epilepsia. 1992;33(5):898-907. https://doi.org/10.1111/j.1528-1157.1992.tb02198.x
Guldvog B, Loyning Y, Hauglie-Hanssen E, Flood S, Bjornaes H. Surgical Treatment for Partial Epilepsy Among Norwegian Adults. Epilepsia. 1994;35(3):540-553. https://doi.org/10.1111/j.1528-1157.1994.tb02474.x
Pompili M, Girardi P, Tatarelli G, Angeletti G, Tatarelli R. Suicide after Surgical Treatment in Patients with Epilepsy: A Meta-Analytic Investigation. Psychol Rep. 2006;98(2):323-338. https://doi.org/10.2466/pr0.98.2.323-338
Hamid H, Devinsky O, Vickrey B, Berg A, Bazil C, Langfitt J, Walczak T, Sperling M, Shinnar S, Spencer S. Suicide outcomes after resective epilepsy surgery. Epilepsy & Behavior. 2011;20(3):462-464. https://doi.org/10.1016/j.yebeh.2010.12.031
Corna L, Cairney J, Streiner D. Suicide Ideation in Older Adults: Relationship to Mental Health Problems and Service Use. Gerontologist. 2010;50(6):785-797. https://doi.org/10.1093/geront/gnq048
Pylaeva OA, Mukhin KYu, Shatenshteyn AA. Epilepsy and risk of suicide (areview). Russkii Zhurnal Detskoi Nevrologii. 2013;8(2):23-40. (In Russ.) https://doi.org/10.17650/2073-8803-2013-8-2-23-40
Osso M, Caserta A, Baroni S, Nisita C, Marazziti D. The Relationship Between Epilepsy and Depression: An Update. Curr Med Chem. 2013;20(23):2861-2867. https://doi.org/10.2174/0929867311320230002
Chesney E, Goodwin G, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014;13(2):153-160. https://doi.org/10.1002/wps.20128
Beghi M, Rosenbaum JF, Cerri C, Cornaggia CM. Risk factors for fatal and nonfatal repetition of suicide attempts: a literature review. Neuropsychiatr Dis Treat. 2013;1725. https://doi.org/10.2147/ndt.s40213
Hecimovic H, Santos J, Carter J, Attarian H, Fessler A, Vahle V, Gilliam F. Depression but not seizure factors or quality of life predicts suicidality in epilepsy. Epilepsy & Behavior. 2012;24(4):426-429. https://doi.org/10.1016/j.yebeh.2012.05.005
Wigg C, Filgueiras A, Gomes M. The relationship between sleep quality, depression, and anxiety in patients with epilepsy and suicidal ideation. Arq Neuropsiquiatr. 2014;72(5):344-348. https://doi.org/10.1590/0004-282x20140017
Castro S, Baroni G, Martins W, Palmini A, Bisol L. Suicide risk, temperament traits, and sleep quality in patients with refractory epilepsy. Epilepsy & Behavior. 2018;80:254-258. https://doi.org/10.1016/j.yebeh.2018.01.022
Kaplan M, Huguet N, McFarland B, Caetano R, Conner K, Giesbrecht N, Nolte K. Use of alcohol before suicide in the United States. Ann Epidemiol. 2014;24(8):588-592. https://doi.org/10.1016/j.annepidem.2014.05.008
Pan C, Jhong J, Tsai S, Lin S, Chen C, Kuo C. Excessive suicide mortality and risk factors for suicide among patients with heroin dependence. Drug Alcohol Depend. 2014;145:224-230. https://doi.org/10.1016/j.drugalcdep.2014.10.021
Kustov GV, Akzhigitov RG, Lebedeva AV, Pochigayeva KI, Guekht AB. Interictal dysphoric disorder: a current state of the problem. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2017;117(9):39-43. (In Russ.) https://doi.org/10.17116/jnevro20171179239-43
Espinosa A, Machado R, González S, González M, Montoto A, Sotomayor G. Wisconsin Card Sorting Test performance and impulsivity in patients with temporal lobe epilepsy: Suicidal risk and suicide attempts. Epilepsy & Behavior. 2010;17(1):39-45. https://doi.org/10.1016/j.yebeh.2009.09.010
Moschetta S, Fiore L, Fuentes D, Gois J, Valente K. Personality traits in patients with juvenile myoclonic epilepsy. Epilepsy & Behavior. 2011;21(4):473-477. https://doi.org/10.1016/j.yebeh.2011.03.036