Citation

Dickstein LP, Viguera AC, Nowacki AS, Thompson NR, Griffith SD, Baldessarini RJ, Katzan IL. Psychosomatics 2014; 56(1): 44-51.

Copyright

(Copyright © 2014, Academy of Psychosomatic Medicine, Publisher Elsevier Publishing)

DOI

10.1016/j.psym.2014.05.008

PMID

unavailable

Abstract

Background
Patients with epilepsy or multiple sclerosis (MS) have high risks of depression and increased risks of suicide, but little is known about their risks of suicidal ideation.

OBJECTIVE
We sought to: (1) estimate the prevalence of thoughts of being better off dead or of self-harm among patients with epilepsy or MS, (2) identify risk-factors for such thoughts, and (3) determine whether any risk-factors interact with depression to predict such thoughts.

METHODS
A Cleveland Clinic database provided information on 20,734 visits of 6,586 outpatients with epilepsy or MS. Outcome measures were thoughts of death or self-harm (Patient Health Questionnaire [PHQ] item-9), and total score ≥10 for the 8 remaining PHQ items (probable major depression). Generalized estimating equations accounted for repeat visits in tests of associations of PHQ item-9 responses with depression, age, sex, race, household income, disease severity, and quality-of-life.

RESULTS
Prevalence of thoughts of death or self-harm averaged 14.4% overall (epilepsy, 14.0% and MS, 14.7%). Factors associated with positive PHQ-item-9 responses in epilepsy were depression and male sex, modified by poor QOL. Factors associated with positive PHQ-item-9 in MS were depression, male sex, medical co-morbidity, and poor QOL; the effect of depression was worse with greater MS severity and being unmarried.

CONCLUSIONS
Among patients with common neurological disorders (epilepsy or MS), 14%-15% reported thoughts of death or self-harm associated with illness-severity, depression, QOL, male sex, and being unmarried. Such patients require further evaluation of clinical outcomes and effects of treatment.