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October 2021; 11 (5) Research

Suicide and Seizures

A National Cohort Study in Veterans

Yarden Bornovski, Ebony Jackson-Shaheed, Stephanie Argraves, Adrianna Hitchins, View ORCID ProfileBenjamin Tolchin, Daniela Galluzzo, Kei-Hoi Cheung, View ORCID ProfileJoseph Goulet, Melissa Skanderson, View ORCID ProfileCynthia A. Brandt, Mary Jo Pugh, View ORCID ProfileHamada Altalib
First published March 12, 2021, DOI: https://doi.org/10.1212/CPJ.0000000000001070
Yarden Bornovski
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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Ebony Jackson-Shaheed
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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Stephanie Argraves
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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Adrianna Hitchins
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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Benjamin Tolchin
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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Daniela Galluzzo
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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Kei-Hoi Cheung
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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Joseph Goulet
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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Melissa Skanderson
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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Cynthia A. Brandt
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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Mary Jo Pugh
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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Hamada Altalib
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
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  • ORCID record for Hamada Altalib
Full PDF
Citation
Suicide and Seizures
A National Cohort Study in Veterans
Yarden Bornovski, Ebony Jackson-Shaheed, Stephanie Argraves, Adrianna Hitchins, Benjamin Tolchin, Daniela Galluzzo, Kei-Hoi Cheung, Joseph Goulet, Melissa Skanderson, Cynthia A. Brandt, Mary Jo Pugh, Hamada Altalib
Neurol Clin Pract Oct 2021, 11 (5) 372-376; DOI: 10.1212/CPJ.0000000000001070

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Abstract

Objective The increased rate of suicide associated with epilepsy has been described, but no studies have reported the rates of suicide and suicide-related behavior (SRB) associated with psychogenic nonepileptic seizures (PNESs).

Methods This retrospective cohort study analyzed data from October 2002 to October 2017 within Veterans Health Administration services. Of 801,734 veterans, 0.09% had PNES, 1.37% had epilepsy, and 98.5% had no documented seizures. Veterans coded for completed suicide, suicide attempts, and suicidal ideation were identified from electronic health records. The primary measure was the suicide-specific standardized mortality ratio (SMR) based on the number of suicide deaths and CDC national suicide mortality database. A Poisson regression was used to calculate the relative risk (RR) of suicide across groups.

Results A total of 1,870 veterans (mean age [SD] 33.76 [7.81] years) completed suicide. Veterans with PNES (RR = 1.75, 95% confidence interval [CI] 0.84–4.24) and veterans with epilepsy (RR = 2.19, 95% CI 2.10–2.28) had a higher risk of suicide compared with the general veteran population. Veterans with PNES or epilepsy had a higher risk of suicide and SRB if they had comorbid alcohol abuse, illicit drug abuse, major depression, posttraumatic stress disorder, and use of psychotropic medications. Conversely, those who were married or attained higher education were at a decreased risk. The SMR for completed suicide for PNES, epilepsy, and the comparison group was 2.65 (95% CI 1.95–5.52), 2.04 (95% CI 1.60–2.55), and 0.70 (95% CI 0.67–0.74), respectively.

Conclusions Veterans with seizures (both psychogenic and epileptic) are at a greater risk of death by suicide and SRB than the comparison group. These findings suggest that although the pathophysiology of PNES and epilepsy is different, the negative impact of seizures is evident in the psychosocial outcomes in both groups.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Received July 10, 2020.
  • Accepted January 18, 2021.
  • © 2021 American Academy of Neurology
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