Predictors of Suicidal Ideation in People with Epilepsy Living in Korea
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Background and PurposezzThe risk of suicide or suicide attempts is reported higher in people with epilepsy (PWE) than in the general population. Although epileptic, psychiatric, and psychosocial factors are known risk factors for suicide or suicide attempt, no studies have evaluated the predictors of the severity of suicidal ideation-which is a warning sign for suicide attempts-in PWE. Therefore, we measured the severity of suicidal ideation and its risk factors. MethodszzConsecutive PWE who were medicated with antiepileptic drugs (AEDs) and attended epilepsy clinic were included in the study. The subjects completed self-reported questionnaires,which included the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Checklist-90-Revised (SCL-90-R), and Scale for Suicide Ideation-Beck (SSI-Beck). We compared the patients’demographic and clinical variables, and BDI, BAI, and SCL-90-R scores with their SSI-Beck score, and used our findings to determine the predictors for suicidal ideation. ResultszzIn total, 257 PWE were enrolled in the study. SSI-Beck scores correlated strongly with several seizure-related variables, duration of education, IQ, BDI and BAI scores, and nine domains of the SCL-90-R questionnaire. However, the strongest predictor for suicidal ideation was BDI score (β=0.41, p<0.001), followed by several SCL-90-R domains, such as obsessive-compulsive (β=-0.39, p<0.001), depression (β=0.38, p<0.001), hostility (β=0.22, p=0.002), paranoid ideation (β=0.17, p=0.01), and IQ (β=-0.10, p=0.017). These variables explained 59% of the variance in the SSI-Beck score. The seizure-related variables that influenced the BDI score were seizure frequency, duration of education, MRI abnormality, and number of AEDs. However, these variables explained only 18% of the variance in the BDI score. ConclusionszzMajor risk factors for suicidal ideation in PWE were depressive and psychiatric symptoms rather than seizure-related variables. Therefore, clinicians should focus on screening for depression and other psychiatric problems and treat them appropriately in order to reduce suicidal behavior in PWE. Since seizure-related variables also exhibited a minor role in determining depressive symptoms, stronger seizure-related risk factors for depression should be sought, such as seizure severity or psychosocial factors, to minimize suicidal behavior.
Abstract
Background and PurposezzThe risk of suicide or suicide attempts is reported higher in people with epilepsy (PWE) than in the general population. Although epileptic, psychiatric, and psychosocial factors are known risk factors for suicide or suicide attempt, no studies have evaluated the predictors of the severity of suicidal ideation-which is a warning sign for suicide attempts-in PWE. Therefore, we measured the severity of suicidal ideation and its risk factors. MethodszzConsecutive PWE who were medicated with antiepileptic drugs (AEDs) and attended epilepsy clinic were included in the study. The subjects completed self-reported questionnaires,which included the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Checklist-90-Revised (SCL-90-R), and Scale for Suicide Ideation-Beck (SSI-Beck). We compared the patients’demographic and clinical variables, and BDI, BAI, and SCL-90-R scores with their SSI-Beck score, and used our findings to determine the predictors for suicidal ideation. ResultszzIn total, 257 PWE were enrolled in the study. SSI-Beck scores correlated strongly with several seizure-related variables, duration of education, IQ, BDI and BAI scores, and nine domains of the SCL-90-R questionnaire. However, the strongest predictor for suicidal ideation was BDI score (β=0.41, p<0.001), followed by several SCL-90-R domains, such as obsessive-compulsive (β=-0.39, p<0.001), depression (β=0.38, p<0.001), hostility (β=0.22, p=0.002), paranoid ideation (β=0.17, p=0.01), and IQ (β=-0.10, p=0.017). These variables explained 59% of the variance in the SSI-Beck score. The seizure-related variables that influenced the BDI score were seizure frequency, duration of education, MRI abnormality, and number of AEDs. However, these variables explained only 18% of the variance in the BDI score. ConclusionszzMajor risk factors for suicidal ideation in PWE were depressive and psychiatric symptoms rather than seizure-related variables. Therefore, clinicians should focus on screening for depression and other psychiatric problems and treat them appropriately in order to reduce suicidal behavior in PWE. Since seizure-related variables also exhibited a minor role in determining depressive symptoms, stronger seizure-related risk factors for depression should be sought, such as seizure severity or psychosocial factors, to minimize suicidal behavior.
참고문헌 (36)
- Hendin H, "Epidemiology of suicide in Asia", pp.7~18 (2008), WHO Document Production Services
- Bark HM, "The Trends and Patterns on Suicide in Korea", pp.93~130 (2007), Korean Institute of Criminology
- Pompili M, "Suicide in the epilepsies:a meta-analytic investigation of 29 cohorts", Epilepsy Behav, 7, pp.305~310 (2005)
- Christensen J, "Epilepsy and risk of suicide:a population-based case-control study", Lancet Neurol, 6, pp.693~698 (2007)
- Tellez-Zenteno JF, "Psychiatric comorbidity in epilepsy:a population-based analysis", Epilepsia, 48, pp.2336~2344 (2007)
- Jones JE, "Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy", pp.S31~S38 (2003), Epilepsy Behav
- Nilsson L, "Risk factors for suicide in epilepsy:a case control study", Epilepsia, 43, pp.644~651 (2002)
- Mainio A, "Depression and suicide in epileptic victims:a population-based study of suicide victims during the years 1988-2002 in northern Finland", Epilepsy Behav, 11, pp.389~393 (2007)
- Kalinin VV, "Gender and suicidality prediction in epilepsy", Epilepsy Behav, 7, pp.657~663 (2005)
- Ritaccio A, "Personality disorders in epilepsy. In: Psychiatric issues in epilepsy: a practical guide to diagnose and treatment. 2nd ed", pp.147~161 (2007), Lippincott Williams and Wilkins
- Verrotti A, "Epilepsy and suicide:pathogenesis,risk factors,and prevention", Neuropsychiatr Dis Treat, 4, pp.365~370 (2008)
- Brown GK, "Risk factors for suicide in psychiatric outpatients:a 20-year prospective study", J Consult Clin Psychol, 68, pp.371~377 (2000)
- Mann JJ, "Toward a clinical model of suicidal behavior in psychiatric patients", Am J Psychiatry, 156, pp.181~189 (1999)
- Jacobs DG, "Suicide:clinical", risk management issues for the psychiatrist, 2000, pp.5, 32~54
- Jacobs DG, "Suicide assessment: an overview and recommended protocol. In: The Harvard Medical School guide to suicide assessment and intervention", pp.3~39 (1999), Jossey-Bass
- Sheehan DV, "The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10", J Clin Psychiatry, 59(Suppl 20), pp.S22~S33 (1998)
- Beck AT, "An inventory for measuring depression", Arch Gen Psychiatry, 4, pp.561~571 (1961)
- Beck AT, "Assessment of suicidal intention:the Scale for Suicidal Ideation", J Consult Clin Psychol, 47, pp.343~352 (1979)
- Kim ZS, "Two-and four-subtest short forms of the Korean-Wechsler Adult Intelligence Scale", Seoul J Psychiatry, 19, pp.121~126 (1994)
- Rhee MK, "A standardization study of Beck Depression Inventory II-Korean Version(K-BDI):validity", Kor J Psychopathol, 4, pp.96~104 (1995)
- Yook SP, "A clinical study on the Korean version of Beck Anxiety Inventory:comparative study of patient and non-patient", Kor J Clin Psychol, 16, pp.185~197 (1997)
- Kim KI, "The standardization study of Symptom Checklist-90-Revision in Korea III", Korean J Mental Health Res, 2, pp.278~311 (1984)
- Shin MS, "A study of suicidal ideation among high school students:the structural relation among depression,hopelessness,and suicidal ideation", Korean J Clin Psychol, 9, pp.1~19 (1990)
- Miller JM, "Depressive symptoms in epilepsy:prevalence,impact,aetiology,biological correlates and effect of treatment with antiepileptic drugs", Drugs, 68, pp.1493~1509 (2008)
- Ketter TA, "Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders", Neurology, 53, pp.S53~S67 (1999)
- Blumer D, "Suicide in epilepsy:psychopathology,pathogenesis,and prevention", Epilepsy Behav, 3, pp.232~241 (2002)
- Cramer JA, "The influence of comorbid depression on seizure severity", Epilepsia, 44, pp.1578~1584 (2003)
- Brent DA, "Phenobarbital treatment and major depressive disorder in children with epilepsy", Pediatrics, 80, pp.909~917 (1987)
- "U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, Office of Translational Sciences, Office of Biostatistics", Statistical Review and Evaluation: Antiepileptic Drugs and Suicidality, ~ (2008)
- Hesdorffer DC, "The FDA alert on suicidality and antiepileptic drugs:fire or false alarm?", Epilepsia, 50, pp.978~986 (2009)
- Kanner AM, "Psychiatric issues in epilepsy:the complex relation of mood,anxiety disorders,and epilepsy", Epilepsy Behav, 15, pp.83~87 (2009)
- Zigmond AS, "The hospital anxiety and depression scale", Acta Psychiatr Scand, 67, pp.361~370 (1983)
- Gilliam FG, "Rapid detection of major depression in epilepsy:a multicentre study", Lancet Neurol, 5, pp.399~405 (2006)
- Harris EC, "Suicide as an outcome for mental disorders.A meta-analysis", Br J Psychiatry, 170, pp.205~228 (1997)
- Grabowska-Grzyb A, "Risk factors for depression in patients with epilepsy", Epilepsy Behav, 8, pp.411~417 (2006)
- Thompson AW, "Sociodemographic and clinical factors associated with depression in epilepsy", Epilepsy Behav, 14, pp.655~660 (2009)