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Psychosomatics. 2015 Jan-Feb;56(1):44-51. doi: 10.1016/j.psym.2014.05.008. Epub 2014 Jun 5.

Thoughts of death and self-harm in patients with epilepsy or multiple sclerosis in a tertiary care center.

Author information

1
Cleveland Clinic-Lerner College of Medicine, Cleveland, OH (LPD); Department of Psychiatry, Cleveland Clinic, Cleveland, OH (ACV); Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH (ILK).
2
Cleveland Clinic-Lerner College of Medicine, Cleveland, OH (LPD); Department of Psychiatry, Cleveland Clinic, Cleveland, OH (ACV); Neurological Institute Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH (ACV, NRT, SDG, ILK); Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH (ILK). Electronic address: viguera@ccf.org.
3
Cleveland Clinic-Lerner College of Medicine, Cleveland, OH (LPD); Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH (ASN, NRT, SDG); Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH (ILK).
4
Neurological Institute Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH (ACV, NRT, SDG, ILK); Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH (ASN, NRT, SDG); Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH (ILK).
5
Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH (ILK); Department of Psychiatry, Harvard Medical School, Boston, MA (RJB); International Consortium for Psychotic & Mood Disorders Research, McLean Hospital, Belmont, MA (RJB).
6
Neurological Institute Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH (ACV, NRT, SDG, ILK); Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH (ILK).

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 6586 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 quality of life. Factors associated with positive PHQ item-9 in MS were depression, male sex, medical comorbidity, and poor quality of life; the effect of depression was worse with greater MS severity and being unmarried.

CONCLUSIONS:

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

PMID:
25619673
DOI:
10.1016/j.psym.2014.05.008
[Indexed for MEDLINE]

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