Abstracts

High rates of depression in children with epilepsy (Caplan et al., 1998, in press; Davies et al., 2003; Ott et al., 2000; Dunn et al., 1999; Etinger, et al., 1998; Oguz et al., 2002) and the reported high rate of suicide in epilepsy patients (Jones et al., 2003) highlight the importance of determining if suicide occurs in children with epilepsy. A few studies of relatively small samples of children with epilepsy report that psychopathology measures (Ettinger et al., 1998), cognition (Ott et al., 2001), type of antiepileptic drug (Brent et al., 1991), but not seizure control (Ott et al., 2001) are associated with the presence of suicidal ideation or plan (SI/P). We examine suicidal behavior in a large sample of children with epilepsy and the association with psychopathology, cognition, language, and seizure variables. The Kiddie Schedule for Affective disorders and Schizophrenia (K-SADS) (Kaufman et al., 1997), the Child Depression Inventory (Kovacs, 1985), the Multidimensional Anxiety Scale for Children (March et al., 1997), cognitive and language testing were administered to 167 children with epilepsy (99 complex partial seizures, 68 childhood absence epilepsy) and 92 normal children, aged 5-16 years. Parents were interviewed about the child with the K-SADS, completed the Child Behavior Checklist (Achenbach, 1991), and provided demographic and seizure-related information. Although none of the patients had made a suicide attempt, the children with epilepsy (20%) had a significantly higher rate (X² = 5.94, [underline]p[/underline] [lt] .01) of SI/P than the normal group (9%). Among the 34 patients with SI/P, 79% had a DSM-IV diagnosis compared to 52% in those without SI/P (X² = 8.16, [underline]p[/underline] [lt] .004). Regarding type of psychiatric diagnosis, 21% had disruptive disorders, 9% had major affective or anxiety disorders and 50% had combined disruptive and affective/anxiety diagnoses. In contrast, only 10% of the epilepsy patients without SI/P had combined disruptive and affective/anxiety disorder diagnoses (X² (3) = 29.31, [underline]p[/underline] [lt] .0001). In addition to a high rate of psychiatric diagnoses, the children with SI/P had significantly higher scores in the borderline/clinical range for total ([underline]p[/underline] [lt] .0001), internalizing ([underline]p[/underline] [lt] .001), externalizing ([underline]p[/underline] [lt] .02), and anxiety/depression CBCL scores ([underline]p[/underline] [lt] .0001), CDI scores ([underline]p[/underline] [lt] .009), and MASC scores ([underline]p[/underline] [lt] .004) than those without SI/P. Other than longer duration of illness in the patients with SI/P compared to those without SI/P ([underline]p[/underline] [lt] .005), seizure, cognitive, and linguistic variables were unrelated to the presence of SI/P. Increased suicidal ideation/plan and the association with severe psychopathology in children with epilepsy with these symptoms emphasize the need for psychiatric evaluations in children with epilepsy. (Supported by RO1 NS 32070)