Abstracts

Rationale: In people with epilepsy 9 years old or older, the risk for suicide is three times that in the general population. However, little is known about when, where, and how suicide occurs, why occurrence is higher in people with epilepsy, and how to prevent suicide in epilepsy. This study's goal was to shed light on these questions based on the U.S. National Violent Death Reporting System (NVDRS).Methods: NVDRS is a state-based, active surveillance system created and monitored by the U.S. Centers for Disease Control and Prevention to collect accurate, timely, and comprehensive data on violent deaths including suicides for better understanding of violent deaths and ultimately guide their prevention. From 2003-2011, NVDRS collected data on 82,501 suicides in persons 10 years old or older in a total of 17 states (7 states from 2003–2011, 6 states from 2004-2011, 3 states from 2005-2011, and 1 state from 2011). Among those who died by suicide, epilepsy was identified by ICD-10 multiple condition codes and by text searching for epilepsy-related terms within NVDRS narrative descriptions of the suicide incidents. We compared records of 1,015 suicide cases mentioning epilepsy to those of 81,486 suicide cases not mentioning epilepsy with respect to the selected demographic characteristics. We also used continual data provided by 16 out of these 17 states from 2005-2011 to describe trends in the proportion of suicide in people with epilepsy (n=871) and without epilepsy (n=68,624).Results: From 2003─2011, suicide in people with epilepsy did not vary by month and suicide occurrence did not differ by month between people with and without epilepsy. Three-quarters of both groups committed suicide in a house or apartment. The three most common methods of suicide in both groups were poisoning, use of firearms, and hanging/strangulation/ suffocation. Suicide decedents with epilepsy were more than twice as likely to poison themselves as those without epilepsy (41.3% vs. 16.9%) (P<0.01). In both groups, most suicides occurred among non-Hispanic whites and among those 18─59 years old. Among suicide decedents, the proportion aged 40-49 was higher among those with epilepsy (28.7% vs. 22.0%) (p<0.01). Within the 16 states providing continual data from 2005–2011, the proportion of suicide deaths with epilepsy documented or mentioned increased significantly, peaking in 2010 (p<0.01) before falling (attached table 1, figure 1 A and B).Conclusions: Because poisoning is the most common method people with epilepsy use to commit suicide, people with epilepsy may benefit from having caregivers supervise the availability of potentially harmful materials, especially in the home. Epilepsy caregivers might also benefit from Mental Health First Aid training to appropriately intervene with patients in mental health crisis. Enhanced social support for adults with epilepsy, especially those aged 40─49, may help prevent suicide deaths in this more vulnerable group. The 2010 peak of suicide deaths in people with epilepsy could be related to socioeconomic or psychological factors, but further investigation is needed.