PDF(Pubmed)
Abstract：
BACKGROUND: People with functional/dissociative seizures (FDS) are at elevated suicidality risk.
OBJECTIVE: To identify risk factors for suicidality in FDS or epilepsy.
METHODS: Retrospective cohort study from the UK\'s largest tertiary mental healthcare provider, with linked national admission data from the Hospital Episode Statistics. Participants were 2383 people with a primary or secondary diagnosis of FDS or epilepsy attending between 01 January 2007 and 18 June 2021. Outcomes were a first report of suicidal ideation and a first hospital admission for suicide attempt (International Classification of Diseases, version 10: X60-X84). Demographic and clinical risk factors were assessed using multivariable bias-reduced binomial-response generalised linear models.
RESULTS: In both groups, ethnic minorities had significantly reduced odds of hospitalisation following suicide attempt (OR: 0.45-0.49). Disorder-specific risk factors were gender, age and comorbidity profile. In FDS, both genders had similar suicidality risk; younger age was a risk factor for both outcomes (OR: 0.16-1.91). A diagnosis of depression or personality disorders was associated with higher odds of suicidal ideation (OR: 1.91-3.01). In epilepsy, females had higher odds of suicide attempt-related hospitalisation (OR: 1.64). Age had a quadratic association with both outcomes (OR: 0.88-1.06). A substance abuse disorder was associated with higher suicidal ideation (OR: 2.67). Developmental disorders lowered the risk (OR: 0.16-0.24).
CONCLUSIONS: This is the first study systematically reporting risk factors for suicidality in people with FDS. Results for the large epilepsy cohort complement previous studies and will be useful in future meta-analyses.
CONCLUSIONS: Risk factors identified will help identify higher-risk groups in clinical settings.
OBJECTIVE: To identify risk factors for suicidality in FDS or epilepsy.
METHODS: Retrospective cohort study from the UK\'s largest tertiary mental healthcare provider, with linked national admission data from the Hospital Episode Statistics. Participants were 2383 people with a primary or secondary diagnosis of FDS or epilepsy attending between 01 January 2007 and 18 June 2021. Outcomes were a first report of suicidal ideation and a first hospital admission for suicide attempt (International Classification of Diseases, version 10: X60-X84). Demographic and clinical risk factors were assessed using multivariable bias-reduced binomial-response generalised linear models.
RESULTS: In both groups, ethnic minorities had significantly reduced odds of hospitalisation following suicide attempt (OR: 0.45-0.49). Disorder-specific risk factors were gender, age and comorbidity profile. In FDS, both genders had similar suicidality risk; younger age was a risk factor for both outcomes (OR: 0.16-1.91). A diagnosis of depression or personality disorders was associated with higher odds of suicidal ideation (OR: 1.91-3.01). In epilepsy, females had higher odds of suicide attempt-related hospitalisation (OR: 1.64). Age had a quadratic association with both outcomes (OR: 0.88-1.06). A substance abuse disorder was associated with higher suicidal ideation (OR: 2.67). Developmental disorders lowered the risk (OR: 0.16-0.24).
CONCLUSIONS: This is the first study systematically reporting risk factors for suicidality in people with FDS. Results for the large epilepsy cohort complement previous studies and will be useful in future meta-analyses.
CONCLUSIONS: Risk factors identified will help identify higher-risk groups in clinical settings.
摘要：
背景：患有功能性/分离性癫痫（FDS）的人自杀风险升高。
目的：确定FDS或癫痫患者自杀的危险因素。
方法：来自英国最大的三级精神卫生保健提供者的回顾性队列研究，与来自医院事件统计的国家入院数据相关联。参与者是2007年1月1日至2021年6月18日期间患有FDS或癫痫的主要或次要诊断的2383人。结果是首次报告自杀意念和首次因自杀未遂入院（国际疾病分类，版本10：X60-X84）。使用多变量偏倚减少的二项反应广义线性模型评估人口统计学和临床危险因素。
结果：在两组中，少数族裔在自杀未遂后住院的几率显著降低(OR:0.45~0.49).特定疾病的危险因素是性别，年龄和合并症概况。在FDS,两种性别的自杀风险相似;年龄较小是两种结局的危险因素(OR:0.16~1.91).抑郁症或人格障碍的诊断与自杀意念的几率较高相关（OR：1.91-3.01）。在癫痫中，女性自杀未遂相关住院的几率较高(OR:1.64).年龄与两种结果呈二次相关（OR：0.88-1.06）。药物滥用障碍与较高的自杀意念相关（OR：2.67）。发育障碍降低了风险（OR：0.16-0.24）。
结论：这是第一项系统性报道FDS患者自杀危险因素的研究。大型癫痫队列的结果补充了以前的研究，并将在未来的荟萃分析中有用。
结论：确定的危险因素将有助于确定临床环境中的高风险人群。
目的：确定FDS或癫痫患者自杀的危险因素。
方法：来自英国最大的三级精神卫生保健提供者的回顾性队列研究，与来自医院事件统计的国家入院数据相关联。参与者是2007年1月1日至2021年6月18日期间患有FDS或癫痫的主要或次要诊断的2383人。结果是首次报告自杀意念和首次因自杀未遂入院（国际疾病分类，版本10：X60-X84）。使用多变量偏倚减少的二项反应广义线性模型评估人口统计学和临床危险因素。
结果：在两组中，少数族裔在自杀未遂后住院的几率显著降低(OR:0.45~0.49).特定疾病的危险因素是性别，年龄和合并症概况。在FDS,两种性别的自杀风险相似;年龄较小是两种结局的危险因素(OR:0.16~1.91).抑郁症或人格障碍的诊断与自杀意念的几率较高相关（OR：1.91-3.01）。在癫痫中，女性自杀未遂相关住院的几率较高(OR:1.64).年龄与两种结果呈二次相关（OR：0.88-1.06）。药物滥用障碍与较高的自杀意念相关（OR：2.67）。发育障碍降低了风险（OR：0.16-0.24）。
结论：这是第一项系统性报道FDS患者自杀危险因素的研究。大型癫痫队列的结果补充了以前的研究，并将在未来的荟萃分析中有用。
结论：确定的危险因素将有助于确定临床环境中的高风险人群。
