title: Suicide in people with epilepsy: how great is the risk?
abstract: OBJECTIVE
  Suicide is more common in populations with epilepsy, but estimates vary concerning the magnitude of the risk. We aimed to estimate the risk using meta-analysis.
  
  
  METHODS
  A literature search identified 74 articles (76 cohorts of people with epilepsy) in whom the number of deaths by suicide in people with epilepsy and the number of person-years at risk could be estimated. Standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated for each cohort, for groups of cohorts, and for the total population.
  
  
  RESULTS
  The overall SMR was 3.3 (95% CI 2.8-3.7) based on 190 observed deaths by suicide compared with 58.4 expected. The SMR was significantly increased in people with incident or newly diagnosed epilepsy in the community (SMR 2.1), in populations with mixed prevalence and incidence cases (SMR 3.6), in those with prevalent epilepsy (SMR 4.8), in people in institutions (SMR 4.6), in people seen in tertiary care clinics (SMR 2.28), in people with temporal lobe epilepsy (SMR 6.6), in those following temporal lobe excision (SMR 13.9), and following other forms of epilepsy surgery (SMR 6.4). The SMR was significantly low overall in two community-based studies of people with epilepsy and developmental disability.
  
  
  CONCLUSIONS
  We confirm that the risk of suicide is increased in most populations of people with epilepsy. Psychiatric comorbidity has been demonstrated to be a risk factor for suicide in the general population and in people with epilepsy, and such comorbidity should thus be identified and treated.
authors.affiliation: Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Gail S
authors.initials: GS
authors.lastname: Bell
authors.forename: Athanasios
authors.initials: A
authors.lastname: Gaitatzis
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Bell
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Johnson
authors.forename: Josemir W
authors.initials: JW
authors.lastname: Sander
mesh_terms: D016001:Confidence Intervals; D004827:Epilepsy / Q000453:epidemiology / Q000401:mortality / Q000523:psychology*; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*