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Validation of rapid suicidality screening in epilepsy using the NDDIE
Marco Mula1,2,3, Aileen McGonigal4,5, Jean-Arthur Micoulaud-Franchi6,7
1Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
Epilepsia
|March 26, 2016
Summary
Patients with epilepsy have a higher risk of suicide. The Neurological Disorder Depression Inventory for Epilepsy (NDDIE) item 4 effectively screens for suicidality, enabling better suicide prevention strategies in epilepsy centers.
Area of Science:
- Neurology
- Psychiatry
- Public Health
Background:
- Patients with epilepsy exhibit a significantly higher mortality ratio for suicide compared to the general population.
- This elevated risk persists even after accounting for clinical and socioeconomic variables, underscoring the need for targeted interventions.
Purpose of the Study:
- To validate the Neurological Disorder Depression Inventory for Epilepsy (NDDIE) as a reliable screening tool for suicidality in individuals with epilepsy.
- To establish effective screening instruments and care pathways for suicide prevention within epilepsy care settings.
Main Methods:
- Adult patients with epilepsy were assessed using the Mini International Neuropsychiatric Interview (MINI) and the NDDIE.
- High suicidality risk, defined by the MINI's Suicidality Module, served as the gold standard for comparison.
- Receiver operating characteristic (ROC) analyses were performed on NDDIE scores to determine optimal cutoff points and psychometric properties.
Main Results:
- A score greater than 2 on item 4 ('I'd be better off dead') of the NDDIE demonstrated excellent psychometric properties (Youden index J = 0.751).
- This cutoff showed high validity (Area Under the Curve [AUC] = 0.906), sensitivity (84.21%), and specificity (90.86%) for identifying high suicidality risk.
- Positive and negative likelihood ratios indicated strong discriminative ability for the screening item.
Conclusions:
- Item 4 of the NDDIE is a highly effective instrument for screening suicidality in patients with epilepsy.
- The findings support the integration of this screening tool into epilepsy centers to facilitate the development of crucial suicide prevention care pathways.
