Risk factors of suicide-related events in patients with epilepsy: A systematic review and meta-analysis
Yu Zhang1, Haijiao Wang2, Ling Liu3
1Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu 610041, Sichuan, PR China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Shang Jin Road 253 Chengdu 610000, Sichuan, PR China.
Purpose:
This systematic review and meta-analysis examined the risk factors for suicide-related events (SRE) in patients with epilepsy (PWE).
Methods:
The PubMed, Embase, Cochrane Online Library, and ClinicalTrials.gov databases were searched for relevant articles published from 1946 to August 30, 2022. The quality of the extracted articles was assessed using the Newcastle-Ottawa scale. Subsequently, a meta-analysis of PWE was performed to calculate the random-effects pooled odds ratios (ORs) for studies investigating the association between suicide and its associated risk factors. All statistical analyses were performed using R version 4.1.0.
Results:
A total of 2,803 studies were screened, of which 23 articles comprising 6,723 PWE were included in our meta-analysis. Female sex (odds ratio [OR]=1.24, 95 % confidence interval [CI]: 1.08-1.43), low quality of life (QOL) scores (standardized mean difference [SMD]= -0.89, CI: -1.17 - -0.61), poor social support (OR=3.44, CI: 1.83-6.46), unemployment (OR=1.82, CI: 1.40-2.38), unmarried status (OR=1.48, CI: 1.12-1.97), low income (OR=1.37, CI: 1.07-1.76), low education (OR=1.33, CI: 1.04-1.68), use of antidepressant drugs (OR=7.77, CI: 3.17-19.03), uncontrolled seizures (OR=2.28, CI: 1.63-3.18), use of multiple antiepileptic drugs (OR=1.70, CI: 1.33-2.18), early age at onset of epilepsy (SMD= -0.15, CI: -0.30 - -0.0002), depression (OR=6.85, CI: 4.88-9.62), and anxiety (OR=3.76, CI: 2.92-4.84) were identified as significant risk factors of SRE.
Significance:
There are many risk factors for SRE in PWE, as outlined above. Interventions targeting these risk factors may help reduce the risk of SRE in PWE.
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