University of Sarajevo, Sarajevo, Bosnia and Herzegovina ... sexual/physical abuse history (5.95, p=0.015), level of hopelessness (20.7; p=0.000) ... In the prediction of suicidal ideation in this population of patients, there is no single variable.
Psychiatria Danubina, 2014; Vol. 26, No. 1, pp 52-55 © Medicinska naklada - Zagreb, Croatia
Original paper
SUICIDAL IDEATION AND THOUGHTS OF DEATH IN EPILEPSY PATIENTS Nataša Loga Andrijić1, Azra Alajbegović1, Svjetlana Loga Zec2 & Slobodan Loga3 1
Department of Neurology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina 2 Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina 3 Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina received: 14.8.2013;
revised: 7.1.2014;
accepted: 28.1.2014
SUMMARY Background: Suicidal behavior is an important worldwide health problem. Psychiatric disorders, especially mood disorders, are the main risk factors for suicidal behavior. Suicide is an important cause of death in patients with epilepsy. The aim of this study was to analyze the presence of suicidal ideation in patients with epilepsy. Subjects and methods: The study included 50 epilepsy inpatients and outpatients of both genders, aged 18 years and older, treated at the Department of Neurology, Clinical Center University of Sarajevo in the period from 1st of April – October 1st 2007. The sample was selected randomly. Applied research instruments were general questionnaire, HAM-D-17, BHS and BSS. Results: Suicidal ideation and thoughts of death were present in 38% epilepsy patients. Symptoms of depression as well as feelings of hopelessness were found in half of the participants (52% and 48%), and were significantly more common in epilepsy patients with suicidal ideation. There was a significant relation of suicidal ideation with the presence of chronic pain (3.86; p=0.49), sexual/physical abuse history (5.95, p=0.015), level of hopelessness (20.7; p=0.000) and severity of depression (14.48; p=0.000) in epilepsy patients. Multiple logistic regression analysis showed that unemployment (Exp(B) 33.9; p=0.007) and the level of hopelessness (Exp(B) 14.9; p=0.001) were independently related to suicidal ideation in these patients. Conclusions: The study has shown that the level of hopelessness and unemployment have a predictive value for appearance of suicidal ideation in epilepsy patients. In the prediction of suicidal ideation in this population of patients, there is no single variable that should be considered as specific and separate.
Key words: suicidal ideation – epilepsy – depression – hopelessness
* * * * * INTRODUCTION Suicidal behavior is an important worldwide health problem and consists of a wide spectrum of selfdestructive behavior including suicidal ideation, suicide attempts and suicide itself. Suicidal ideation is a medical term for thoughts, wishes and plans intended to result in suicide (Gliatto & Rai 1999) and can vary from passive ideas to ideas with detailed planning and intent on committing suicide. Psychiatric disorders, especially mood disorders, are the main risk factors for suicidal behavior. Suicide is more common in patients with depression, alcohol or other psychoactive substance abuse, schizophrenia, personality disorder, epilepsy and chronic pain diseases (Loga 1999). Suicide is an important cause of death in patients with epilepsy and the significance of epilepsy as a suicide risk factor varies in available studies. Suicide is present as a cause of death in 11% of patients with epilepsy which is significantly more than the rate of suicide in the general population of the USA (1.5%; 11.6/100 000) (Jones et al. 2003). The available literature shows that suicide rates in patients with epilepsy
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can vary from 0.7% to 24% (Jones et al. 2003, Robertson 1997). The aim of this study was to analyze the presence of suicidal ideation in patients with epilepsy.
SUBJECTS AND METHODS Subjects The study included 50 epilepsy patients selected randomly. The inpatients and outpatients who were examined had to meet the following criteria: to have a clinically established diagnosis of epilepsy, to have been treated at the Department of Neurology CCUS in the period from April 1st 2007 until October 1st 2007, to be older than 18 years of age, of both genders, and to have given signed voluntary consent to participate in the research. The protocol of this study was approved by the Ethics Committee of the Clinical Center of the University of Sarajevo and was carried out in accordance with the ethical standards laid down in the Declaration of Helsinki. All patients were voluntarily admitted and gave an informed consent.
Nataša Loga Andrijić, Azra Alajbegović, Svjetlana Loga Zec & Slobodan Loga: SUICIDAL IDEATION AND THOUGHTS OF DEATH IN EPILEPSY PATIENTS Psychiatria Danubina, 2014; Vol. 26, No. 1, pp 52–55
Methods Applied research instruments were: general questionnaire, constructed for the purposes of this study, Hamilton Rating Scale for Depression, 17-items version (HAM-D-17) (Hamilton 1960), The Beck Hopelessness Scale (BHS) (Beck et al. 1974) and the Beck Scale for Suicide Ideation (BSS) (Beck et al. 1988). All patients were administered a questionnaire to obtain information on the demographic and clinical characteristics of the patients, as well as questions for the assessment of suicide risk. Demographic variables (age, gender, marital status, level of education, employment status) and clinical characteristics of patients including types of seizures, age of onset, presence of chronic pain and used medications were collected. Suicide risk assessment included: the presence of a mental disorder, psychoactive substance abuse, recent stressful life events, sexual/physical abuse history, family history of suicide, and the level of social support. Depression was evaluated and confirmed by HAM-D17. Finally, all respondents were tested using the selfadministered BHS and BSS scales. By application of these tests, two groups of patients were formed: the first (experimental) group of epilepsy patients with suicidal thoughts, and the second (control) group of epilepsy patients without suicidal thoughts.
Statistical analysis Statistical analyses were conducted using SPSS computer software for statistical analysis, version 16.0. Results are presented in charts as a percentage, absolute value, odds ratio with corresponding 95% confidence intervals and the mean value (x) with standard deviation (SD). For the analysis of categorical variables the chisquare test was used. Multiple logistic regression analysis was used to determine the predictive value of each variable on the outcome of the dependent variable (suicidal ideation). P
