Gender differences in risk factors of suicidal behavior in epilepsy
Introduction
The suicide rate among epileptic patients is 5 times higher, and for those with temporal lobe epilepsy and complex partial seizures about 25 times higher, than in the general population [1], [2], [3]. Concomitant depression usually is the main causal factor in suicidal behavior in epilepsy, and the incidence of affective disorders in the epilepsy population ranges from 11 to 65% [4], whereas feelings of depression have been reported in up to 80% of patients [5]. Although the incidence of depression is not higher in any specific subtype of epilepsy, left-sided foci are thought to be more important in terms of risk factors [4].
Exact data on suicide risk factors in epilepsy remain scarce, controversial, and even speculative [3], [6]. Thus, Mendez et al. [7] consider interictal psychopathology to be the main risk factor for self-poisoning, and psychosocial circumstances as not causative. The so-called intermittent interictal dysphoric disorder described by Kraepelin may be considered a variant of psychopathology that causes suicidal behavior [8], [9], although dysphoria and depression are not the same disorder.
On the other hand, Diehl [10] points to such risk factors for suicides as (1) psychiatric disorders; (2) relatively young age in males (25–49 years); (3) generalized and temporal lobe seizures (with brain lesions); (4) prolonged duration of seizures and inadequate therapy; (5) personal and social difficulties; and (6) availability of large amounts of antiepileptic drugs.
In the general population, suicides are usually completed more frequently by males than females (ratio 3:1), whereas women attempt, but do not complete, suicides more frequently than men (ratio 2:1) [2].
Gender discrepancies in any signs and variables are thought to reflect evolutionary development in all species and Homo sapiens in particular [11]. According to this hypothesis, the appearance of any genetic and subsequently phenotypic signs in males usually precedes the appearance of similar signs in females. In other words, the prevalence in females of any sign, syndrome, disease, or behavior pattern points to an ancient origin for these variables, whereas their prevalence in males indicates they are new signs that will dominate in the future [11]. It is well known that depression and affective disorders are more frequent among females than males [12].
Another example of gender difference in the epilepsy domain concerns the so-called propulsive petit mal epilepsy, which is more typical of boys than girls. On the contrary, retropulsive petit mal seizures occur more frequently in girls [13]. Similarly, so-called photosensitive epilepsy is more typical of girls than boys (ratio 2:1) [14], [15]. On the other hand, the frequencies of Lennox–Gastaut syndrome, West syndrome, Landau–Kleffner syndrome, awakening epilepsy, and myoclonic absence epilepsy are higher in boys than girls [15].
The differences between epileptic patients who attempt suicide and those who complete the act have not been specified and gender ratios in epileptics with respect to suicidal behavior are lacking. Moreover whether there exist gender discrepancies in suicidal risk factors in epileptic patients has not been thoroughly established yet. Not only psychopathology but the basic variables of epilepsy itself are involved.
Section snippets
Objective
The principal aim of this study was to determine possible suicide risk factors associated with gender within the basic characteristics of epilepsy such as type of seizure, duration of disease, kind and daily dose of AED, and comorbid psychopathological disorders in epileptic patients. The role of psychosocial factors in suicidal behavior was not studied. The main a priori hypothesis was that there are discrepancies between male and female with respect to risk factors for suicide.
Methods
For assessment purposes, a special scale for rating suicide was designed. On this scale, 0 = lack of suicidal experience, 1 = suicidal thoughts without attempts, 2 = attempted but not completed suicide, and 3 = completed suicide.
One hundred five epileptic patients were selected for study and subdivided into three groups. The first group (37 persons) comprised patients who had attempted suicide; 35 had attempted but not completed, and 2 persons had completed suicide. All those who survived attempts were
Statistics
All data were statistically processed on a personal computer using the program Statistica, sixth version. The χ2 test (with Yates correction) was used for analysis of a possible association between the diagnosis of organic affective disorder and cognitive deterioration, on the one hand, and suicidal behavior, on the other hand.
Spearman rank correlations were calculated between the basic variables of epilepsy and degree of suicidality for joint groups of patients (regardless of gender) and
Results
The main results are summarized in Table 2, Table 3. There was a relationship between diagnosis of organic affective disorder and suicidality in the joint group (men and women) and the women-only group, but not in the men-only group (Table 2). In other words, so-called organic affective disorder determines suicidality only in females, not in males. Interestingly, the ratio of the odds committing suicide in patients with organic depression to the odds in those without depression in the joint
Discussion
Several aspects of the current study can be criticized. First, the study comprised mostly patients who had attempted or planned suicide; only two persons had completed suicide. Certain discrepancies in psychopathological experience are believed to exist between persons who attempt (plan) and those who complete suicide. To overcome such contradictions, a scale was designed to rate suicidal behavior. Attempted suicide should be considered the preliminary stage to completed suicide, whereas
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