Risk factors for self-harm in people with epilepsy

Gorton, Hayley C.; Webb, Roger T.; Pickrell, W. Owen; Carr, Matthew J.; Ashcroft, Darren M.; Pickrell, Owen

doi:10.1007/s00415-018-9094-2

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Risk factors for self-harm in people with epilepsy

Hayley C. Gorton, Roger T. Webb, W. Owen Pickrell, Matthew J. Carr, Darren M. Ashcroft, Owen Pickrell

Journal of Neurology

Swansea University Author: Owen Pickrell

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DOI (Published version): 10.1007/s00415-018-9094-2

Abstract

Objective:To estimate the risk of self-harm in people with epilepsy and identify factors which influence this risk.Methods: We identified people with incident epilepsy in the Clinical Practice Research Datalink (CPRD), linked to hospitalization and mortality data, in England (01/01/1998-03/31/2014)....

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Published in:	Journal of Neurology
ISSN:	0340-5354 1432-1459
Published:	2018
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URI:	https://cronfa.swan.ac.uk/Record/cronfa44846
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first_indexed	2018-10-11T13:29:03Z
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spelling	2018-10-26T14:08:33.9613597 v2 44846 2018-10-11 Risk factors for self-harm in people with epilepsy 1c3044b5ff7a6552ff5e8c9e3901c807 0000-0003-4396-5657 Owen Pickrell Owen Pickrell true false 2018-10-11 FGMHL Objective:To estimate the risk of self-harm in people with epilepsy and identify factors which influence this risk.Methods: We identified people with incident epilepsy in the Clinical Practice Research Datalink (CPRD), linked to hospitalization and mortality data, in England (01/01/1998-03/31/2014). In Phase 1, we estimated risk of self-harm among people with epilepsy, versus those without, in a matched cohort study using a stratified-Cox proportional hazards model. In Phase 2, we delineated a nested case-control study from the incident epilepsy cohort. People who had self-harmed (cases) were matched with up to 20 controls. From conditional logistic regression models, we estimated relative risk of self-harm associated with mental and physical illness comorbidity, contact with healthcare services and antiepileptic drug (AED) use.Results: Phase 1 included 11,690 people with epilepsy and 215,569 individuals without. We observed an adjusted hazard ratio of 5.31 (95% CI 4.08-6.89) for self-harm in the first year following epilepsy diagnosis and 3.31 (95% CI 2.85-3.84) in subsequent years. In Phase 2, there were 273 cases and 3,790 controls. Elevated self-harm risk was associated with mental illness (OR 4.08, 95% CI 3.06-5.42), multiple General Practitioner consultations, treatment with two AEDs versus monotherapy (OR 1.84, 95% CI 1.33-2.55) and AED treatment augmentation (OR 2.12, 95% CI 1.38-3.26). Conclusion: People with epilepsy have elevated self-harm risk, especially in the first year following diagnosis. Clinicians should adequately monitor these individuals and be especially vigilant to self-harm risk in people with epilepsy and comorbid mental illness, frequent healthcare service contact, those taking multiple AEDs and during treatment augmentation. Journal Article Journal of Neurology 0340-5354 1432-1459 Epilepsy, Self-harm, Case-control, Cohort, Epidemiology 31 12 2018 2018-12-31 10.1007/s00415-018-9094-2 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 2018-10-26T14:08:33.9613597 2018-10-11T08:23:09.1420571 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Hayley C. Gorton 1 Roger T. Webb 2 W. Owen Pickrell 3 Matthew J. Carr 4 Darren M. Ashcroft 5 Owen Pickrell 0000-0003-4396-5657 6 0044846-26102018140743.pdf 44846.pdf 2018-10-26T14:07:43.4070000 Output 792590 application/pdf Version of Record true 2018-10-24T00:00:00.0000000 Released under the terms of a Creative Commons Attribution 4.0 International License (CC-BY). true eng
title	Risk factors for self-harm in people with epilepsy
spellingShingle	Risk factors for self-harm in people with epilepsy Owen Pickrell
title_short	Risk factors for self-harm in people with epilepsy
title_full	Risk factors for self-harm in people with epilepsy
title_fullStr	Risk factors for self-harm in people with epilepsy
title_full_unstemmed	Risk factors for self-harm in people with epilepsy
title_sort	Risk factors for self-harm in people with epilepsy
author_id_str_mv	1c3044b5ff7a6552ff5e8c9e3901c807
author_id_fullname_str_mv	1c3044b5ff7a6552ff5e8c9e3901c807_***_Owen Pickrell
author	Owen Pickrell
author2	Hayley C. Gorton Roger T. Webb W. Owen Pickrell Matthew J. Carr Darren M. Ashcroft Owen Pickrell
format	Journal article
container_title	Journal of Neurology
publishDate	2018
institution	Swansea University
issn	0340-5354 1432-1459
doi_str_mv	10.1007/s00415-018-9094-2
college_str	Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id	facultyofmedicinehealthandlifesciences
hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id	facultyofmedicinehealthandlifesciences
hierarchy_parent_title	Faculty of Medicine, Health and Life Sciences
department_str	Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str	1
active_str	0
description	Objective:To estimate the risk of self-harm in people with epilepsy and identify factors which influence this risk.Methods: We identified people with incident epilepsy in the Clinical Practice Research Datalink (CPRD), linked to hospitalization and mortality data, in England (01/01/1998-03/31/2014). In Phase 1, we estimated risk of self-harm among people with epilepsy, versus those without, in a matched cohort study using a stratified-Cox proportional hazards model. In Phase 2, we delineated a nested case-control study from the incident epilepsy cohort. People who had self-harmed (cases) were matched with up to 20 controls. From conditional logistic regression models, we estimated relative risk of self-harm associated with mental and physical illness comorbidity, contact with healthcare services and antiepileptic drug (AED) use.Results: Phase 1 included 11,690 people with epilepsy and 215,569 individuals without. We observed an adjusted hazard ratio of 5.31 (95% CI 4.08-6.89) for self-harm in the first year following epilepsy diagnosis and 3.31 (95% CI 2.85-3.84) in subsequent years. In Phase 2, there were 273 cases and 3,790 controls. Elevated self-harm risk was associated with mental illness (OR 4.08, 95% CI 3.06-5.42), multiple General Practitioner consultations, treatment with two AEDs versus monotherapy (OR 1.84, 95% CI 1.33-2.55) and AED treatment augmentation (OR 2.12, 95% CI 1.38-3.26). Conclusion: People with epilepsy have elevated self-harm risk, especially in the first year following diagnosis. Clinicians should adequately monitor these individuals and be especially vigilant to self-harm risk in people with epilepsy and comorbid mental illness, frequent healthcare service contact, those taking multiple AEDs and during treatment augmentation.
published_date	2018-12-31T03:56:18Z
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score	11.013686

Risk factors for self-harm in people with epilepsy

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