Risk factors for self-harm in people with epilepsy

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

Research output: Contribution to journalArticle

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, 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 3790 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.

Original languageEnglish
Pages (from-to)3009-3016
Number of pages8
JournalJournal of Neurology
Volume265
Issue number12
Early online date24 Oct 2018
DOIs
Publication statusPublished - 1 Dec 2018
Externally publishedYes

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Epilepsy
Anticonvulsants
Drug Synergism
Logistic Models
Delivery of Health Care
Proportional Hazards Models
England
General Practitioners
Comorbidity
Hospitalization
Cohort Studies
Therapeutics
Referral and Consultation
Mortality
Research

Cite this

Gorton, H. C., Webb, R. T., Pickrell, W. O., Carr, M. J., & Ashcroft, D. M. (2018). Risk factors for self-harm in people with epilepsy. Journal of Neurology, 265(12), 3009-3016. https://doi.org/10.1007/s00415-018-9094-2
Gorton, Hayley C. ; Webb, Roger T. ; Pickrell, W. Owen ; Carr, Matthew J. ; Ashcroft, Darren M. / Risk factors for self-harm in people with epilepsy. In: Journal of Neurology. 2018 ; Vol. 265, No. 12. pp. 3009-3016.
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Gorton, HC, Webb, RT, Pickrell, WO, Carr, MJ & Ashcroft, DM 2018, 'Risk factors for self-harm in people with epilepsy', Journal of Neurology, vol. 265, no. 12, pp. 3009-3016. https://doi.org/10.1007/s00415-018-9094-2

Risk factors for self-harm in people with epilepsy. / Gorton, Hayley C.; Webb, Roger T.; Pickrell, W. Owen; Carr, Matthew J.; Ashcroft, Darren M.

In: Journal of Neurology, Vol. 265, No. 12, 01.12.2018, p. 3009-3016.

Research output: Contribution to journalArticle

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Gorton HC, Webb RT, Pickrell WO, Carr MJ, Ashcroft DM. Risk factors for self-harm in people with epilepsy. Journal of Neurology. 2018 Dec 1;265(12):3009-3016. https://doi.org/10.1007/s00415-018-9094-2