@article{ref1,
title="Thoughts of death and self-harm in patients with epilepsy or multiple sclerosis in a tertiary-care center",
journal="Psychosomatics",
year="2014",
author="Dickstein, Leah P. and Viguera, Adele C. and Nowacki, Amy S. and Thompson, Nicolas R. and Griffith, Sandra D. and Baldessarini, Ross J. and Katzan, Irene L.",
volume="56",
number="1",
pages="44-51",
abstract="Background Patients with epilepsy or multiple sclerosis (MS) have high risks of depression and increased risks of suicide, but little is known about their risks of suicidal ideation. <br><br>OBJECTIVE We sought to: (1) estimate the prevalence of thoughts of being better off dead or of self-harm among patients with epilepsy or MS, (2) identify risk-factors for such thoughts, and (3) determine whether any risk-factors interact with depression to predict such thoughts. <br><br>METHODS A Cleveland Clinic database provided information on 20,734 visits of 6,586 outpatients with epilepsy or MS. Outcome measures were thoughts of death or self-harm (Patient Health Questionnaire [PHQ] item-9), and total score ≥10 for the 8 remaining PHQ items (probable major depression). Generalized estimating equations accounted for repeat visits in tests of associations of PHQ item-9 responses with depression, age, sex, race, household income, disease severity, and quality-of-life. <br><br>RESULTS Prevalence of thoughts of death or self-harm averaged 14.4% overall (epilepsy, 14.0% and MS, 14.7%). Factors associated with positive PHQ-item-9 responses in epilepsy were depression and male sex, modified by poor QOL. Factors associated with positive PHQ-item-9 in MS were depression, male sex, medical co-morbidity, and poor QOL; the effect of depression was worse with greater MS severity and being unmarried. <br><br>CONCLUSIONS Among patients with common neurological disorders (epilepsy or MS), 14%-15% reported thoughts of death or self-harm associated with illness-severity, depression, QOL, male sex, and being unmarried. Such patients require further evaluation of clinical outcomes and effects of treatment.<p />",
language="en",
issn="0033-3182",
doi="10.1016/j.psym.2014.05.008",
url="http://dx.doi.org/10.1016/j.psym.2014.05.008"
}