@article{ref1,
title="Risk factors for self-harm in people with epilepsy",
journal="Journal of neurology",
year="2018",
author="Gorton, Hayley C. and Webb, Roger T. and Pickrell, W. Owen and Carr, Matthew J. and Ashcroft, Darren M.",
volume="265",
number="12",
pages="3009-3016",
abstract="OBJECTIVE: To estimate the risk of self-harm in people with epilepsy and identify factors which influence this risk. <br><br>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. <br><br>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). <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="0340-5354",
doi="10.1007/s00415-018-9094-2",
url="http://dx.doi.org/10.1007/s00415-018-9094-2"
}