New Findings Reveal Suicidal Behavior in Children with Epilepsy
“Reports indicating a high rate of suicidal behavior in adults and adolescents with epilepsy and studies with evidence of high rates of depression in children with epilepsy prompted this study," said Rochelle Caplan,M.D., Professor and Director of Pediatric Neuropsychiatry, Department of Psychiatry and Biobehavioral Sciences at UCLA, today at the 58th annual American Epilepsy Society Conference (AES) in New Orleans. In the study Caplan et al. examined suicidal behavior in a large sample of children with epilepsy and the association with psychopathology, cognition, language and seizure variables.
167 children with epilepsy and 92 healthy children (aged 5-16) participated in the study. “The children in this study were recruited from the community and from UCLA solely based on their neurological diagnosis, either complex partial seizures or childhood absence epilepsy”, said Caplan. Of the 167 children with epilepsy, 99 had complex partial seizures and 68 had childhood absence epilepsy. Caplan et al. administered several measures to the children including the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) (Kaufman et. al. 1997), the Child Depression Inventory (Kovacs, 1985), the Multidimensional Anxiety Scale for Children (March et al.,1997), cognitive, and language testing. Parents were interviewed as well and completed the Child Behavior Checklist (Achenbach, 1991). In addition, parents provided demographic and seizure-related information.
What Caplan et al. found was that children with complex partial seizures or childhood absence epilepsy with average intelligence had significantly higher rates of psychiatric disorders than children in the general population (Caplan et al., 2004; Ott et al., 2001) and than what has been described among children with chronic illness (Davies et al., 2003). Furthermore, although none of the children with epilepsy in the study had made a suicide attempt, the children with epilepsy had a significantly higher rate of suicidal ideation/plan(20%) than the healthy group (9%). Among the 34 patients with suicidal ideation/plan, 79% had a DSM-IV diagnosis compared to 52% in those without suicidal ideation/plan. In terms of psychiatric diagnosis, 21% had disruptive disorders such as ADHD, 9% had major affective or anxiety disorders and 50% had a combination of disruptive and affective/anxiety diagnoses. Seizure, cognitive and linguistic variables were unrelated to the presence of suicidal ideation/plan.
When asked what the implications of this study are, Caplan stated “We tend to focus more on seizure control when treating children with epilepsy and do not acknowledge as much as we should the underlying psychological ramifications and the impact of epilepsy on behavior of kids.” Currently, psychiatric evaluations are not commonplace diagnostic tools used by pediatric neurologists. Caplan speculates that part of the reason for the lack of psychiatric evaluations in children with epilepsy is due in part to a lack of knowledge within the scientific community regarding suicidal ideation in the pediatric population. She believes children already manifesting suicidal ideation are at a greater risk for suicidality in adolescence and said, “This issue needs to be explored further and the scientific community needs to be made aware of the increases in suicidal ideation/plan and the association with severe psychopathology in children with epilepsy.”
A copy of this abstract is published in Epilepsia 2004, Vol. 45, Supplement 7, p.356-357.