Correlates of schizophrenia spectrum disorders in children and adolescents cared for in community settings

BACKGROUND: This study examined the prevalence and correlates of schizophrenia spectrum disorders (SSD) among a national sample of 9006 children. METHODS: Clinician-assigned diagnoses were used to divide the sample into two groups: children with SSD and children with other Axis I disorders. RESULTS: Three percent of the sample had a SSD diagnosis. African American (OR=1.71, 95% CI: 1.11, 2.65) and Hispanic race/ethnicity (OR=1.96, 95% CI: 1.31, 2.94), a greater number of comorbid psychiatric diagnoses (three diagnoses, OR=2.22, 95% CI: 1.49, 3.31), a history of attempting suicide (OR=1.45; 95% CI: 1.05, 2.02), and past residential treatment (OR=1.59; 95% CI: 1.11, 2.28) were all associated with increased odds of SSD diagnosis. CONCLUSIONS: Although schizophrenia spectrum disorders in youth are rare, children with these disorders present with a distinct risk profile that may inform service planning and delivery and assist in identifying individuals early in the course of their illness.     

Preterm birth or foetal growth impairment and psychiatric hospitalization in adolescence and early adulthood in a Swedish population-based birth cohort

Objective: Preterm birth and restricted foetal growth are related to symptoms of psychiatric disorder. Our aim was therefore to investigate possible relations between being born preterm and/or small for gestational age (SGA) and later psychiatric hospitalization. Method: A population‐based registry study of psychiatric hospitalization of in total 155 994 boys and 148 281 girls born in Sweden in 1973–1975. Results: The risk of hospitalization for all mental disorders was increased for preterm SGA boys (OR 2.19, 95% CI 1.49–3.21); at‐term SGA boys (OR 1.55, 95% CI 1.34–1.79); at‐term SGA girls (OR 1.31, 95% CI 1.15–1.50). At‐term SGA boys and girls suffered increased risk of anxiety and adjustment disorders (OR 1.70, 95% CI 1.18–2.45 and OR 1.49, 95% CI 1.14–1.94). Preterm SGA boys were at risk of personality disorders (OR 3.30, 95% CI 1.16–9.41) and psychotic disorders (OR 4.36, 95% CI 1.85–10.30). Conclusion: The results show a relationship between being born SGA and later psychiatric hospitalization, where preterm birth and male gender seem to increase the risk.     

Association between cannabis and psychiatric hospitalization

Schubart CD, Boks MPM, Breetvelt EJ, van Gastel WA, Groenwold RHH, Ophoff RA, Sommer IEC, Kahn RS. Association between cannabis and psychiatric hospitalization. Objective: To investigate the relationship between cannabis use and mental health. Method: A cross‐sectional analysis in a sample of 17 698 individuals with a mean age of 22 years (SD: 4.2). Participants provided information on the amount and initial age of cannabis use and history of psychiatric hospitalizations through a web‐based questionnaire. To quantify Δ⁹‐tetrahydrocannabinol exposure, we operationalized cannabis use as the amount of money spent on cannabis per week over the last month. The odds ratio of having a history of psychiatric hospitalizations was the primary outcome measure. Results: We found a dose–response relationship between the amount of cannabis use and the odds for psychiatric hospitalization. Adjusted odds ratios for hospitalization increased with the amount of cannabis consumed from 1.6 (95% CI: 1.1–2.3) in incidental users to 6.2 (95% CI: 4.3–8.9) in heavy users (>€25/week). Our data suggested that concomitant drug use was an intermediate factor. Exposure to cannabis before the age of 12 years was found to carry a 4.8 (95% CI: 2.9–7.8) times increased odds for past psychiatric hospitalizations. Conclusion: We conclude that early and heavy uses of cannabis are each and independently associated with poor mental health in its users.     

Psychiatric disorders among the HIV-positive population in Nigeria: a control study

OBJECTIVE: This article estimates the point prevalence of psychiatric disorders in a sample of HIV-positive subjects in Nigeria in comparison with normal HIV-negative controls and evaluates the possible sociodemographic and clinical correlates of psychiatric disorders in HIV-positive subjects. METHODS: HIV-positive subjects (n=88) and HIV-negative healthy controls (n=87) were assessed for their current diagnosis of DSM-IV psychiatric disorders via the Mini International Neuropsychiatric Interview. Sociodemographic and clinical details were also obtained. RESULTS: The rate of psychiatric disorders in subjects with HIV was 59.1% compared to 19.5% in subjects without HIV infection [odds ratio (OR)=5.95, 95% confidence interval (CI)=3.02-11.75]. The subjects with HIV had significantly higher rates of affective disorders (OR=3.58, 95% CI=1.44-8.94), anxiety disorders (OR=3.57, 95% CI=1.65-7.72), and psychotic disorders (OR=1.10, 95% CI=1.01-1.12) than healthy controls. The factors significantly associated with psychiatric disorders include poor level of social support and stage of the disease. CONCLUSION: Psychiatric disorders are common in our Nigerian subjects with HIV, and the rates are significantly higher when compared to the healthy general population. Proactive identification and treatment of mental disorders should be integrated into HIV intervention policies in this region.     

Association of childhood family environments with the risk of social withdrawal ('hikikomori') in the community population in Japan

Aims: Hikikomori is a form of social withdrawal among those who retreat from social interaction for protracted periods of time. This study examines family‐related childhood factors for hikikomori using the retrospective data derived from a population‐based survey. Methods: We derived data from World Mental Health Survey Japan. The subjects of this study were community residents aged 20–49 years (n = 708). Multiple logistic regression was applied to examine the association between the lifetime experience of hikikomori and childhood family environment, adjusting for sex, age, and respondents' history of common mental disorders. Results: Father's high educational level (odds ratio [OR] = 6.0, 95% confidence interval [CI] = 1.6–22.9), mother's common mental disorders (OR = 5.9, 95%CI = 1.1–33.3), and mother's panic disorders (OR = 6.6, 95%CI = 1.1–39.1) were significantly and positively associated with hikikomori after controlling for respondents' sex, age, and history of mental disorders. Conclusions: Our findings suggest that hikikomori cases are more likely to occur in families where the parents have high levels of education. Maternal panic disorder may be another risk factor for children to develop hikikomori.     

Predictors of psychiatric comorbidity in cancer patients at the time of their discharge from the hospital

Purpose

A cancer diagnosis can have a substantial impact on one’s mental health. The present study investigated the prevalence and predictors of psychiatric comorbidities in cancer patients at the time of their discharge from the hospital.

Methods

Psychiatric comorbidities were assessed shortly before hospital discharge and half a year after hospitalization using a structured clinical interview (SCID), based on the diagnostic and statistical manual of mental disorders (DSM-IV). Frequencies at both time points were estimated using percentages and corresponding 95% confidence intervals. Predictors of mental disorders were identified using binary logistic regression models.

Results

At time of hospital discharge, 39 out of 334 patients (12%) were diagnosed with a psychiatric comorbidity, and 15 (7%) were diagnosed half a year later. Among the diagnoses, adjustment disorders (3%) were most frequent at the time of hospital release, while major depression (3%) was the most frequent 6 months later. Having a mental disorder was associated with unemployment (odds ratio (OR) 3.4, confidence interval (CI) 1.1–10.9, p = 0.04). There was no evidence that school education (OR 2.0, CI 0.4–9.0, p = 0.38), higher education (OR 0.7, CI 0.2–2.4, p = 0.60), income (OR 1.0, CI 1.0–1.0, p = 0.06), tumor stage (OR 1.1, CI 0.4–3.2, p = 0.85), type of disease (OR 0.6, CI 0.2–2.1, p = 0.47), pain (OR 1.0, CI 1.0–1.0, p = 0.15), fatigue (OR 1.0, CI 1.0–1.0, p = 0.77), or physical functioning (OR 1.0, CI 1.0–1.0, p = 0.54) were related to the presence of a psychiatric comorbidity.

Conclusions

Unemployment was associated with at least a threefold increased risk of mental disorder, which highlights the need for special attention to be given to this subgroup of cancer patients.

     

Variations in pharmacotherapy for attention deficit hyperactivity disorder in managed care

The purpose of this study was to identify the patterns of pharmacotherapy in the treatment of children diagnosed with attention deficit hyperactivity disorder (ADHD) in a large, non-profit, group-model managed care organization from January 1997 through July 1998. We sought to determine whether children with uncomplicated ADHD use different drug therapies when compared to children with ADHD and psychiatric comorbidity. We also examined the relationships between the use of specialty mental health services and the use of various psychotropic medications for treatment of ADHD. We found that children with ADHD and psychiatric comorbidity were less likely to use psychostimulants (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.55-0.93, p = 0.01) but more likely to use antidepressants (OR = 2.74, 95% CI = 1.95-3.86, p < 0.01), alpha adrenergic agonists (OR = 2.63, 95% CI = 1.93-3.57, p < 0.01), and other psychotropic medications (OR = 2.40, 95% CI = 1.27-4.50, p < 0.01) than children with uncomplicated ADHD (who were more likely to use stimulants only). Additionally, children with psychiatric comorbidity were more likely to use multiple psychotropic drugs (p < 0.01). The results of this study indicate that children with potentially more complex mental health needs are being treated with more varied drug therapy and/or specialty mental health care services.     

Increased occurrence of left-handedness after severe childhood bacterial meningitis: support for the pathological left-handedness hypothesis

The hypothesis that brain damage during infancy causes pathological left-handedness was tested by assessing handedness in 182 survivors of childhood non-Hemophilus influenza type b bacterial meningitis in the Netherlands (mean age of 9.7 years). These children were selected randomly after clustering them into those with or without parental report on academic and behavioural problems. Medical records were obtained from the hospitals, while handedness and neurodevelopmental outcome were assessed at school age. Logistic regression analysis was used to study the relationship between a severity score of bacterial meningitis and handedness. Fifteen percent were left-handed. Severity of childhood bacterial meningitis was related to left-handedness (Odds ratio (OR) 6.2, 95% confidence interval (CI) 2.0-18.6 for those with a total severity score above the median as compared to those below). Compared to non-left-handed children, left-handed children had lower IQ (mean difference -6.6, 95% CI -12 to -1.2), tended to have lower vocabulary scores on WISC-r (-1.0, -2.1 to 0), and lower Beery scores on visual-motor integration (-4.9, -10.1 to 0.4). Left-handed children also tended to have more combined academic and behavioural limitations (OR 2.7, 95% CI 0.9-8.6), lower manual speed of the dominant hand (mean difference -9 taps, p < 0.05) and better manual steadiness in the non-dominant hand (mean difference of contact's time -2.7 s, p < 0.05). Left-handed post-meningitic children generally have worse neurodevelopmental outcome than non-left-handed survivors. Our results support the role of early life brain damage in left-handedness.     

Military Psychiatry

Objective: Rape is associated with posttraumatic stress disorder (PTSD) and related comorbidities. Most victims do not obtain treatment for these conditions. Acute care medical settings are well positioned to link patients to services; however, difficulty engaging victims and low attendance at provided follow-up appointments is well documented. Identifying factors associated with follow-up can inform engagement and linkage strategies. Method: Administrative, patient self-report, and provider observational data from Harborview Medical Center were combined for the analysis. Using logistic regression, we examined factors associated with follow-up health service utilization after seeking services for rape in the emergency department. Results: Of the 521 diverse female (n = 476) and male (n = 45) rape victims, 28% attended the recommended medical/counseling follow-up appointment. In the final (adjusted) logistic regression model, having a developmental or other disability (OR = 0.40, 95% CI = 0.21–0.77), having a current mental illness (OR = 0.25, 95% CI = 0.13–0.49), and being assaulted in public (OR = 0.50, 95% CI = 0.28–0.87) were uniquely associated with reduced odds of attending the follow-up. Having a prior mental health condition (OR = 3.02, 95% CI = 1.86–4.91), a completed Sexual Assault Nurse Examiner’s (SANE) examination (OR = 2.97, 95% CI = 1.84–4.81), and social support available to help cope with the assault (OR = 3.54, 95% CI = 1.76–7.11) were associated with an increased odds of attending the follow-up. Conclusions: Findings point to relevant characteristics ascertained at the acute care medical visit for rape that may be used to identify victims less likely to obtain posttraumatic medical and mental health services. Efforts to improve service linkage for these patients is warranted and may require alternative service delivery models that engage rape survivors and support posttraumatic recovery.     

Association between nonpsychotic psychiatric diagnoses in adolescent males and subsequent onset of schizophrenia

BACKGROUND: Nonpsychotic psychiatric symptoms may occasionally herald the later development of schizophrenia. This study followed a population-based cohort of adolescents with nonpsychotic, non-major affective psychiatric disorders to ascertain future hospitalization for schizophrenia. METHODS: Results of the medical and mental health assessments on 124 24416- to 17-year-old males screened by the Israeli draft board were cross-linked with the National Psychiatric Hospitalization case registry, which contains data on all psychiatric hospitalizations in the country, during a 4- to 8-year-long follow-up through age 25 years. In the cohort, 9365 adolescents were assigned a nonpsychotic, non-major affective diagnosis by the draft board. RESULTS: After excluding 167 adolescents who were hospitalized before or up to 1 year after the draft board assessment, 1.03% of the adolescents assigned a nonpsychotic, non-major affective psychiatric diagnosis, compared with only 0.23% of the adolescents without any psychiatric diagnosis, were later hospitalized for schizophrenia. Of the patients with schizophrenia, 26.8%, compared with only 7.4% in the general population, had been assigned a nonpsychotic, non-major affective psychiatric diagnosis in adolescence (overall odds ratio [OR], 4.5; 95% confidence interval [CI], 3.6-5.6), ranging from OR, 21.5 (95% CI, 12.6-36.6) for schizophrenia spectrum personality disorders to OR, 3.6 (95% CI, 2.1-6.2) for neurosis. CONCLUSION: These results reflect the relatively common finding of impaired functioning in patients later hospitalized for schizophrenia and the relatively low power of these disorders in predicting schizophrenia.     

Psychiatric diagnoses in 3275 suicides: a meta-analysis

Background

It is well known that most suicide cases meet criteria for a psychiatric disorder. However, rates of specific disorders vary considerably between studies and little information is known about gender and geographic differences. This study provides overall rates of total and specific psychiatric disorders in suicide completers and presents evidence supporting gender and geographic differences in their relative proportion.

Methods

We carried out a review of studies in which psychological autopsy studies of suicide completers were performed. Studies were identified by means of MEDLINE database searches and by scanning the reference list of relevant publications. Twenty-three variables were defined, 16 of which evaluating psychiatric disorders. Mantel-Haenszel Weighted Odds Ratios were estimated for these 16 outcome variables.

Results

Twenty-seven studies comprising 3275 suicides were included, of which, 87.3% (SD 10.0%) had been diagnosed with a mental disorder prior to their death. There were major gender differences. Diagnoses of substance-related problems (OR = 3.58; 95% CI: 2.78–4.61), personality disorders (OR = 2.01; 95% CI: 1.38–2.95) and childhood disorders (OR = 4.95; 95% CI: 2.69–9.31) were more common among male suicides, whereas affective disorders (OR = 0.66; 95% CI: 0.53–0.83), including depressive disorders (OR = 0.53; 95% CI: 0.42–0.68) were less common among males. Geographical differences are also likely to be present in the relative proportion of psychiatric diagnoses among suicides.

Conclusions

Although psychopathology clearly mediates suicide risk, gender and geographical differences seem to exist in the relative proportion of the specific psychiatric disorders found among suicide completers.

     

Relationship between abdominal pain subgroups in the community and psychiatric diagnosis and personality. A birth cohort study

INTRODUCTION: It is unclear if there is a causal link between psychiatric disorders and unexplained chronic gastrointestinal (GI) symptomatology. The role of personality is also in dispute. We aimed to assess the association of these factors with functional GI symptoms in a birth cohort study. METHODS: The Dunedin birth cohort is well characterised and has been followed-up prospectively to age 26 (n=980). Measured were upper and lower GI symptoms over the prior year at age 26 using a validated questionnaire, psychiatric diagnoses at ages 18 and 21 by standardised interview applying DSM-III-R criteria, and personality at age 18 using the Multidimensional Personality Questionnaire (MPQ). Natural symptom groupings were identified using factor analysis and k-means clustering. The association of these clusters and psychiatric diagnoses or personality was assessed by logistic regression. RESULTS: The k-means analysis produced a six-cluster solution, which was made up of a health group, and five "disease" clusters defined by higher than average scores on a single symptom. A diagnosis of depression at age 18 or 21 years was associated with increases in the odds of 1.69 (95% CI: 1.27-2.25) for all GI, of 2.16 (95% CI: 1.12-4.16) for dysmotility and of 2.07 (95% CI: 1.13-3.80) for constipation, but not with the other clusters. Similar results were observed with respect to anxiety disorders for the odds of GI overall (OR=1.42, 95% CI: 1.01-1.99) and constipation (OR=2.11, 95% CI: 1.17-3.79). The personality subscales were not strongly linked; membership of "any" diseased cluster was associated with a reduced odds of being in the fourth quartile for the well-being scale (OR=0.64, 95% CI: 0.46-0.88) but increased odds of being in the fourth quartile for the social potency scale (OR=1.64, 95% CI: 1.18-2.28). CONCLUSIONS: In a young adult community sample, unexplained GI symptoms appear to be linked to psychiatric disorders but personality differences were minimal.     

Morbidity associated with sleep disorders in primary care: a longitudinal cohort study

Objective: Few epidemiologic studies evaluate the relative contribution of different risk factors on sleep problems. The aim of the present study was to assess demographics, comorbid characteristics, and health outcomes in patients with sleep disorders.Method: A population-based cohort study with nested case-control analysis was conducted in adults using the U.K. General Practice Research Database. Information was collected for 12,437 patients with a new sleep disorder diagnosis during the year 1996 and 18,350 age- and sex-matched controls. Logistic regression analysis was used to compute odds ratios (OR) and 95% confidence intervals (CI).Results: The incidence of a new sleep disorder diagnosis was 12.5 per 1000 person-years. There was a clear association of sleep disorders with smoking and excessive alcohol consumption; prior psychiatric disorders, including stress (OR = 3.6, 95% CI = 2.9 to 4.4) and depression (OR = 3.1, 95% CI = 2.8 to 3.3); prior circulatory diseases, including heart failure (OR = 1.8, 95% CI = 1.4 to 2.2) and coronary heart disease (OR = 1.4, 95% CI = 1.2 to 1.6); and prior gastrointestinal diseases, including gastroesopha-geal reflux disease (OR = 1.4, 95% CI = 1.2 to 1.7) and irritable bowel syndrome (OR = 1.5, 95% CI = 1.2 to 1.9). Use of hypnotics and anti-depressants was increased in the year after diagnosis. Relative 1-year mortality risk was 3-fold higher in the sleep disorder group than in controls, with a noticeably higher proportion of deaths due to suicide.Conclusion: The fact that sleep disorders were associated with several morbidities, most strongly with psychiatric disorders as well as with increased mortality, underscores the importance of sleep problems as indicators of health status.     

Suicidal and death ideation in Parkinson's disease

Parkinson's disease (PD) is a chronic, disabling illness affecting primarily the elderly and is associated with a high prevalence of depression. Although these are known risk factors for suicidal and death ideation, little is known about the prevalence and correlates of such ideation in PD. A convenience sample of 116 outpatients with idiopathic PD at two movement disorders centers were administered a modified Paykel Scale for suicidal and death ideation, as well as an extensive psychiatric, neuropsychological, and neurological battery. Univariate and multivariate logistic regression models were used to determine the correlates of suicidal or death ideation. Current death ideation (28%) or suicide ideation (11%) were present in 30% of the sample, and 4% had a lifetime suicide attempt. On univariate logistic regression analysis, increasing severity of depression (odds ratio = 2.92, 95% CI 2.01–4.24, P < 0.001), impulse control disorder (ICD) behaviors sometime during PD (odds ratio = 6.08, 95% CI 1.90–19.49, P = 0.002), and psychosis (odds ratio = 2.45, 95% CI 1.05–5.69, P = 0.04) were associated with either ideation. On multivariate logistic regression analysis, only increasing severity of depressive symptoms (odds ratio = 2.76, 95% CI 1.88–4.07, P < 0.001) predicted suicidal or death ideation. In conclusion, active suicidal or death ideation occurs in up to one‐third of PD patients. Comorbid psychiatric disorders, more than PD‐related disease variables, are associated with this ideation, highlighting the need for a comprehensive approach to the clinical care of PD patients. © 2008 Movement Disorder Society     

A population study of the association between sleep disturbance and suicidal behaviour in people with mental illness

Limited representative research has considered the relationship between sleep disturbance and suicidal behaviour among people with mental illness. We investigated the relationship between sleep disturbance and suicidal behaviour across Part II interview of the National Comorbidity Survey Replication (NCSR). The associations between sleep disturbance and suicidal behaviour (thoughts, plans and attempts) were investigated using logistic and multinomial logistic regressions and stratified across six mental disorder groups (depression, anxiety, substance use disorders (SUD), eating disorders (ED), bipolar disorders (BD) and early life disorders). From 5701 participants (mean age 43.4 years 58% women), people with any mental disorder experiencing sleep disturbance were at increased odds of suicidal thoughts (odds ratio (OR): 2.5; 95% CI: 1.7, 3.6) and suicidal plans and attempts (OR: 5.7; 95% CI: 2.7, 11.9) adjusting for age, sex and income. People with BD (OR: 8.9; 95 CI: 2.1, 38.1), early life disorders (OR 6.98, 95% ci 2.48, 19.67), depression (OR 1.88, 95% CI 1.14, 3.11), anxiety (OR 1.90, 95% CI 1.28, 2.85) and SUD (2.60, 95% CI 1.23, 5.49) but not ED, were at increased odds of suicidal thoughts in the presence of sleep disturbance. Adjusting for anti-depressant intake attenuated the effect sizes by up to 20% but the associations remained significant. In conclusion, sleep disturbance is a potential risk factor for suicidal behaviours in people with mental illness. Monitoring and management of sleep disturbance in clinical practice might be an important strategy to mitigate suicidal behaviours in people with mental illness.     

Is sexual orientation related to mental health problems and suicidality in young people?

BACKGROUND: This study examines the extent to which gay, lesbian, and bisexual young people are at increased risk of psychiatric disorder and suicidal behaviors using data gathered on a New Zealand birth cohort studied to age 21 years. METHODS: Data were gathered during the course of the Christchurch Health and Development Study, a 21-year longitudinal study of a birth cohort of 1265 children born in Christchurch, New Zealand. At 21 years of age, 1007 sample members were questioned about their sexual orientation and relationships with same-sex partners since the age of 16 years. Twenty-eight subjects (2.8%) were classified as being of gay, lesbian, or bisexual sexual orientation. Over the period from age 14 to 21 years, data were gathered on a range of psychiatric disorders that included major depression, generalized anxiety disorder, conduct disorder, and substance use disorders. Data were also gathered on suicidal ideation and suicide attempts. RESULTS: Gay, lesbian, and bisexual young people were at increased risks of major depression (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.8-9.3), generalized anxiety disorder (OR, 2.8; 95% CI, 1.2-6.5), conduct disorder (OR, 3.8; 95% CI, 1.7-8.7), nicotine dependence (OR, 5.0; 95%, CI, 2.3-10.9), other substance abuse and/or dependence (OR, 1.9; 95% CI, 0.9-4.2), multiple disorders (OR, 5.9; 95% CI, 2.4-14.8), suicidal ideation (OR, 5.4; 95% CI, 2.4-12.2), and suicide attempts (OR, 6.2; 95% CI, 2.7-14.3). CONCLUSIONS: Findings support recent evidence suggesting that gay, lesbian, and bisexual young people are at increased risk of mental health problems, with these associations being particularly evident for measures of suicidal behavior and multiple disorder.     

Impact of the New Mental Health Services on Rates of Suicide and Hospitalisations by Attempted Suicide,Psychiatric Problems,and Alcohol Problems in Brazil

A sizeable proportion of all suicides have mental health issues in the background. The association between access to mental health care in the community and decreased suicide rates is inconsistent in the literature. Brazil undertook a major psychiatric reform strengthening psychiatric community-based care. To evaluate the impact of the new Brazilian community mental health care units (CAPS-Psychosocial-Community-Centres) on municipal rates of suicide, and hospitalisations by attempted suicide, psychiatric and alcohol problems. We performed robust multivariable negative binomial regression models with fixed effect for panel data from all 5507 Brazilian municipalities. Suicide and hospitalization rates were calculated by sex and standardised by age for each municipality and year from 2008 to 2012. The main variable of interest was municipal CAPS coverage. CAPS municipal coverage was associated with lower suicide rates but this was not statistically significant (RR: 0.981; 95% CI 0.952–1.011). However, increased CAPS coverage was associated with lower hospitalizations for attempted suicide (RR: 0.887; 95% CI 0.841–0.935), psychiatric (RR: 0.841; 95% CI 0.821–0.862), and alcohol problems (RR: 0.882; 95% CI 0.860–0.904). Our results suggest that access to community mental health services seems to reduce hospitalisations due to attempted suicide, psychiatric and alcohol problems but not suicidal rates. Therefore, increased investments in community mental health services in low-middle-income countries might decrease costs associated with potentially avoidable hospitalizations.     

Psychiatric comorbidity and suicidal behavior in epilepsy: A community‐based case–control study

Purpose: To provide information about psychiatric comorbidity and suicidal behavior in people with epilepsy compared to those without epilepsy from a community sample in Brazil. Methods: An attempt was made to evaluate all 174 subjects with epilepsy (cases) identified in a previous survey. For every case identified, an individual without epilepsy (control) matched by sex and age was selected in the same neighborhood. A structured interview with validated psychiatric scales was performed. One hundred and fifty‐three cases and 154 controls were enrolled in the study. Results: People with epilepsy had anxiety more frequently [39.4% vs. 23.8%, odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2–3.5; p = 0.006], depression (24.4% vs. 14.7%, OR 1.9, 95% CI 1.01–3.5; p = 0.04), and anger (55.6% vs. 39.7%, OR 1.9, 95% CI 1.2–3.1; p = 0.008). They also reported more suicidal thoughts [36.7% vs. 23.8%, OR 1.8, 95% CI 1.1–3.1; p = 0.02), plans (18.2% vs. 3.3%, OR 2.0, 95% CI 1.0–4.0; p = 0.04), and attempts (12.1% vs. 5.3%, OR 2.4, 95% CI 1.1–3.2, p = 0.04) during life than controls. Conclusions: These findings call attention to psychiatric comorbidity and suicidal behavior associated with epilepsy. Suicide risk assessment, mental evaluation, and treatment may improve quality of life in epilepsy and ultimately prevent suicide.