Premature mortality in epilepsy and the role of psychiatric comorbidity: a total population study
Open accessAbstract
Background Epilepsy is associated with high rates of premature mortality, but the contribution of psychiatric comorbidity is uncertain. We assessed the prevalence and risks of premature mortality from external causes such as suicide, accidents, and assaults in people with epilepsy with and without psychiatric comorbidity.Methods We studied all individuals born in Sweden between 1954 and 2009 with inpatient and outpatient diagnoses of epilepsy (n=69,995) for risks and causes of premature mortality. Patients were compared with age-matched and sex-matched general population controls (n=660,869) and unaffected siblings (n=81,396). Sensitivity analyses were done to investigate whether these odds differed by sex, age, seizure types, comorbid psychiatric diagnosis, and different time periods after epilepsy diagnosis.Results 6155 (8.8%) people with epilepsy died during follow-up, at a median age of 34·5 (IQR 21·0-44·0) years with substantially elevated odds of premature mortality (adjusted odds ratio [aOR] of 11·1 [95% CI 10·6-11·6] compared with general population controls, and 11·4 [10·4-12·5] compared with unaffected siblings). Of those deaths, 15·8% (n=972) were from external causes, with high odds for non-vehicle accidents (aOR 5·5, 95 % CI 4·7-6·5) and suicide (3·7, 3·3-4·2). Of those who died from external causes, 75·2% had comorbid psychiatric disorders, with strong associations in individuals with co-occurring depression (13·0, 10·3-16·6) and substance misuse (22·4, 18·3-27·3), compared with patients with no epilepsy and no psychiatric comorbidity.Interpretation Reducing premature mortality from external causes of death should be a priority in epilepsy management. Psychiatric comorbidity plays an important part in the premature mortality seen in epilepsy. The ability of health services and public health measures to prevent such deaths requires review.Funding Wellcome Trust, the Swedish Prison and Probation Service, and the Swedish Research Council.
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Depression, bipolar disorder, schizophrenia-spectrum disorders, substance use disorders, epilepsy, and traumatic brain injury each raise the odds of completed suicide by more than threefold.
“Depression, bipolar disorder, schizophrenia-spectrum disorders, substance use disorders, epilepsy,13 and traumatic brain injury14 each increases the odds of completed suicide by a factor of more than 3.”
From Suicide (2020) · cites this paper as [13]
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Cites
Murray, C. J. L., Vos, T., Lozano, R., Naghavi, M., Flaxman, A. D., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J. A., Abdalla, S., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61689-4 · Cited by 8,888 · see citing works
Self-citationExternal review and validation of the Swedish national inpatient register
Ludvigsson, J. F., Andersson, E., Ekbom, A., Feychting, M., Kim, J.-L., Reuterwall, C., Heurgren, M., & Olausson, P. O. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-450 · Cited by 5,055 · see citing works
Berg, A. T., Berkovic, S. F., Brodie, M. J., Buchhalter, J., Cross, J. H., Van Emde Boas, W., Engel, J., French, J., Glauser, T. A., Mathern, G. W., et al. (2010) · Epilepsia · doi:10.1111/j.1528-1167.2010.02522.x · Cited by 4,363 · see citing works
Estimation of the burden of active and life-time epilepsy: a meta-analytic approach
Ngugi, A. K., Bottomley, C., Kleinschmidt, I., Sander, J. W., & Newton, C. R. (2010) · Epilepsia · doi:10.1111/j.1528-1167.2009.02481.x · Cited by 1,447 · see citing works
Self-citationPsychiatric comorbidity in epilepsy: a population-based analysis
Tellez‐Zenteno, J. F., Patten, S. B., Jetté, N., Williams, J., & Wiebe, S. (2007) · Epilepsia · doi:10.1111/j.1528-1167.2007.01222.x · Cited by 1,113 · see citing works
Schizophrenia, substance abuse, and violent crime
Fazel, S. (2009) · JAMA · doi:10.1001/jama.2009.675 · Cited by 726 · see citing works
The psychiatric comorbidity of epilepsy
Gaitatzis, A., Trimble, M., & Sander, J. W. A. S. (2004) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.2004.00324.x · Cited by 596 · see citing works
Epilepsy and risk of suicide: a population-based case–control study
Christensen, J., Vestergaard, M., Mortensen, P. B., Sidenius, P., & Agerbo, E. (2007) · The Lancet Neurology · doi:10.1016/s1474-4422(07)70175-8 · Cited by 559 · see citing works
The population impact of severe mental illness on violent crime
Fazel, S., & Grann, M. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.8.1397 · Cited by 539 · see citing works
Self-citationSudden unexpected death in epilepsy
Shorvon, S. D., & Tomson, T. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60176-1 · Cited by 502 · see citing works
Runeson, B., Tidemalm, D., Dahlin, M., Lichtenstein, P., & Langstrom, N. (2010) · BMJ · doi:10.1136/bmj.c3222 · Cited by 396 · see citing works
Self-citationMortality from epilepsy: results from a prospective population-based study
Cockerell, O. C., Hart, Y. M., Sander, J. W. A. S., Goodridge, D. M. G., Shorvon, S. D., & Johnson, A. L. (1994) · The Lancet · doi:10.1016/s0140-6736(94)92270-5 · Cited by 396 · see citing works
National Strategy for Suicide Prevention: Goals and Objectives for Action
Satcher, D. S. (2003) · Cited by 392 · see citing works
Bipolar Disorder and Violent Crime
Fazel, S., Lichtenstein, P., Grann, M., Goodwin, G. M., & Långström, N. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.97 · Cited by 354 · see citing works
Self-citationNilsson, L., Tomson, T., Farahmand, B. Y., Diwan, V. K., & Persson, P. (1997) · Epilepsia · doi:10.1111/j.1528-1157.1997.tb01194.x · Cited by 331 · see citing works
Hjern, A., Lindblad, F., & Vinnerljung, B. (2002) · The Lancet · doi:10.1016/s0140-6736(02)09674-5 · Cited by 329 · see citing works
Epilepsy and psychiatric comorbidity: A nationally representative population‐based study
Rai, D., Kerr, M., McManus, S., Jordanova, V., Lewis, G., & Brugha, T. S. (2012) · Epilepsia · doi:10.1111/j.1528-1167.2012.03500.x · Cited by 308 · see citing works
Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses
Ekholm, B., Ekholm, A., Adolfsson, R., Vares, M., Ösby, U., Sedvall, G. C., & Jönsson, E. G. (2005) · Nordic Journal of Psychiatry · doi:10.1080/08039480500360906 · Cited by 242 · see citing works
Sudden unexpected death in epilepsy: Evidence-based analysis of incidence and risk factors
Téllez‐Zenteno, J. F., Hernández‐Ronquillo, L., & Wiebe, S. (2005) · Epilepsy Research · doi:10.1016/j.eplepsyres.2005.05.004 · Cited by 220 · see citing works
Sellgren, C. M., Landén, M., Lichtenstein, P., Hultman, C. M., & Långström, N. (2011) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2011.01747.x · Cited by 208 · see citing works
Self-citationFazel, S., Lichtenstein, P., Grann, M., & Långström, N. (2011) · PLoS Medicine · doi:10.1371/journal.pmed.1001150 · Cited by 181 · see citing works
Self-citationSuicide in people with epilepsy: How great is the risk?
Bell, G. S., Gaitatzis, A., Bell, C. L., Johnson, A. L., & Sander, J. W. A. S. (2009) · Epilepsia · doi:10.1111/j.1528-1167.2009.02106.x · Cited by 163 · see citing works
Validity of register data on acute myocardial infarction and acute stroke
Lindblad, U., Råstam, L., Ranstam, J., & Peterson, M. (1993) · Scandinavian Journal of Social Medicine · doi:10.1177/140349489302100102 · Cited by 146 · see citing works
Cause‐Specific Mortality in Epilepsy
Lhatoo, S. D., & Sander, J. W. A. S. (2005) · Epilepsia · doi:10.1111/j.1528-1167.2005.00406.x · Cited by 134 · see citing works
van den Broek, M., Beghi, E., & RESt‐1 Group (2004) · Epilepsia · doi:10.1111/j.0013-9580.2004.33903.x · Cited by 114 · see citing works
Neeleman, J., & Wessely, S. C. (1997) · Psychological Medicine · doi:10.1017/s0033291796004631 · Cited by 108 · see citing works
Faingold, C. L., Tupal, S., & Randall, M. (2011) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2011.06.015 · Cited by 97 · see citing works
Bell, G. S., & Sander, J. W. A. S. (2009) · Current Opinion in Neurology · doi:10.1097/wco.0b013e328328f8c3 · Cited by 94 · see citing works
Reliability and Sensitivity of Suicide Certification in Higher‐Income Countries
Rockett, I. R. H., & Thomas, B. M. (1999) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.1999.tb01052.x · Cited by 77 · see citing works
Don’t be afraid to treat depression in patients with epilepsy!
Kondziella, D., & Asztély, F. (2008) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.2008.01088.x · Cited by 65 · see citing works
Reducing mortality: an important aim of epilepsy management
Sander, J. W. A. S. (2004) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2003.029223 · Cited by 61 · see citing works
Motor vehicle accidents, suicides, and assaults in epilepsy
Kwon, C., Liu, M., Quan, H., Thoo, V., Wiebe, S., & Jetté, N. (2011) · Neurology · doi:10.1212/wnl.0b013e31820e7b3b · Cited by 56 · see citing works
Jiang, G., de Pedro-Cuesta, J., & Fredrikson, S. (2009) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.1995.tb00416.x · Cited by 47 · see citing works
Klein-Geltink, J., Rochon, P. A., Dyer, S., Laxer, M., & Anderson, G. (2007) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2006.11.008 · Cited by 34 · see citing works
Christensen, J., & Sidenius, P. (2012) · Epilepsia · doi:10.1111/j.1528-1167.2012.03553.x · Cited by 18 · see citing works
Flagged first, then by citations
Cited by
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Suicide and suicidal behaviour
Turecki, G., & Brent, D. A. (2016) · The Lancet · doi:10.1016/s0140-6736(15)00234-2 · Cited by 2,338 · see citing works
Comorbidities of epilepsy: current concepts and future perspectives
Keezer, M. R., Sisodiya, S. M., & Sander, J. W. (2016) · The Lancet Neurology · doi:10.1016/s1474-4422(15)00225-2 · Cited by 778 · see citing works
Fazel, S., & Runeson, B. (2020) · New England Journal of Medicine · doi:10.1056/nejmra1902944 · Cited by 502 · see citing works
Self-citationFazel, S., Wolf, A., Pillas, D., Lichtenstein, P., & Långström, N. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.3935 · Cited by 159 · see citing works
Self-citationCause of death and predictors of mortality in a community-based cohort of people with epilepsy
Keezer, M. R., Bell, G. S., Neligan, A., Novy, J., & Sander, J. W. (2016) · Neurology · doi:10.1212/wnl.0000000000002390 · Cited by 102 · see citing works
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Bertelsen, E. N., Larsen, J. T., Petersen, L., Christensen, J., & Dalsgaard, S. (2016) · Pediatrics · doi:10.1542/peds.2015-4654 · Cited by 82 · see citing works
The biopsychosocial model and quality of life in persons with active epilepsy
Elliott, J. O., & Richardson, V. E. (2014) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2014.09.035 · Cited by 56 · see citing works
- Authors
- Fazel, S., Wolf, A., Långström, N., Newton, C. R., & Lichtenstein, P.
- Affiliations
- Warneford Hospital (GB)
- Karolinska Institutet (SE)
- Corresponding author
- Fazel, Seena
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2013-11
- Volume
- 382
- Issue
- 9905
- Pages
- 1646-1654
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC3899026
- OpenAlex
- W2171256257
- Cited by
- 383
- References
- 35
- Citations by year
- 2026: 18 · 2025: 24 · 2024: 30 · 2023: 24 · 2022: 30 · 2021: 28 · 2020: 57 · 2019: 36 · 2018: 32 · 2017: 21 · 2016: 25 · 2015: 24 · 2014: 29 · 2013: 5
- FWCI
- 19.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- The Lancet (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust (092654, 095806)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Keywords
- epilepsy, premature mortality, psychiatric comorbidity, suicide, substance abuse, depression, external causes of death, mortality risk
- MeSH terms
- Accidents, Adolescent, Adult, Mental Disorders, Epilepsy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk Factors, Suicide, Sweden, Violence, Prevalence, Young Adult, Mortality, Premature
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