Thoughts of death and self-harm in patients with epilepsy or multiple sclerosis in a tertiary care center

Psychosomatics. Jan-Feb 2015;56(1):44-51. doi: 10.1016/j.psym.2014.05.008. Epub 2014 Jun 5.


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.

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.

Methods: A Cleveland Clinic database provided information on 20,734 visits of 6586 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.

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 quality of life. Factors associated with positive PHQ item-9 in MS were depression, male sex, medical comorbidity, and poor quality of life; the effect of depression was worse with greater MS severity and being unmarried.

Conclusions: Among patients with common neurologic disorders (epilepsy or MS), 14%-15% reported thoughts of death or self-harm associated with illness severity, depression, quality of life, male sex, and being unmarried. Such patients require further evaluation of clinical outcomes and effects of treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude to Health*
  • Comorbidity
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / psychology*
  • Epilepsy / epidemiology
  • Epilepsy / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multiple Sclerosis / epidemiology
  • Multiple Sclerosis / psychology*
  • Outpatients / psychology
  • Prevalence
  • Quality of Life / psychology
  • Risk Factors
  • Self-Injurious Behavior / epidemiology*
  • Severity of Illness Index
  • Sex Factors
  • Suicidal Ideation*
  • Surveys and Questionnaires
  • Tertiary Care Centers