AUTHOR=Puteikis Kristijonas , Kazėnaitė Edita , Mameniškienė Rūta 

TITLE=Psychiatric comorbidities and all-cause mortality in epilepsy: A nationwide cohort study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.956053

DOI=10.3389/fneur.2022.956053

ISSN=1664-2295

ABSTRACT=Background
People with epilepsy (PWE) having comorbid psychiatric conditions may be at greater risk of death. We aimed to determine the association between psychiatric disorders and all-cause mortality among PWE after adjustment for somatic comorbidities.
Methods
Based on data from the National Health Insurance Fund, a Cox survival analysis was done within a retrospective open cohort of all PWE (≥12 years) in Lithuania between January 2014 and June 2020. Cox models comparing mortality between PWE with or without psychiatric comorbidities were adjusted for sex, age, hospitalizations, and the epilepsy-specific comorbidity index.
Results
Of 47964 PWE (age Md=49, IQR=34-62 years, 60.3% male, follow-up Md=4.4 IQR=2.1-6.1 years), 10290 (21.5%) died during the study. The diagnosis of any psychiatric disorder (n=26137, 54.5%) was associated with increased mortality when adjusted for only sex and age (HR=1.13, 95% CI=1.09 to 1.18). After including the epilepsy-specific comorbidity index, the number of hospitalizations and hospital days in the analysis, only self-harm (HR=1.55, 95% CI=1.40 to 1.71) and substance use disorders (HR=1.39 95% CI=1.32 to 1.47), but not any psychiatric comorbidities (HR=0.92 95% CI=0.88 to 0.96) were related to elevated all-cause mortality. Mood, anxiety and behavioral disorders were associated with lower odds of mortality; however, they were rarely documented.
Conclusions
Our results suggest that psychiatric comorbidities increase all-cause mortality among PWE through their association with coexisting somatic conditions as only substance use disorders and self-harm were independently related to elevated all-cause mortality. Future clinical interview-based studies should explore the relationship between mortality in epilepsy and psychiatric comorbidities while adjusting for somatic comorbidities.