{
  "abstract": "Introduction Potentially owing to higher rates of psychiatric comorbidities associated with functional seizures (FS), suicidal behavior, suicidal thoughts, and deliberate self-harm are commonly reported in this patient group. Recent studies have also reported high mortality rates amongst people with FS, with or without comorbid epilepsy. The factors that may contribute to the risk of self-harm in people with FS are, though, still unclear and it is not well understood whether certain demographics might be at particular risk.Methods We performed a systematic review of the literature across 12 databases. We included 76 studies, of which 58 were eligible for meta-analysis. We disaggregated data by clinical features, age, and sex and also sought to understand if people from certain regions were at greater risk.Results Included studies captured data from 10928 patients with FS, of whom 6553 were included in the meta-analysis. The pooled prevalence of previous suicide attempts was 23% (95%CI=19- 27%), with lower suicide attempt rates in Latin America and Asia compared to Africa and Europe (p-value for subgroup differences < 0.001). The pooled prevalence of reported suicidal ideation was 25% (95%CI=14-38%), with African regions having significantly higher rates of suicidal ideation compared to North America (43% vs 16%, p<0.001). The pooled prevalence of deliberate self-harm was 22% (95%CI=16-30%). In people with only FS compared to those with only epileptic seizures, there was an increased risk of suicide attempts (OR 3.07) and suicidal ideation (OR 2.02).Conclusions Around one-quarter of people with FS report previous suicide attempts, current suicidal thoughts, and/or deliberate self-harmful behavior. This is additional to the known greater risk of suicide-related death in those with FS. Our work highlights the importance of appropriate screening strategies for at-risk behaviors in all people with FS. There is a clear need for targeted psychotherapeutic interventions in this vulnerable group, particularly in resource- underprivileged settings.",
  "authors": [
    {
      "affiliations": [
        "Centre for Global Epilepsy, Wolfson College, University of Oxford, Oxford. OX2 6UJ. United Kingdom",
        "Biologie Intégrative et Physiologie–Neurosciences Cellulaires et Intégrées, Faculté des Sciences et Ingénierie, Sorbonne Université, Paris, France",
        "Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin. Institut of Public Health. Berlin, Germany",
        "All authors contributed equally to this work"
      ],
      "name": "Asma Hallab"
    },
    {
      "affiliations": [
        "Centre for Global Epilepsy, Wolfson College, University of Oxford, Oxford. OX2 6UJ. United Kingdom",
        "Department of Neurosciences, Bufalini Hospital, Azienda Unità Sanitaria Locale della Romagna, Cesena, Italy",
        "All authors contributed equally to this work"
      ],
      "name": "Michele Romoli"
    },
    {
      "affiliations": [
        "Centre for Global Epilepsy, Wolfson College, University of Oxford, Oxford. OX2 6UJ. United Kingdom",
        "Oxford Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford. OX3 9DU. United Kingdom",
        "All authors contributed equally to this work"
      ],
      "name": "Arjune Sen"
    }
  ],
  "title": "#8165 Mortality, suicidality and deliberate self-harm in people with functional seizures: systematic review, age-, region-, and sex-based meta-analyses",
  "uid": "4c1854af-5ca2-5e20-a5a0-2ac8cac3a9d4"
}