Abstracts

Rationale: Every day, 20 U.S. Veterans or military service members die by suicide, amounting to over 6,000 suicide-related deaths per year. Research indicates that people with seizures are at increased risk for suicide. Estimates of risk for suicide death in US Veterans with epilepsy and conversion disorder have not been published. However, Veterans may be particularly vulnerable to both suicide and seizures (including epileptic and psychogenic non-epileptic seizures [PNES]) given the high prevalence of shared risk factors, including mental health comorbidities and traumatic brain injury. Methods: Retrospective cohort study using aggregate de-identified diagnostic data from the VA Corporate Data Warehouse (CDW). ICD-9 codes were used to identify all Veterans treated in the VA Health Care System in fiscal years (FY) 2006 through 2015 for epilepsy, conversion disorder, depression, substance use disorder (SUD), PTSD, Parkinson’s disease (PD), multiple sclerosis (MS), and numerous chronic medical illnesses (see Table for complete list with corresponding ICD-9 codes). Among these patients, we identified all Veterans with each chronic condition who were also diagnosed with SRB, including suicidal ideation (SI), suicide attempt (SA) (i.e. “suicide and self-inflicted harm” ICD-9 E95), or presumed suicide death (SD) (i.e. death within the same year of ICD-9 E95 code). Results: Veterans with epilepsy and conversion disorder diagnoses had significantly higher unadjusted odds of reported suicide-related behaviors compared to Veterans with all comparator medical, neurological and psychological disorders studied. We calculated the unadjusted proportions of Veterans with each diagnosis who had each outcome, then used these proportions to calculate odds ratios (OR) with hypertension selected as the comparator condition (OR = 1.0) and 95% confidence intervals (95% CI).OR for SD, SA and SI in epilepsy (4.6, 5.0, 4.5, respectively) and conversion disorder (3.6, 6.8, 6.7) were higher than depression (2.6, 3.0, 3.3), SUD (2.1, 2.5, 2.5), PTSD (2.3, 3.4, 3.7), MS (1.3, 1.6, 1.6), and PD (1.01, 1.26, 1.29). Among the chronic medical illnesses studied, Veterans with asthma had the highest OR of SD, SA, and SI (1.5, 2.0, 2.0). Veterans with conversion disorder had significantly higher odds of SA and SI than those with epilepsy, but were not at higher risk for suicide death. Conclusions: Veterans with epilepsy and conversion disorder appear to be at higher risk for suicide death, suicide attempt and suicidal ideation than Veterans with depression, PTSD, SUD, PD, MS, and chronic medical illnesses. Veterans with conversion disorder appear to be at higher risk for suicide attempt and SI than Veterans with epilepsy, but they may be equally or less likely to die by suicide. Funding: No funding