Validation of rapid suicidality screening in epilepsy using the NDDIE
Epilepsia. 2016-03-25; 57(6): 949-955
DOI: 10.1111/epi.13373
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1. Epilepsia. 2016 Jun;57(6):949-55. doi: 10.1111/epi.13373. Epub 2016 Mar 25.
Validation of rapid suicidality screening in epilepsy using the NDDIE.
Mula M(1)(2)(3), McGonigal A(4)(5), Micoulaud-Franchi JA(6)(7), May TW(8),
Labudda K(9)(10), Brandt C(10).
Author information:
(1)Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George’s
University Hospitals NHS Foundation Trust, London, United Kingdom.
(2)South West London & St. George’s Mental Health Trust, London, United Kingdom.
(3)Institute of Medical and Biomedical Sciences, St. George’s University of
London, London, United Kingdom.
(4)Aix Marseille University, Inserm, INS UMR_S 1106, Marseille, France.
(5)Clinical Neurophysiology Department, Timone Hospital, Marseille, France.
(6)Neurophysiological Unit, Sleep Clinic, Bordeaux University Hospital, CHU
Pellegrin, Bordeaux, France.
(7)USR CNRS 3413 SANPSY, Bordeaux University, CHU Pellegrin, Bordeaux, France.
(8)Society for Epilepsy Research, Bielefeld, Germany.
(9)Department of Clinical Neuropsychology and Epilepsy Research, University of
Bielefeld, Bielefeld, Germany.
(10)Bethel Epilepsy Center, Mara Hospital, Bielefeld, Germany.
OBJECTIVE: Standard mortality ratio for suicide in patients with epilepsy is
three times higher than in the general population, and such a risk remains high
even after adjusting for clinical and socioeconomic factors. It is thus important
to have suitable screening instruments and to implement care pathways for suicide
prevention in every epilepsy center. The aim of this study is to validate the use
of the Neurological Disorder Depression Inventory for Epilepsy (NDDIE) as a
suicidality-screening instrument.
METHODS: The study sample included adult patients with epilepsy assessed with the
Mini International Neuropsychiatric Interview (MINI) and the NDDIE. A high
suicidality risk according to the Suicidality Module of the MINI was considered
the gold standard. Receiver operating characteristic analyses for NDDIE total and
individual item scores were computed and subsequently compared using a
nonparametric approach. The best possible cutoff was identified with the highest
Youden index (J). Likelihood ratios were then computed, and specificity,
sensitivity, positive, and negative predictive values calculated.
RESULTS: The study sample consisted of 380 adult patients with epilepsy: 46.3%
male; mean age was 39.4 ± 14.6; 76.7% had a diagnosis of focal epilepsy; mean age
at onset of the epilepsy was 23.3 ± 17.5. According to the MINI, 74 patients
(19.5%) fulfilled criteria for a major depressive episode and 19 (5%) presented a
high suicidality risk. A score >2 (J = 0.751) for item 4 « I’d be better off dead »
of the NDDIE displayed excellent psychometric properties with a good to excellent
validity (area under the curve [AUC] 0.906; 95% confidence interval [CI]
0.820-0.992; p < 0.001), sensitivity 84.21% (95% CI 60.4-96.6), specificity
90.86% (95% CI 87.4-93.6), likelihood ratio+ 9.21 (95% CI 6.3-13.5), likelihood
ratio- 0.17 (95% CI 0.06-0.50).
SIGNIFICANCE: Item 4 of the NDDIE has shown to be an excellent suicidality
screening instrument allowing the development of further care pathways for
suicide prevention in epilepsy centers.
Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.
DOI: 10.1111/epi.13373
PMID: 27012840 [Indexed for MEDLINE]