Psychiatric disorders and intellectual disability impact epilepsy care in adolescents: A nationwide registry study

Abstract

Objective

To investigate the associations of intellectual disability (ID) and psychiatric comorbidities with healthcare utilization and mortality among adolescents with epilepsy.

Method

A nationwide, population-based observational study using the data from Swedish national patient registries was conducted. Individuals born during 1997–2001 with epilepsy were included and data on healthcare utilization, prescriptions, comorbidities, socioeconomic status and mortality were obtained during a 5-year period (16–20 years of age). We examined associations of psychiatric disorders and ID with healthcare utilization and mortality using unadjusted and covariate-adjusted models. A time-lagged sensitivity analysis was conducted to address potential reverse causation.

Results

Of the 2116 participants included in the study, 33% had specialist care contact for ID and 43% had contact for psychiatric disorders. Psychiatric disorders were, after adjustment for covariates, associated with higher odds of both epilepsy-related and all-cause emergency care and inpatient care. Having ID was associated with lower odds of epilepsy-related and all-cause emergency care, but higher mortality. Furthermore, several psychiatric disorders were linked to higher odds of all-cause or epilepsy-related inpatient care or all-cause emergency care.

Significance

Psychiatric comorbidities and ID are common in young people with epilepsy and were associated with higher healthcare utilization and mortality in the unadjusted analysis. When adjusting for covariates, psychiatric comorbidity was linked to increased care consumption, while having ID was linked to lower emergency care use but higher mortality. These findings indicate that comorbidities are clinically relevant in young persons with epilepsy and support the need for tailored, multidisciplinary follow-up during this important life period.

Plain Language Summary

Many adolescents with epilepsy also have mental health or learning difficulties, which may affect their need for healthcare. In this Swedish nationwide study, psychiatric conditions were linked to more emergency visits and unplanned hospital admissions, while intellectual disability was associated with fewer emergency visits but a higher risk of death. These findings highlight the need for tailored, coordinated support for young people with epilepsy during the transition to adult care.