Evidence map›Paper›PMID 36414426›Full record

ArticleNeurology2023

Directionality of the Association Between Epilepsy and Depression: A Nationwide Register-Based Cohort Study.

Eva Bølling-Ladegaard, Julie Werenberg Dreier, Lars Vedel Kessing, Esben Budtz-Jørgensen, Kasper Lolk, Jakob Christensen

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
35citing papers in PubMed, 1 pooled it
6.1field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

35 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.

  1. How can social cognition be improved in neurological patients? a systematic review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
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  7. Self-Injury Mortality: Global Ascertainment and Prevention.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2026
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  12. Modelling risk factors for depressive symptoms in seizure disorders.Therapeutic advances in neurological disorders · 2026
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 1 institution in 2 countries.

Eva Bølling-LadegaardFrom the Department of Clinical Medicine, Neurology (E.B.-L., K.L., J.C.), Department of Economics and Business Economics (J.W.D., K.L., J.C.), Business and Social Science, The National Center for Register-Based Research, and Centre for Integrated Register-Based Research (CIRRAU) (J.W.D., K.L., J.C.), Aarhus University; Department of Clinical Medicine (L.V.K.), University of Copenhagen; Copenhagen Affective Disorder Research Center (CADIC) (L.V.K.), Psychiatric Center Copenhagen; Section of Biostatistics (E.B.-J.), Department of Public Health, University of Copenhagen; and Department of Neurology (J.C.), Aarhus University Hospital, Denmark. eva@clin.au.dk.ORCID 0000-0002-3430-0883
Julie Werenberg DreierFrom the Department of Clinical Medicine, Neurology (E.B.-L., K.L., J.C.), Department of Economics and Business Economics (J.W.D., K.L., J.C.), Business and Social Science, The National Center for Register-Based Research, and Centre for Integrated Register-Based Research (CIRRAU) (J.W.D., K.L., J.C.), Aarhus University; Department of Clinical Medicine (L.V.K.), University of Copenhagen; Copenhagen Affective Disorder Research Center (CADIC) (L.V.K.), Psychiatric Center Copenhagen; Section of Biostatistics (E.B.-J.), Department of Public Health, University of Copenhagen; and Department of Neurology (J.C.), Aarhus University Hospital, Denmark.ORCID 0000-0002-9339-4170
Lars Vedel KessingFrom the Department of Clinical Medicine, Neurology (E.B.-L., K.L., J.C.), Department of Economics and Business Economics (J.W.D., K.L., J.C.), Business and Social Science, The National Center for Register-Based Research, and Centre for Integrated Register-Based Research (CIRRAU) (J.W.D., K.L., J.C.), Aarhus University; Department of Clinical Medicine (L.V.K.), University of Copenhagen; Copenhagen Affective Disorder Research Center (CADIC) (L.V.K.), Psychiatric Center Copenhagen; Section of Biostatistics (E.B.-J.), Department of Public Health, University of Copenhagen; and Department of Neurology (J.C.), Aarhus University Hospital, Denmark.
Esben Budtz-JørgensenFrom the Department of Clinical Medicine, Neurology (E.B.-L., K.L., J.C.), Department of Economics and Business Economics (J.W.D., K.L., J.C.), Business and Social Science, The National Center for Register-Based Research, and Centre for Integrated Register-Based Research (CIRRAU) (J.W.D., K.L., J.C.), Aarhus University; Department of Clinical Medicine (L.V.K.), University of Copenhagen; Copenhagen Affective Disorder Research Center (CADIC) (L.V.K.), Psychiatric Center Copenhagen; Section of Biostatistics (E.B.-J.), Department of Public Health, University of Copenhagen; and Department of Neurology (J.C.), Aarhus University Hospital, Denmark.ORCID 0000-0002-5551-0724
Kasper LolkFrom the Department of Clinical Medicine, Neurology (E.B.-L., K.L., J.C.), Department of Economics and Business Economics (J.W.D., K.L., J.C.), Business and Social Science, The National Center for Register-Based Research, and Centre for Integrated Register-Based Research (CIRRAU) (J.W.D., K.L., J.C.), Aarhus University; Department of Clinical Medicine (L.V.K.), University of Copenhagen; Copenhagen Affective Disorder Research Center (CADIC) (L.V.K.), Psychiatric Center Copenhagen; Section of Biostatistics (E.B.-J.), Department of Public Health, University of Copenhagen; and Department of Neurology (J.C.), Aarhus University Hospital, Denmark.ORCID 0000-0003-2639-7969
Jakob ChristensenFrom the Department of Clinical Medicine, Neurology (E.B.-L., K.L., J.C.), Department of Economics and Business Economics (J.W.D., K.L., J.C.), Business and Social Science, The National Center for Register-Based Research, and Centre for Integrated Register-Based Research (CIRRAU) (J.W.D., K.L., J.C.), Aarhus University; Department of Clinical Medicine (L.V.K.), University of Copenhagen; Copenhagen Affective Disorder Research Center (CADIC) (L.V.K.), Psychiatric Center Copenhagen; Section of Biostatistics (E.B.-J.), Department of Public Health, University of Copenhagen; and Department of Neurology (J.C.), Aarhus University Hospital, Denmark.ORCID 0000-0002-9385-6435
University of Copenhagen · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesEpilepsy and depression share a bidirectional relationship; however, its magnitude and long-term temporal association remain to be elucidated. This study investigates the magnitude and long-term association between epilepsy and depression, comparing with the risks of the 2 disorders after another chronic medical illness (asthma).

methodsIn a nationwide register-based matched cohort study, we identified all individuals who received a first diagnosis of epilepsy, depression, and asthma from January 1, 1980, to December 31, 2016. We used a Cox regression model to estimate the risk of epilepsy after depression and vice versa and the risk of epilepsy or depression after asthma, compared with healthy references matched on age and sex, adjusting for medical comorbidity, substance abuse, and calendar time. Results were stratified by epilepsy subtype. We furthermore investigated the risk of admission with acute seizures for persons with epilepsy who became depressed.

resultsIn a population of 8,741,955 individuals, we identified 139,014 persons with epilepsy (54% males, median age at diagnosis 43 years [inter quartile range (IQR) 17-65 years]), 219,990 persons with depression (37% males, median age at diagnosis 43 years [IQR 29-60 years]), and 358,821 persons with asthma (49% males, median age at diagnosis 29 years [IQR 6-56 years]). The adjusted hazard ratio (aHR) of depression after epilepsy was 1.88 (95% CI 1.82-1.95), and the aHR of epilepsy after depression was 2.35 (95% CI 2.25-2.44). The aHR of depression after asthma was 1.63 (95% CI 1.59-1.67) and that of epilepsy after asthma, 1.48 (95% CI 1.44-1.53). The risk of depression was highest in the few years preceding and after an epilepsy diagnosis, and vice versa, but remained elevated during the entire follow-up period for both directions of the association. There was no evidence of a stronger association with depression for any epilepsy subtype. Receiving a diagnosis of depression subsequent to an epilepsy diagnosis was associated with a 1.20-fold (95% CI 1.07-1.36) increased HR of acute hospital admission with seizures. DISCUSSION: We identified a long-term bidirectional relationship between depression and epilepsy in a large-scale cohort study. Risk estimates were higher than those of epilepsy or depression after asthma.

Indexed as

AsthmaEpilepsyAdolescentAdultAgedChildCohort StudiesDepressionFemaleHumansMaleMiddle AgedRisk FactorsSeizuresYoung Adult

Identifiers

PMID36414426
PMCPMC9990426
OpenAlexW4309643833

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.