Self-efficacy in seizure management differentially correlated with quality of life in persons with epilepsy depending on seizure recurrence and felt stigma

Moderating effects of general self-efficacy on courtesy stigma and anxiety and depressive symptoms of parents of children with autism spectrum disorder

Background

Stigma, anxiety and depressive symptoms are highly prevalent in parents of children with autism spectrum disorder (ASD) and may have a detrimental impact on the rehabilitation and treatment of children with ASD, ultimately leading to more behavioral issues and higher rates of disability. Therefore, the purpose of this study was to identify the association between general self-efficacy, courtesy stigma, and anxiety and depressive symptoms, and to further discuss whether general self-efficacy moderated the association between courtesy stigma and anxiety and depressive symptoms in parents of children with ASD.

Methods

A total of 409 parents of children with ASD from Lianyungang, Jiangsu Province, Eastern China participated in a cross-sectional survey. A structured questionnaire was used to collect sociodemographic characteristics, courtesy stigma, general self-efficacy, anxiety symptoms, and depressive symptoms. Hierarchical multiple regression was used to assess the associations of courtesy stigma, general self-efficacy and courtesy stigma × general self-efficacy interaction with anxiety and depressive symptoms. Simple slope analysis was used to visualize the interaction.

Results

The courtesy stigma of parents of children with ASD was positively correlated with anxiety (B = 0.374, P < 0.001) and depressive symptoms (B = 0.366, P < 0.001). General self-efficacy was negatively correlated with anxiety (B = -0.200, P < 0.001) and depressive symptoms (B = -0.210, P < 0.001). The association between courtesy stigma and anxiety symptoms was different in the high (1 standard deviation (SD) above the mean, b = 0.258, standard error (SE) = 0.056, t = 4.567, P < 0.001) and low (1 SD below the mean, b = 0.470, SE = 0.053, t = 8.870, P < 0.001) groups of general self-efficacy. In addition, the association between courtesy stigma and depressive symptoms was also different in the high (1 SD above the mean, b = 0.241, SE = 0.056, t = 4.268, P < 0.001) and low (1 SD below the mean, b = 0.469, SE = 0.053, t = 8.844, P < 0.001) groups of general self-efficacy.

Conclusions

General self-efficacy could moderate the impact of courtesy stigma on anxiety and depressive symptoms. Therefore, among parents of children with ASD who experienced high courtesy stigma, enhancing general self-efficacy could be an effective strategy to reduce anxiety and depressive symptoms in this population.

Systematic literature review of the humanistic and economic burden of focal epilepsy and primary generalized tonic-clonic seizures in adults

This systematic literature review (SLR) assessed the humanistic and economic burden of focal epilepsy and primary generalized tonic-clonic seizures (PGTCS) in adults to evaluate these domains in both populations and identify evidence gaps to inform future research. A search was conducted on December 7, 2022, using MEDLINE and Embase to identify studies published from 2012 onwards reporting humanistic burden (patient-reported or caregiver-reported outcomes or utilities, qualitative evaluations), economic burden (productivity loss, caregiver and societal costs of epilepsy), and sleep-related outcomes. Of the 2830 citations identified, 136 were included. Most studies were in the focal epilepsy population; very few studies reported outcomes in the PGTCS population. The presence of epilepsy-specific instruments varied based on the domain evaluated. Epilepsy exerted considerable humanistic and economic burden. Indicators of poor disease control (e.g., high seizure frequency, resistance to anti-seizure medications, polypharmacy) increased epilepsy burden. Seizure frequency and type, disease severity, and polypharmacy also affected work productivity. Adults with epilepsy, particularly focal epilepsy, reported higher indirect costs, more sick days accrued, and early entry into retirement. Caregivers similarly reported high productivity loss and absenteeism related to caregiving duties. The results of this SLR highlight the high humanistic and economic burden of focal epilepsy and PGTCS, although limited data were available for the PGTCS population. The results include patient-reported outcome data specific to focal epilepsy and PGTCS, expanding the limited humanistic burden evidence identified in previous reviews, and show the effect of poor disease control on individuals' lives and as a driver of indirect costs. PLAIN LANGUAGE SUMMARY: Our systematic literature review identified studies that evaluated the impact of focal epilepsy and primary generalized tonic-clonic seizures on patients and their caregivers. We found that focal epilepsy negatively impacted patients' mental health and sleep and was associated with higher indirect costs and lower work productivity in people with more severe disease. The impact of primary generalized tonic-clonic seizures on patients was rarely reported, and future research is needed.

Clinical correlates of perceived stigma among people living with epilepsy enrolled in a self-management clinical trial

BACKGROUND AND PURPOSE

Stigma is a pervasive barrier for people living with epilepsy (PLWE) and can have substantial negative effects. This study evaluated clinical correlates of perceived stigma in a research sample of PLWE considered to be at high risk due to frequent seizures or other negative health events.

METHODS

Analyses were derived from baseline data from an ongoing Centers for Disease Control and Prevention (CDC)-funded randomized controlled trial (RCT) testing an epilepsy self-management approach. Standardized measures assessed socio-demographics, perceived epilepsy stigma, epilepsy-related self-efficacy, epilepsy self-management competency, health literacy, depressive symptom severity, functional status, social support and epilepsy-related quality of life.

RESULTS

There were 160 individuals, mean age of 39.4, (Standard deviation/SD=12.2) enrolled in the RCT, 107 (66.9 %) women, with a mean age of epilepsy onset of 23.9 (SD 14.0) years. The mean seizure frequency in the prior 30 days was 6.4 (SD 21.2). Individual factors correlated with worse perceived stigma were not being married or cohabiting with someone (p = 0.016), lower social support (p < 0.0001), lower self-efficacy (p < 0.0001), and lower functional status for both physical health (p = 0.018) and mental health (p < 0.0001). Perceived stigma was associated with worse depressive symptom severity (p < 0.0001). Multivariable linear regression found significant independent associations between stigma and lower self-efficacy (β -0.05; p = 0.0096), lower social support (β -0.27; p = 2.4x10-5, and greater depression severity (β 0.6; p = 5.8x10-5).

CONCLUSIONS

Perceived epilepsy stigma was positively correlated with depression severity and negatively correlated with social support and self-efficacy. Providers caring for PLWE may help reduce epilepsy stigma by screening for and treating depression, encouraging supportive social relationships, and providing epilepsy self-management support. Awareness of epilepsy stigma and associated factors may help reduce some of the hidden burden borne by PLWE.

The relationship between seizure self-efficacy and quality of life in children with epilepsy

AIM

This study aimed to examine seizure self-efficacy and quality of life of children with epilepsy and to evaluate the relationship between these parameters.

METHOD

The study was conducted between November 2022 and November 2023 in the Pediatric Neurology Outpatient Clinic of a university hospital with 200 children aged 9-14 who met the inclusion criteria and accepted the study. The data were collected using the "Child Descriptive Form," "Seizure Self-Efficacy Scale in Children with Epilepsy," and "KIDSCREEN-27 Health-Related Quality of Life Scale". The data were evaluated using the IBM SPSS Statistics Standard Concurrent User V 26 statistical package program. Number, percentage, mean-standard deviation, median, minimum and maximum values, Cronbach's Alpha coefficient, Shapiro Wilk normality test, Independent Sample t-test, Analysis of Variance (ANOVA), Bonferroni test, Pearson correlation coefficient, linear regression analysis, Durbin-Watson value and normality of residuals Q-Q graphs were used in the evaluation of the data. A value of p < 0.05 was considered statistically significant.

RESULTS

It was determined that 53 % of the children participating in the study were male, and the median age was 12 years. The mean total score of the seizure self-efficacy scale was 3.13 ± 1.03, and the mean total score of the health-related quality of life scale was 89.83 ± 15.63. There was a statistically significant positive correlation between the dimension of individual seizure control and total score of health-related quality of life and physical well-being, emotional well-being and social support, and peer dimensions (p < 0.05). A statistically significant positive correlation was determined between the effect of environment on seizure control and health-related quality of life total score, physical well-being, social support, and peer and school environment dimensions (p < 0.05). A statistically significant positive correlation was determined between seizure self-efficacy total score and health-related quality of life total score and physical well-being, emotional well-being, social support, and peer dimensions (p < 0.05).

CONCLUSION

The study results reveal that high self-efficacy levels of children with epilepsy improve the quality of life of children with epilepsy.

Stigma, seizure self-efficacy, and quality of life in children with epilepsy

INTRODUCTION

In addition to seizure care, it has been well-established that a holistic approach to the treatment of children with epilepsy that addresses the social, behavioral, and psychological dimensions also benefits their quality of life (QoL). The aim of this study was to investigate the patient and parental perceived stigma, seizure self-efficacy of children with epilepsy, and the relationship with quality of life in terms of sociodemographic and epilepsy-related factors.

METHOD

The study group consisted of children, aged between 8 and 18 years and with a diagnosis of epilepsy of at least six months duration and their parents. Pediatric Quality of Life Inventory (PedsQL), Child-Parent Stigma Scales, and the Seizure Self-Efficacy Scale for Children (SSES-C) were used for evaluation.

RESULTS

One hundred and forty-four children (mean age 12.6 ± 2.9 years) took part, of whom 48.6% were female. The mean Child Stigma Scale score was 1.77 ± 0.82, Parent Stigma Scale score 2.41 ± 0.75, SSES-C score was 3.37 ± 0.98, and PedsQL score was 72.8 ± 18.6 for children self-reports (CsR) and 73.2 ± 18.8 for parent proxy-reports. The intraclass correlation coefficient for parent-child PedsQL indicated a good level of agreement. There was a significant negative correlation between the Child Stigma Scale and the PedsQL-CsR scores. A significant positive correlation was identified between the SSES-C scores and the PedsQL-CsR scores.

DISCUSSION

Perceptions of stigma in children with epilepsy and their parents were high in this study population. Of note, the elevated stigma perception reported by the patients had a detrimental impact on seizure self-efficacy. This relationship may affect the children's QoL and further complicates epilepsy management in this patient group.

Felt stigma proportion in people living with epilepsy: A systematic review

PURPOSE

Numerous inventories to identify felt stigma (FS) in people living with epilepsy (PLWE) have been developed. Past studies have mainly focused on the relationship between FS scores and clinical factors, making it challenging to delineate FS proportions and compare FS between groups. We aimed to integrate FS proportions in PLWE and compare them by continent.

METHODS

We searched MEDLINE, EMBASE, the Cochrane Library, Web of Science, and Scopus. Among the identified studies, we chose the ones providing an FS proportion measured by Jacoby's Stigma Scale (JSS) and its revised version (JSS-R) in PLWE. We applied the random-effects model.

RESULTS

A total of 63 datasets from 47 studies were included. There were 29,924 PLWE, with 14,323 of them experiencing FS. The overall FS proportion was 48.4%. Of these datasets, 51 used JSS, and 12 used JSS-R. The FS proportions were 44.9% for the former and 62.1% for the latter, with significant heterogeneity. In the intercontinental comparison with 51 datasets employing JSS, the difference in FS proportions was insignificant: 51.2% in Africa, 47.2% in Europe, 35.4% in Asia, and 28.8% in the Middle East. Furthermore, the meta-regression revealed that the year of each primary study did not influence the FS proportion.

CONCLUSION

Among PLWE, FS proportions depended on the choice of a measurement tool. When measured using JSS, the FS proportion was 44.9%, while it was 62.1% when evaluated with JSS-R. Even though the FS proportions were integrated differently, no substantial differences were observed between continents.

What is the price of residence in rural areas for patients with epilepsy?

INTRODUCTION

We aimed to investigate the effects of the urban or rural dwelling of patients with epilepsy living in Giresun on their use of health services, quality of life, and self-efficacy.

METHODS

In this cross-sectional study, patients with epilepsy who were admitted to the neurology outpatient clinic between January 2022 and August 2022 were evaluated. All the participants were individually interviewed to complete the Epilepsy Self-Efficacy Scale (ESES) and Quality of Life in Epilepsy Inventory (QOLIE-10) questionnaire. The frequency of admission to the emergency department, neurology outpatient clinic, and general practitioner clinic where the primary reason for the visit was epilepsy in the last year was determined using the hospital database.

RESULTS

This study was composed of 109 patients. The rural dwelling was found in 45% of the participants. The mean age of seizure onset was significantly lower in patients dwelling in rural areas Mean GP and ED visits didn't differ according to dwelling. On the other hand, mean neurology outpatient clinic visits were significantly lower in patients living in rural areas. The QOLIE-10 didn't differ according to the dwelling. However, lower ESES results were obtained in patients living in rural areas.

CONCLUSION

This study shows that there is a disparity in neurologist visits among patients with epilepsy dwelling in rural areas. Furthermore, lower ESES scores were found in these patients. Educational interventions should be addressed particularly to the patients dwelling in rural areas to strengthen self-efficacy, and fill the gaps for the shortage of health personnel and qualified health care.

General self-efficacy differentially moderates depressive symptoms in adults with epilepsy depending on seizure severity

PURPOSE

We evaluated whether the relationship between general self-efficacy and depressive symptoms in patients with epilepsy differed depending on age, sex, and seizure status.

METHODS

This multicenter, cross-sectional study was conducted on 299 adults with epilepsy, using the Beck Depression Inventory (BDI) and the General Self-efficacy Scale (GSES). We performed stepwise linear regression analysis and analysis of covariance with interaction terms.

RESULTS

The stepwise linear regression analysis showed that BDI scores were negatively correlated with GSES scores and positively correlated with age ≥ 40 years, unemployed status, recurrence of generalized or focal to bilateral tonic-clonic seizures (GTCS or FBTCS), and antiseizure medication polytherapy. The final model explained 38.9% of the variance in BDI scores. The analysis of covariance revealed that the moderating effect of GSES scores on BDI scores was less in subjects who had seizure freedom for at least 1 year than in those who did not. In contrast, the moderating effect of GSES scores on BDI scores was greater in subjects who had an age ≥ 40 years and those who experienced GTCS or FBTCS during the previous year than in those who did not. The negative relationship between GSES and BDI scores tended to be stronger in men than in women, but it did not reach statistical significance (p = 0.098). All models were adjusted by significant factors in the linear regression analysis of BDI scores.

CONCLUSIONS

The negative relationship between general self-efficacy and depressive symptoms may be stronger in older patients and patients with poorer seizure outcomes.

The impact of infectious disease prevention behavior on quality of life: A moderated mediation model

Objective

To explore the mechanism of infectious disease prevention behavior on quality of life, and to investigate the mediating role of self-efficacy and the moderating role of family structure.

Methods

A total of 3015 subjects were selected by multistage stratified cluster sampling.

Results

Infectious disease prevention behavior had a significant positive predictive effect on the quality of life (β = 0.08, p < 0.001), The self-efficacy of family members had a partial mediating effect on the relationship between infectious disease prevention behavior and quality of life (β = 0.01, p < 0.001). Compared to nuclear family, conjugal family (β = 0.05, p < 0.001) and single-parent family (β = 0.04, p < 0.01) could regulate the relationship between infectious disease prevention behavior and the quality of life, stem family (β = -1.53, p < 0.05), conjugal family (β = 1.63, p < 0.05), and collective family (β = -1.37, p < 0.05) could regulate the relationship between infectious disease prevention behavior and self-efficacy, conjugal family (β = 0.00, p < 0.001) could regulate the relationship between self-efficacy and quality of life.

Conclusion

Infectious disease prevention behavior can affect the quality of life through self-efficacy. Different family structures play a regulatory role in different paths, and a regulatory mediation model is established.

Felt stigma may potentiate the relationship between perceived stress and depressive symptoms in persons with epilepsy

PURPOSE

This study assessed the strengths of association among perceived stress, felt stigma, and depression in adults with epilepsy, and evaluated whether felt stigma altered the association between perceived stress and depression.

METHODS

This multicenter, cross-sectional study included adults with epilepsy. Depression was assessed using the Beck Depression Inventory (BDI), and perceived stress was evaluated using the 10-item Perceived Stress Scale. Felt stigma was determined using the three-item Stigma Scale for Epilepsy, with individuals categorized as positive for felt stigma if they answered "yes" to at least one of these items. A hierarchical linear regression analysis and an analysis of covariance with interaction terms were performed.

RESULTS

The 316 adults with epilepsy included 171 men and 145 women; of these, 109 (34.5%) reported felt stigma. A hierarchical linear regression analysis showed that perceived stress was the most important correlate of depressive symptoms, followed by felt stigma, being unemployed, recurrence of generalized or focal to bilateral tonic-clonic seizures, and being married. The model explained 54.0% of the variance of BDI scores. Significant interactions between felt stigma and perceived stress on BDI scores was identified in both crude and adjusted models (p < 0.05 each). Specifically, in an adjusted model, BDI scores were more strongly associated with perceived stress in persons with (p < 0.001, partial eta² = 0.225) than without (p < 0.001, partial eta² = 0.205) felt stigma.

CONCLUSIONS

Perceived stress was the most significant correlate of depressive symptoms in adults with epilepsy, followed by felt stigma. The interaction between perceived stress and felt stigma on depressive symptoms was significant. These findings may help in developing cognitive behavioral therapy for stigma and stress management in persons with epilepsy.

Self-rated executive dysfunction in adults with epilepsy and effects of a cognitive-behavioral intervention (HOBSCOTCH)

RATIONALE

Cognitive problems are common in adults with epilepsy and significantly affect their quality of life. HOBSCOTCH (HOme Based Self-management and COgnitive Training CHanges lives) was developed to teach problem-solving and compensatory memory strategies to these individuals. This study examined whether HOBSCOTCH is associated with improvement in specific aspects of subjective executive functions.

METHODS

Fifty-one adults, age 18-65, with epilepsy and subjective cognitive concerns were randomized to receive HOBSCOTCH (n = 31) or a care-as-usual control sample (n = 20). Participants completed the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A), as well as the Patient Health Questionnaire-9 (PHQ-9) to assess depression. Rates of elevated (i.e., T ≥ 65, impaired) BRIEF-A scores at baseline, as well as pre-post score changes for the BRIEF-A clinical scales were evaluated. Significance was set at α = 0.05, one-tailed, given our directional hypothesis.

RESULTS

At baseline, a considerable percentage of patients in the overall sample endorsed executive dysfunction on BRIEF-A scales: Inhibit = 28%, Shift = 51%, Emotional Control = 45%, Self-Monitor = 33%, Initiate = 35%, Working Memory = 88%, Plan/Organize = 45%, Task Monitor = 47%, Organization of Materials = 28%. Significant improvement was seen in mean T-scores for Inhibit, Shift, Initiate, and Working Memory in the treatment group, but only Working Memory improved in the control group. The control group endorsed worse task monitoring and organization of materials at baseline and follow-up. Change in depression was not observed for either group, and there was no association between changes in depression and BRIEF-A scores.

CONCLUSIONS

A sizeable subset of adults with epilepsy reported experiencing executive dysfunction in their everyday lives, especially for working memory. HOBSCOTCH resulted in amelioration of subjective executive functioning independent of changes in mood.

Factors associated with self-efficacy among patients with epilepsy in Turkey

PURPOSE

This study aimed to determine the self-efficacy levels of individuals with epilepsy and also compare individuals' self-efficacy with sociodemographic and epilepsy-related characteristics.

MATERIAL AND METHODS

The cross-sectional study was carried out with 200 individuals with epilepsy who were suitable for the inclusion criterias. Data were collected using patient information form which includes sociodemographic and clinical characteristics and Epilepsy Self-Efficacy Scale for evaluating epilepsy-related self-efficacy levels of patients.

RESULTS

The self-efficacy levels of the patients were moderate. Education, gender, occupational status, income, seizure frequency, regular use of medication, the number of drugs used, patient behavior following a drug-related problem, family support, the ability to obtain information about the illness, and hiding the illness from other people were significant factors determining scores on the epilepsy self-efficacy scale.

CONCLUSION

This study confirms the findings of previous studies that were conducted to determine factors affecting self-efficacy. In order to increase self-efficacy, the findings show that there is a need for social support, education of epilepsy individuals, and information and awareness in society.

Gender differences in factors associated with resilience for health-related quality of life in persons with epilepsy

PURPOSE

We determined whether resilience factors such as self-efficacy, stress coping styles, and social support were differentially associated with health-related quality of life (HRQoL) in men and women with epilepsy after controlling for depression, anxiety, and daily-life stress.

METHODS

This was a cross-sectional study of 129 adults with epilepsy. The Quality of Life in Epilepsy Inventory-31 (QOLIE-31), Epilepsy Self-Efficacy Scale, Way of Stress Coping Checklist, Social Support Scale, Beck Depression Inventory (BDI), Beck Anxiety Inventory, and Daily Hassles Scale were used. Stepwise linear regression analyses were performed.

RESULTS

Except for medication effects, there were no gender differences in the QOLIE-31 and its subscales. The medication effects score was higher in men than in women after controlling for BDI scores. The BDI scores were independently associated with the QOLIE-31 score in men and women. Epilepsy self-efficacy was associated with the QOLIE-31 in men, whereas social support was associated with the QOLIE-31 in women. Coping strategies were associated with the QOLIE-31 in neither men nor women. Seizure frequency, daily-life stress, and anxiety were also negatively associated with the QOLIE-31, but only in men. The coefficients of determination were 0.637 and 0.587 in the men's and women's models, respectively.

CONCLUSIONS

The influence of self-efficacy and social support on HRQoL differed between men and women with epilepsy even after controlling for psychological distress. These findings could contribute to the development of successful gender-specific psychosocial interventions to improve HRQoL in men and women with epilepsy.