First population study of the general public awareness and perception of epilepsy in Bosnia and Herzegovina

Have attitudes toward epilepsy improved in Germany over the last 50 years?

OBJECTIVE

In Germany, six previous representative surveys on attitudes toward epilepsy (AE) have been conducted between 1967 and 2008 using the four original Caveness questions (CQs) from 1949 to 1980. The aims of this study were (1) to investigate changes in AE over the time span of 50 years, including the current survey in 2018 (2) to investigate the first-time emotional reactions measured with the Scales of Attitudes toward People with Epilepsy (SAPE) (3) to identify predictors of AE.

METHODS

A representative face-to-face survey with CQ, in addition with the SAPE scales of Social Distance, Stereotypes, Personal Concerns, and Emotional Reactions was carried out in Germany in 2018. One thousand and twenty-six persons who ever had heard of epilepsy participated. Respondents who answered "don't know" in the CQs were subsequently asked to answer only yes/no. The analysis of trends from 1967 to 2018 was based on the pooled data of the surveys. The four CQs in the 2018 survey were included in the SAPE item pool and an exploratory principal axis factor analysis was performed. General linear models were performed to identify predictors.

RESULTS

For all four CQs, the trend of improved AE was significant over the past 50 years. In the 2018 survey, excluding the "don't know" answer option increased the proportion of negative responses for contact of one's own children with a person with epilepsy (PWE) from 6.9% to 11.4% and for the marriage of one's own children with a PWE from 13.9% to 23.8%. When encountering a PWE, 30.1% would feel insecure or uncomfortable and nearly 60% were concerned that the PWE might be injured in case of a seizure. Knowing what to do in case of a seizure, knowing that seizures can be treated successfully, personal contact with a PWE along with younger age, and higher education were found to be the strongest predictors for positive AE identified by multivariate analyses. Exploratory principal axis factor analysis revealed that three of the four CQs items loaded > 0.30 at the factors of Social Distance and Stereotypes of SAPE but none on the factors measuring emotional reactions.

SIGNIFICANCE

AE measured by CQs have markedly improved in Germany over the last 50 years. Germany is to our knowledge the only country with such a long-term trend investigation in AE. Negative AE may be underestimated by survey questions with "don't know" answer option. Emotional aspects of attitudes are underexposed resp. neglected in the CQs, which are used worldwide for measuring AE. Additional tools like SAPE can close this gap. The identified predictors may help to derive interventions against negative AE.

Systematic review of frequency of felt and enacted stigma in epilepsy and determining factors and attitudes toward persons living with epilepsy-Report from the International League Against Epilepsy Task Force on Stigma in Epilepsy

OBJECTIVE

To review the evidence of felt and enacted stigma and attitudes toward persons living with epilepsy, and their determining factors.

METHODS

Thirteen databases were searched (1985-2019). Abstracts were reviewed in duplicate and data were independently extracted using a standardized form. Studies were characterized using descriptive analysis by whether they addressed "felt" or "enacted" stigma and "attitudes" toward persons living with epilepsy.

RESULTS

Of 4234 abstracts, 132 met eligibility criteria and addressed either felt or enacted stigma and 210 attitudes toward epilepsy. Stigma frequency ranged broadly between regions. Factors associated with enacted stigma included low level of knowledge about epilepsy, lower educational level, lower socioeconomic status, rural areas living, and religious grouping. Negative stereotypes were often internalized by persons with epilepsy, who saw themselves as having an "undesirable difference" and so anticipated being treated differently. Felt stigma was associated with increased risk of psychological difficulties and impaired quality of life. Felt stigma was linked to higher seizure frequency, recency of seizures, younger age at epilepsy onset or longer duration, lower educational level, poorer knowledge about epilepsy, and younger age. An important finding was the potential contribution of epilepsy terminology to the production of stigma. Negative attitudes toward those with epilepsy were described in 100% of included studies, and originated in any population group (students, teachers, healthcare professionals, general public, and those living with epilepsy). Better attitudes were generally noted in those of younger age or higher educational status.

SIGNIFICANCE

Whatever the specific beliefs about epilepsy, implications for felt and enacted stigma show considerable commonality worldwide. Although some studies show improvement in attitudes toward those living with epilepsy over time, much work remains to be done to improve attitudes and understand the true occurrence of discrimination against persons with epilepsy.

Prevalence of depression, risk factors, and quality of life in patients with epilepsy in a remote area of western Rajasthan

BACKGROUND

Depression is a common psychiatric disorder in patients with epilepsy. This study aimed to determine the prevalence and related risk factors for depression among people with epilepsy and their quality of life.

METHODS

Hospital-based cross-sectional study was carried out among 352 individuals with epilepsy from April 2020 to September 2020. Purposive sampling was used to recruit participants over a specified period. The Beck's Depression Inventory-II (BDI-II) was used to measure depression severity, the Perceived Stress Scale (PSS) to assess stress level, the Oslo 3 Social Support Scale (OSSS-3) to assess social support, and the WHOQOL-BREF scale to estimate quality of life (QoL). The statistical analysis was carried out using SPSS version 20. Logistic regression analysis was done to determine the risk factors for depression.

RESULTS

A total of 352 study participants were considered in the study. The prevalence of depression was found to be 41.19%. In the final multivariate analysis, the independent variables that influenced depression were socioeconomic status (OR 2.75, CI 1.21-5.41), frequency of seizures in the previous year (OR 2.17, CI 1.08-5.26), duration of illness (OR 3.49, CI 1.03-7.52), and poor social support (OR 6.37, CI 1.85-9.48) at p-value < 0.05. When compared to patients without depression, the average mean score (SD) in all four domains was lower in physical 39.01 (4.61), psychological 43.93 (8.13), social 52.89 (10.44), and environmental domains 47.14 (6.99) in patients with depression in BREF quality-of-life scale. There was a statistically significant difference in the physical, psychological, and social domains (p-value < 0.05).

CONCLUSION

In people with epilepsy, depression was quite common. Patients that were depressed had a lower QoL. Clinicians should pay special attention to people with epilepsy who lack social support, have low socioeconomic status, longer duration of illness, and have more seizure frequency. Qualified clinicians should do early depression-focused screenings for people with epilepsy.

Evaluation of attitudes toward epilepsy and health fatalism in northeastern Turkey

PURPOSE

This study was carried out to identify the attitudes toward epilepsy, health fatalism, and the factors affecting these in individuals living in Artvin in the northeast of Turkey.

METHOD

This descriptive and cross-sectional study involved 1443 healthy individuals at a hospital in Artvin in northeastern Turkey between January and March 2020. An individual information form, an epilepsy attitude scale, and a religious health fatalism scale were used to assess their views. An independent sample t-test, Mann-Whitney U test, one-way analysis of variance (ANOVA), and Pearson correlation analysis were used to analyze the data.

RESULTS

The mean score of participants' attitudes on epilepsy was 48.17 (standard deviation (SD) = 12.93), while the mean of their health fatalism score was 48.43 (SD = 17.41). There was a significant negative correlation between attitude scores and health fatalism (r = -0.084, p = 0.001). Significant differences were found among attitude, health fatalism mean scores, and misconceptions associated with religion about epilepsy being a contagious, psychiatric, and incurable disease that should be hidden. Significant differences were additionally observed among attitude, health fatalism mean scores, and education, marital status, income, employment status, and presence of chronic disease (p < 0.05).

CONCLUSION

It was found that most individuals had moderate level attitude toward epilepsy and had high health fatalism. Individuals with a high degree of health fatalism were found to have more negative attitude toward epilepsy. Attitude was found to be more negative, and health fatalism was found to be higher in individuals with low education level, low-income level, who were married, who were unemployed, who had a chronic disease, and in those who thought epilepsy was a contagious, psychiatric, and incurable disease associated with religion that should be hidden.

IMPLICATIONS

It is recommended that health professionals organize training programs to increase public understanding of epilepsy, improving individual attitudes toward the condition, and minimizing health fatalism.

An evaluation of knowledge and attitudes toward epilepsy in Eastern Turkey

PURPOSE

This study was designed to determine the knowledge and attitudes regarding epilepsy among individuals in eastern Turkey.

METHOD

This descriptive study involved 530 healthy individuals who came to the Research and Application Hospital of Ataturk University in Erzurum, Turkey. A questionnaire and the epilepsy knowledge and attitude scale were administered to collect data. Mann-Whitney U, Kruskal-Wallis, and Spearman's correlation tests were used to analyze the data.

RESULTS

The participants' epilepsy knowledge mean score was 6.34 (SD=3.71), and their attitude mean score was 50.22 (SD=11.17). There was a positive (r=0.404) correlation between the knowledge and the attitude scores (p<0.001), and negative correlations between age and the knowledge (p=0.036) and the attitude scores (p<0.001). The mean knowledge and attitude scores were higher for the participants who were high school and university graduates, had expenses equal to income, and lived in nuclear families and in the city center (p<0.001). Civil servants and housewives had significantly higher mean knowledge scores, and students had significantly higher mean attitude scores (p<0.001). Significantly higher knowledge and attitude mean scores were also found for those who knew patients with epilepsy, had witnessed epileptic seizures, obtained information from healthcare personnel, and did not believe that epilepsy was associated with religion (p<0.001).

CONCLUSIONS

The study participants had low knowledge about epilepsy but displayed positive attitudes toward it. Higher knowledge positively affected attitude, and younger individuals had greater knowledge and, thus, more positive attitudes. Women, civil servants, and housewives had higher knowledge, whereas singles and students had better attitudes. The participants who had high educational levels and expenses equal to income and lived in nuclear families and the city center had more knowledge and displayed more positive attitudes. Greater knowledge and more positive attitudes were also found among the participants who knew patients with epilepsy, had witnessed epileptic seizures, obtained the information from healthcare personnel, and did not believe that epilepsy was associated with religion.

Epilepsy misconceptions and stigma reduction: Current status in Western countries

OBJECTIVE

This systematized literature review identified reports describing epilepsy misconceptions in the developed Western countries and research interventions focused on reducing these misconceptions.

MATERIALS AND METHODS

English language publications from January 2004 to January 2015 that described original research conducted in Europe, North/Central/South America, or Australia on misconceptions about epilepsy among the general public were used for this review.

RESULTS

Eighty-one publications were selected. Most studies were conducted in the Americas (N=30) and Europe (N=31). Misconceptions and attitudes about epilepsy were assessed among clinical providers (N=9), family members of people with epilepsy (PWE) (N=5), teachers (N=11), students (N=22), and the general public (N=25). Most studies used structured questionnaires, sometimes adding open-ended questions. Misconceptions reflected socially exclusionary attitudes directed at PWE, ignorance about treatment, and overgeneralizations that are stigmatizing when applied to all PWE. Misconceptions were more prevalent in those with less education, lower socioeconomic status, and no exposure to PWE. There were only 12 intervention studies. While intervention studies were generally effective in improving attitudes, many were targeted to healthcare and education settings, were time-intensive, and impractical for broad general population implementation. None incorporated newer technology-based strategies regarding effective health communication approaches.

CONCLUSIONS

Types of epilepsy misconceptions were similar in reports published over the last decade, although most referred to misconceptions that have already been previously described. Existing questionnaires may fail to identify more subtle forms of current misconceptions and negative attitudes. Few interventional studies specifically target epilepsy stigma. Practical and broad scalable approaches to destigmatize epilepsy may help reduce misconceptions.

Knowledge and attitudes towards epilepsy in Zambia: a questionnaire survey

Misconception and stigma towards epilepsy have a profound impact on this disease in Africa. An unselected sample of Zambian people was interviewed to investigate their knowledge and attitudes towards epilepsy. Proper/improper answers were scored, and a composite score was developed with negative values for unsatisfactory awareness and high stigma levels. The sample comprised 231 people residing in urban (107) or in rural (124) areas. The median and interquartile range of scores for epilepsy awareness and stigma were, respectively, -1 (-3; +1) and +1 (-1; +6). Poor education was the only significant predictor of unsatisfactory awareness (p=0.0131), while education and residency were significantly associated with stigma (p<0.0001 and p=0.0004). Rural people were mostly in the highest stigma level (44.2%) and urban people in the lowest stigma level (60.4%). Misconception and negative attitudes towards epilepsy among Zambian people reflect poor education and rural residency.

Public perception of epilepsy in dogs is more favorable than in humans

OBJECTIVES

With the use of YouTube™, this study provides results on both the demographics and public perception for a sample of videos of canine epilepsy.

METHODS

A random sample of 150 videos was collected, the uploader description was recorded, and viewers' comments were coded according to their emotional and informational content.

RESULTS

More comments were found to be sympathetic than derogatory, and there were more information-providing than information-seeking comments. The number of sympathetic comments was found to correlate positively with the number of derogatory comments, and the number of information-providing comments correlated positively with the number of information-seeking comments.

CONCLUSION

These findings shed light on the variation in perceptions of seizures in dogs, which are interestingly more sympathetic towards dogs with epilepsy than towards humans with epilepsy. This highlights the potential future use of YouTube in investigating public views as well as in informing and educating.

A five-year follow-up study of the general public awareness and perception of epilepsy in Croatia

Public reception of epilepsy in Croatia was re-assessed in 2009, 5 years after an initial survey, by interviewing 1000 randomly selected adults. Ninety-two percent (-5.0%) of the respondents had heard about epilepsy, 47% (-7.9%) knew someone with epilepsy, and 38.6% (-6.0%) had witnessed a seizure. Interviewees were quite ready to accept a person with epilepsy. Almost 8% (+1.1%) would object if their child played with a child with epilepsy, and 77.8% (+1.8%) believed that a child with epilepsy could succeed as well as a child without epilepsy. Although 45.9% (-6.6%) would approach a person having a seizure and help, 36.1% (+3.0%) would also call "911." Citizens of Croatia re-declared a high tolerance toward people with epilepsy and positive attitude toward children with epilepsy. Experiential factors remained strong predictors of more positive attitudes. A more prominent role of patients and implementation of social marketing in addressing a large persisting degree of prejudice and stigmatization worldwide are warranted.

Knowledge and attitudes towards epilepsy among inhabitants of Silesia. A questionnaire study

BACKGROUND AND PURPOSE

Epilepsy is one of the most frequent neurological diseases. Social acceptance is very important for people with epilepsy and their relatives. The aim of the study was to assess public knowledge and attitudes towards epilepsy in Silesia.

MATERIAL AND METHODS

We examined 419 people, inhabitants of Silesia, at the mean age of 34 ± 15 years. The study was performed using a questionnaire containing 15 questions evaluating knowledge about epilepsy and attitudes towards people with epilepsy.

RESULTS

43.2% of the respondents knew an epileptic person themselves. 44.7% had witnessed an epileptic seizure; 68.8% would help a person during an epileptic seizure, but most of them (73.4%) would do it incorrectly (by putting an object into the mouth to prevent biting the tongue). 94.5% of respondents had nothing against friendship with an epileptic person, but 12.1% suggested that children with epilepsy should attend special schools. 85.9% of all those examined said that people with epilepsy should inform others about their disease, 81.9% would mention the existence of an epileptic person in their family. 40.5% of respondents believe that people with epilepsy can do the same jobs as healthy people, 75.3% would employ an epileptic person themselves.

CONCLUSIONS

The knowledge about epilepsy and first aid during epileptic seizure is still insufficient among inhabitants of Silesia. Most of the responders, especially better educated ones, declare acceptance and tolerance of people with epilepsy. More effort should be made to improve public knowledge of epilepsy by preparing wide-spread educational programmes.

Familiarity with, knowledge of, and attitudes toward epilepsy in Turkey

The aims of the study described here were to investigate familiarity with, knowledge of, and attitudes toward epilepsy and to assess indicators of positive attitudes toward epilepsy. Questionnaires previously developed for the Turkish population were used to assess knowledge and attitudes. Data were collected from 1354 randomly selected adults. Three-quarters of the sample had heard something about epilepsy, and almost half of the sample personally knew someone with epilepsy. The sample had a moderate level of knowledge of and favorable attitudes toward epilepsy in general. Variables that predicted positive attitudes were young age, male gender, and high level of knowledge of epilepsy. The results for both knowledge and attitudes indicate that the findings of the study are largely in line with previous studies, but where there is wide variability among previous findings, the findings for the Turkish population lie, just as Turkey does geographically, between those of the East and West.

Past and present public knowledge and attitudes toward epilepsy in Italy

A nationwide survey was performed in Italy to assess awareness and attitudes of the public about epilepsy. Knowledge about epilepsy, its clinical features, and attitudes towards its social/individual implications were tested in a telephone interview. Included were 819 women and 737 men aged 18+years. 93.4% declared they knew epilepsy, 56.6% knew a person with epilepsy, and 45.1% saw someone seizing. Only 29.2% gave an exact estimate of the prevalence of the disease. 50.4% were unaware of the causes, 56.1% indicated that epilepsy was a psychological/psychiatric disease, 36.5% a form of insanity, and 4.1% an evil spirit possession. Epilepsy was incurable according to 35.5%. Moderate-to-severe restrictions to driving, regular employment, military career, and leisure activities were suggested by 79.8, 57.0, 71.1, and 57.6%. Limitations included marriage and procreation for 46.2 and 38.7%. Knowledge and attitudes varied with education, age and gender. These findings are partly in keeping with other worldwide reports.

Patient beliefs about epilepsy and brain surgery in a multicultural urban population

We assessed beliefs about epilepsy and brain surgery and the use of alternative epilepsy treatments in a culturally diverse population of people with epilepsy (PWE). Data were obtained from a structured questionnaire administered to 109 PWE treated at a single epilepsy center. Patients were born in 17 countries on five continents. Most patients identified culturally with the Caribbean (41%), United States (39%), or Latin America (9%). Sixty-nine percent of patients endorsed at least one of five stigma-related questions, and 77% used at least one alternative epilepsy treatment. Brain surgery was rated as having a mean dangerousness of 8.3 (on a scale of 1 to 10) among the 94 patients with no history of neurosurgery. In addition, 51% of these patients would not consider surgical treatment even if it were guaranteed to stop their seizures without causing deficits. Educational efforts aimed at reducing both the stigma associated with epilepsy and the fear of resective epilepsy surgery are needed.

Epilepsy impact on aspects of school life of children from different cultural populations in Thrace, Greece

Epilepsy influences the school life of children. The aims of this study were to (1) assess absenteeism and participation in sports activities, (2) investigate whether parents inform school and children inform their classmates, and (3) determine which factors influence these school aspects. Children from both Christian and Muslim families were enrolled and different cultural variables were prospectively documented. A total of 62 children with epilepsy (mean age: 10.2+/-3.3 years, range: 6-18) participated in the present study. Univariate analysis and multivariate logistic regression models were used to explore potential factors that could influence school life. Absenteeism was correlated with shorter disease duration, severity, lower parental educational level, and knowledge of epilepsy. Age>12 was associated with nonparticipation in activities. Schools were informed by 84% of families, and classmates, by 22.6% of children. In conclusion, better knowledge of epilepsy resulted in fewer missed school days. The majority of children did not discuss their disease, and children from the two populations with different religions did not differ significantly in the school aspects examined. These findings suggest a probable positive effect of educational programs on the issue of daily school life.

Knowledge of, attitudes toward, and perceptions of epilepsy among college students in Trinidad and Tobago

Epilepsy is poorly understood by the public and has been associated with numerous myths. This, coupled with its sometimes dramatic clinical manifestations, has often resulted in stigmatization of persons with epilepsy. A questionnaire to measure knowledge of, attitudes toward, and perceptions of epilepsy (KAPE) was adapted from previous studies and administered to students of the University of the West Indies, St. Augustine, Trinidad and Tobago. The response rate was 91% (355 students). Knowledge was limited, especially with respect to epilepsy's cause, its incidence, and management of an acute emergency. Attitudes toward epilepsy were generally positive. Students who knew someone with epilepsy scored significantly higher on knowledge and attitude questions. A stigma score was calculated to assess perceived stigmatization. There were no differences between the genders, but persons from rural areas and persons of mixed ethnicity perceived less stigmatization. Hindus perceived greater stigmatization than people of other religions. Overall, students still feel persons with epilepsy are discriminated against and experience stigmatization.