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Sarac E, Yildiz E. The effect of epilepsy self-management on productivity at work. Epilepsy Behav 2024; 157:109839. [PMID: 38820679 DOI: 10.1016/j.yebeh.2024.109839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Epilepsy is a significant public health concern and the most common neurological disorder. Lack of understanding of the disease may magnify the challenges faced by employees with epilepsy, including effective management of symptoms, and full participation in workplace and work productivity. AIM Study aimed to evaluate epilepsy self-management skills of working individuals with epilepsy and to determine the impact of it on productivity at work. METHODS The study adopted a cross-sectional design and involved 111 individuals with epilepsy. Data collection was carried out using a socio-demographic characteristics form, the "Epilepsy Self-Management Scale" and the "Endikot Work Productivity Scale." RESULTS The average age was 35.76 ± 3.39 in the study. The majority of the participants (57.7 %) were women. Additionally, 33.3 % were private sector employee, and 39.6 % held a bachelor's degree. The mean score of the Epilepsy Self Management Scale was 3.91 ± 0.15, the total score of Endikot Work Productivity Scale was 39.84 ± 6.33. A negative significant correlation was observed between epilepsy self management and work productivity. Moreover, women (3.94 ± 0.17) and healthcare workers (3.97 ± 0.06) had higher scores of epilepsy self management. While men (40.43 ± 0.15) demonstrated higher productivity scores, public servants (35.61 ± 0.34) had lower scores compared to others (p < 0.05). CONCLUSIONS The findings of this study suggest that improved self-management of epilepsy among working individuals leads to increased work productivity. The epilepsy-management skills of women and healthcare workers was higher. Furthermore, men exhibited lower productivity levels, while woman and public servants displayed higher.
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Affiliation(s)
- Elif Sarac
- Ministry of National Defense, The Directorate of Management Services, Ankara, Turkiye.
| | - Esra Yildiz
- Ataturk University, Nursing Faculty, Public Health Nursing Department, Erzurum, Turkiye.
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Pélissié Du Rausas F, Lagger I, Preux PM, Serghini Rousseau K, Martínez OA. Quality of life in people with epilepsy: Associations with resilience, internalized stigma, and clinical factors in a low-income population. Epilepsy Behav 2024; 155:109801. [PMID: 38669973 DOI: 10.1016/j.yebeh.2024.109801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Epilepsy is a common neurological disorder associated with comorbidities and a reduced quality of life (QoL). Internalized stigma is negatively correlatedwiththe QoL, whereas high levels of resilience are associated with increased QoL. Although the stigma towards people with epilepsy (PWE) is expected to be higher in low-income settings than in high-income settings, further research is needed. This study aimed to examine the extent to which resilience and internalized stigma correlatewith the QoL in PWE from a low-income population. MATERIAL AND METHODS A cross-sectional, observational, descriptive study was conducted on 60 PWE who visited the Neurology Department of the Hospital de Clinicas (Buenos Aires, Argentina) between May and September 2022. Demographic and clinical data were collected. Participants completed the Quality of Life, Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), the Chronic Illness Anticipated Stigma Scale (CIASS), and the Resilience Scale (RS). Variables that showed a significant association with the QoL in the univariate analysis were included in a multiple regression model. RESULTS Participants had a low overall QoL score, with a median of 59 (95 %CI: 57.2-61.8). They had an average level of education and a high rate of unemployment. Perceived stigma was higher in the workplace than in the medical or family settings. Univariate analysis revealed that the QoL was associated with internalized stigma score, resilience score, seizure frequency, seizure etiology, work status, and educational level. The multiple regressionrevealed a significant decrease in the QoL when perceived stigma increased (p = 0.0016) or when the cause of epilepsy was structural (p = 0,006) and a significant increase in the QoL when the resilience score was higher (p = 0.0004). CONCLUSION The QoL of PWE in a low-income context is strongly associated with their levels of resilience and internalized stigma. When addressing the social burden of epilepsy, resilience support should be increased in the care of PWE to reduce internalized stigma and improve the QoL.
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Affiliation(s)
| | - Ignacio Lagger
- Instituto de InvestigacionesBiomédicas (BIOMED), Consejo Nacional de InvestigacionesCientíficas y Técnicas (CONICET), Pontificia Universidad Católica Argentina, Ciudad Autónoma de Buenos Aires, Argentina
| | - Pierre-Marie Preux
- InsermU1094, IRD UMR270, University of Limoges, CHU Limoges, EpiMaCT-Epidemiology of Chronic Diseases in the Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, 87000 Limoges, France
| | | | - Oscar A Martínez
- NeurologyDepartment, Hospital de Clínicas José de San Martín, Ciudad Autónoma de Buenos Aires, Argentina
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Naftaly JP, Feldman ECH, Greenley RN. Perceived Stigma in Patients with Autoimmune Hepatitis. J Clin Psychol Med Settings 2024; 31:455-464. [PMID: 38127091 DOI: 10.1007/s10880-023-09983-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/23/2023]
Abstract
Perceived stigma (PS) adversely impacts psychosocial and disease outcomes in patients with chronic liver diseases (CLD), and those with autoimmune hepatitis (AIH) may be at risk for PS given inaccurate assumptions about the origin of their diagnosis. The aims of the current study are to describe the frequency of PS in patients with AIH, compare rates of PS in AIH to rates of PS in primary biliary cholangitis (PBC) and CLD, and examine demographic correlates of PS. 262 adults with AIH (95% female, Mage = 51.53 years) completed online questionnaires on demographics, disease information, and PS. 54-68% reported PS with themes of selective disclosure, non-disclosure, or hiding diagnosis. PS was higher in those with AIH compared to those with PBC, but lower than those with various CLD. Age was inversely related to PS. Given the results, provider screening of PS and integration of clinical health psychologists may be helpful for identifying PS in patients with AIH.
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Affiliation(s)
- Jessica P Naftaly
- Department of Internal Medicine-Gastroenterology, Michigan Medicine, University of Michigan, 1500 E. Medical Center Drive, Floor 3, Reception D, Ann Arbor, MI, 48109, USA.
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, 60064, USA.
| | - Estée C H Feldman
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Rachel N Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, 60064, USA
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Tombini M, Narducci F, Ricci L, Sancetta B, Boscarino M, Quintiliani L, Lanzone J, Straffi M, Di Lazzaro V, Assenza G. Resilience and psychosocial factors in adult with epilepsy: A longitudinal study. Epilepsy Behav 2024; 154:109746. [PMID: 38513570 DOI: 10.1016/j.yebeh.2024.109746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Resilience is conceptually characterized as a dynamic process encompassing positive adaptation in the context of significant adversity. Our goal was to assess the resilience in people with epilepsy (PWE) and how it impacts longitudinally on psychosocial factors, with a particular focus on the manifestation of stigmatization-related feelings. METHODS We consecutively enrolled 78 adults PWE (42.5 ± 16.2 years old); among them 36 (46.1 %) were seizure-free. All subjects completed at baseline (T0) the Resilience Scale (RS-14) and questionnaires for the assessment of depressive symptoms, anxiety and quality of life: respectively, Beck Depression Inventory-II (BD-II), Generalized Anxiety Disorder-7 (GAD-7) and QOLIE-31 (Q31). All patients were followed up prospectively and re-evaluated after 6-22 months (T1; mean: 14 ± 8 months; median 14 months); at follow up they also completed the Stigma Scale of Epilepsy (SSE) for the assessment of the stigma associated with epilepsy. We correlated resilience values with all psychosocial scores at T0 and T1. Factors associated with resilient and vulnerable outcomes were identified. Finally, a multiple stepwise regression analysis was applied to identify predictors for resilience and stigma perception. RESULTS The results showed for the RS-14 score a significant direct correlation with the Q31 (p < 0.001) and an inverse correlation with the depressive and anxiety symptoms at both times (T0 and T1), as evaluated with BDI-II (p < 0.001) and GAD-7 (p < 0.001). Finally, we found a significant inverse correlation between RS-14 at T0 and the levels of stigmatization assessed with SSE at T1 (p =.015). Using a multiple stepwise regression analysis separately for resilience and stigma perception, depressive symptoms turned out as the best predictors for both variables. Finally, considering longitudinal evaluation we did not observe significant changes in depressive and anxious symptoms, despite a significant reduction in the total number of seizures at follow up. CONCLUSIONS Our study showed that depressive symptoms, anxiety and quality of life were significantly associated with resilience in PwE. Finally, as a novel finding resilience was proved to affect the perception of stigma related to epilepsy more than seizures.
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Affiliation(s)
- M Tombini
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy.
| | - F Narducci
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy
| | - L Ricci
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy
| | - B Sancetta
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy
| | - M Boscarino
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy; Dipartimento di Neuroriabilitazione, IRCCS Fondazione Salvatore Maugeri, Milano, Italia
| | - L Quintiliani
- Psicologia Clinica, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy
| | - J Lanzone
- Dipartimento di Neuroriabilitazione, IRCCS Fondazione Salvatore Maugeri, Milano, Italia
| | - M Straffi
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy
| | - V Di Lazzaro
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy
| | - G Assenza
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy
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Cronin W, Kwan P, Foster E. Anxiety and depressive symptoms in adults with new-onset seizures: A scoping review. Epilepsia Open 2023; 8:758-772. [PMID: 37247255 PMCID: PMC10472411 DOI: 10.1002/epi4.12766] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Anxiety and depression are common comorbidities in people living with epilepsy. Emerging research suggests that these conditions may even predate epilepsy onset. This review aimed to summarize the prevalence of clinically significant anxiety and depressive symptoms in people with first seizures and newly diagnosed epilepsy, as well as clinicodemographic factors associated with these symptoms. METHODS A scoping literature review was performed. OVID Medline and Embase were searched from January 1, 2000, through May 1, 2022. Articles of interest were selected based on predetermined inclusion and exclusion criteria. RESULTS From 1836 studies identified on screening, 16 met eligibility criteria and were included in the review. Clinically significant anxiety and depressive symptoms, as determined by validated cutoff scores for anxiety and depression screening instruments, were common in people with first seizures (range 13-28%) and newly diagnosed epilepsy (range 11-45%). They were associated with a range of clinicodemographic factors including past psychiatric history and trauma, personality traits, self-esteem, and stigma profiles. SIGNIFICANCE There is substantial evidence that clinically significant anxiety and depressive symptoms are often present at the time and shortly following the first seizure or epilepsy diagnosis. Future research is needed to better understand the complex interactions between these common psychiatric comorbidities, new-onset seizure disorders, and certain clinicodemographic characteristics. This knowledge may inform targeted and holistic treatment approaches.
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Affiliation(s)
- William Cronin
- Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneVictoriaParkvilleAustralia
| | - Patrick Kwan
- Neurology DepartmentAlfred HealthMelbourneVictoriaAustralia
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneParkvilleVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Monash Institute for Medical Engineering (MIME)Monash UniversityMelbourneVictoriaAustralia
| | - Emma Foster
- Neurology DepartmentAlfred HealthMelbourneVictoriaAustralia
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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Kuramochi I, Iwayama T, Brandt C, Yoshimasu H, Bien CG, Hagemann A. Assessment of self-stigma in epilepsy: Validation of the German version Epilepsy Self-Stigma Scale (ESSS-G). Epilepsia Open 2023; 8:946-958. [PMID: 37254471 PMCID: PMC10472374 DOI: 10.1002/epi4.12765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/23/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE Self-stigma is the internalization of unfavorable public perceptions, which people with epilepsy (PWE) frequently experience. PWE with strong self-stigma have low self-esteem and are less likely to engage in treatment behavior. The Epilepsy Self-Stigma Scale (ESSS) has been developed and validated in Japan. We translated the ESSS into German for this study to examine its reliability and validity. METHODS We created the German version of ESSS (ESSS-G) based on the original Japanese version. From May to October 2022, we recruited out- and inpatients from Bethel Epilepsy Centre, University Hospital for Epileptology, for psychometric evaluation. Inclusion criteria were an age of ≥18 years, sufficient reading and speaking skills in German, and the ability to comprehend the German questionnaires. Participants also completed the Rosenberg Self-Esteem Scale (RSES), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Generalized Anxiety Disorder 7 (GAD-7), Epilepsy Knowledge Scale, and items on "overall quality of life (QOL)" and "overall health" (items from QOLIE-31). RESULTS One hundred twenty-eight of 146 patients asked to participate granted informed consent and completed the study questionnaire (87.7% response rate). 115 cases were analyzed since 13 did not match the inclusion criteria. The analysis revealed a single factor explaining 49.2% of the total variance. All factor loadings were >0.40, and the reliability was high (Cronbach's α = 0.80). Higher ESSS total scores were associated with higher anxiety (GAD-7, r = 0.54, P < 0.001) and depression (NDDI-E, r = 0.45, P < 0.001), lower self-esteem (RSES, r = -0.41, P < 0.001), overall QOL (r = -0.40, P < 0.001), and overall health (r = -0.35, P < 0.001), but not with knowledge about epilepsy (r = 0.03, P = 0.770). In Germany, females, younger individuals, patients with earlier seizure onset, and those with generalized epilepsy had significantly higher self-stigma. SIGNIFICANCE The German version of the ESSS proved reliable and valid. It allows to evaluate the efficacy of treatment strategies in lowering self-stigma and conducting intercultural comparisons of epilepsy self-stigma.
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Affiliation(s)
- Izumi Kuramochi
- Department of Epileptology (Krankenhaus Mara)Bielefeld University, Medical SchoolBielefeldGermany
- Department of Psychiatry, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Takayuki Iwayama
- Department of Psychiatry, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
- Department of PsychologyShowa Women's UniversityTokyoJapan
| | - Christian Brandt
- Department of Epileptology (Krankenhaus Mara)Bielefeld University, Medical SchoolBielefeldGermany
- Society for Epilepsy ResearchBielefeldGermany
| | - Haruo Yoshimasu
- Department of Psychiatry, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Christian G. Bien
- Department of Epileptology (Krankenhaus Mara)Bielefeld University, Medical SchoolBielefeldGermany
- Society for Epilepsy ResearchBielefeldGermany
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Walther K, Kriwy P, Stritzelberger J, Graf W, Gollwitzer S, Lang JD, Reindl C, Schwab S, Welte TM, Hamer HM. Attitudes toward persons with epilepsy as friends: Results of a factorial survey. Epilepsia 2023; 64:769-776. [PMID: 36520011 DOI: 10.1111/epi.17491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Discrimination against persons with epilepsy (PWEs) may persist. The aim of this study was to examine whether epilepsy is an obstacle to desired friendship. METHODS A factorial survey (vignettes), which is less biased by social desirability, was applied to PWEs, their relatives, and lay persons. The vignettes described a person who was varied by the dimensions of age (younger, same age, older), gender (male, female), disease (healthy, mild epilepsy, severe epilepsy [generalized tonic-clonic seizures], diabetes), origin (German, non-German), contact (phone/internet, activities at home, activities outside), frequency of contacts (weekly, monthly), and distance (around the corner, 10 km away). Respondents rated their willingness to befriend the person on a 10-point Likert scale. Multivariate regression determined the contribution of each dimension on the judgment. RESULTS Participants were 64 PWEs (age = 37.1 ± 14.0 years), 64 relatives of PWEs (age = 45.1 ± 13.6 years), and 98 controls without contact with PWEs (age = 24.4 ± 10.1 years). Controls were less interested in a friendship with a PWE with mild epilepsy (-3.4%) and even more avoided PWEs with severe epilepsy (-11.7%), whereas in PWEs with tonic-clonic seizures, a mild form of epilepsy was actually conducive to friendship (+7.0%). Controls preferred females (+5.0%) and disliked younger people (-12.3%) and contacts via the internet or telephone (-7.3%). PWEs were also less interested in younger people (-5.8%), and relatives of PWEs had a lower preference for friendships with longer distance (-2.3%). SIGNIFICANCE PWEs still suffer from a risk of social avoidance, and this becomes more evident with generalized motor seizures.
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Affiliation(s)
- Katrin Walther
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter Kriwy
- Institute of Sociology, Chemnitz University of Technology, Chemnitz, Germany
| | - Jenny Stritzelberger
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Graf
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Stefanie Gollwitzer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Johannes D Lang
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Caroline Reindl
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Stefan Schwab
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Tamara M Welte
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Perceived stigma in adults with epilepsy in Sweden and associations with country of birth, socioeconomic status, and mental health. Epilepsy Behav 2022; 136:108886. [PMID: 36152384 DOI: 10.1016/j.yebeh.2022.108886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Stigma contributes to negative health outcomes and amplifies health disparities in epilepsy. This study aimed to investigate associations of perceived stigma with the country of birth and socioeconomic status (SES). METHODS This is a cross-sectional questionnaire study. Participants were recruited consecutively from three demographically different neurology outpatient clinics in the southwest of Sweden. Participants responded to a questionnaire concerning their epilepsy, country of birth, mother tongue, and different SES-variables. The Neuro-QOL stigma scale and the Jacoby stigma scale were applied to assess stigma and the Hospital Anxiety and Depression Scale (HADS) and PROMIS Mental Health scale were applied to assess mental health. RESULTS In total 161 adults with epilepsy were included in the cohort. The median Neuro-QOL stigma score was 48.3, and was higher among foreign-born than in native-born participants (foreign-born in non-European country 52.3, in other European country 49.8, and in native-born 47.0, p = 0.003). Other factors associated with Neuro-QOL were seizure frequency last year (≥2 seizures 52.4 compared to 1 seizure 50.9 and no seizures 44.3, p < 0.001), having had seizures in public (yes 50.9 compared to no 44.7, p = 0.035), HADS depression score ≥11 (57.4 compared to 47.8 for score <11 points, p < 0.001), HADS anxiety score ≥11 (53.5 compared to 46.8 for score <11 points, p < 0.001), and lower PROMIS Mental Health score (42.9 for PROMIS < 40 compared to 54.4 for PROMIS > 60, p < 0.01). A stepwise multiple regression analysis indicated that having had seizures the last year increased the average Neuro-QOL stigma score with 5.89 and appeared as the most determining factor for the Neuro-QOL stigma score among the variables investigated. CONCLUSIONS It is important that the concerns of foreign-born patients are acknowledged and that the focus of seizure control and the detection and treatment of comorbidities are prioritized in the management of epilepsy and perceived stigma.
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Lalatović S, Milovanović M, Krstić N. Stigma and its association with health-related quality of life in adults with epilepsy. Epilepsy Behav 2022; 135:108874. [PMID: 35973375 DOI: 10.1016/j.yebeh.2022.108874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/15/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the presence of felt and enacted stigma in people with epilepsy (PWE), members of a self-governing epilepsy organization and to evaluate the influence of both types of stigma on health-related quality of life (HRQoL) in PWE. METHODS Participants were 55 PWE (age range: 18-53 years), members of a non-governmental organization (further "NGO"). The sociodemographic and epilepsy-related variables were collected through structured interviews designed for the purpose of the study. Felt stigma was assessed with the Epilepsy Stigma Scale (ESS) and enacted stigma with the Questionnaire for episodes of discrimination against PWE. Quality of Life in Epilepsy Inventory (QOLIE-31) (Serbian version) was used for the evaluation of HRQoL. RESULTS The mean ESS score was 33.93 ± 14.50. Felt stigma was significantly associated with the male gender and the number of antiepileptic drugs (AEDs). Participants' mean score on the Questionnaire for episodes of discrimination was 2.80 ± 2.78. Enacted stigma was significantly correlated with male gender and number of AEDs, as well as with older age/longer duration of the disorder. Felt stigma scores were positively correlated with enacted stigma scores (p < 0.001), but only felt stigma scores were negatively related to QOLIE-31 overall score (p = 0.01). The combination of AEDs, seizure frequency, and felt stigma best explained the HRQoL in PWE (p < 0.001). CONCLUSION Felt and enacted stigma are moderately related, but only felt stigma appears to be a significant predictor of the deteriorating HRQoL in this sample. Interventions targeting felt stigma should be considered a part of comprehensive epilepsy care as well as educating the wider community about epilepsy.
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Affiliation(s)
- Staša Lalatović
- Faculty of Special Education and Rehabilitation, University of Belgrade, Visokog Stevana 2, 11000 Belgrade, Serbia.
| | - Maja Milovanović
- Faculty of Special Education and Rehabilitation, University of Belgrade, Visokog Stevana 2, 11000 Belgrade, Serbia; Department for Epilepsy and Clinical Neurophysiology, Institute of Mental Health, Milana Kašanina 3, 11000 Belgrade, Serbia.
| | - Nadežda Krstić
- Faculty of Special Education and Rehabilitation, University of Belgrade, Visokog Stevana 2, 11000 Belgrade, Serbia.
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Level of Acceptance of Illness and Its Association with Quality of Life among Patients with Epilepsy in North Shewa, Ethiopia. Behav Neurol 2022; 2022:1142215. [PMID: 36134035 PMCID: PMC9484932 DOI: 10.1155/2022/1142215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/22/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022] Open
Abstract
Acceptance of illness is regarded as an indicator of functioning and predictor of quality of life. However, quality of life of patients with epilepsy in sub-Saharan countries worsen because of low medication adherence, increased morbidity and mortality, and the stigmatization associated with the disease. This research is aimed at assessing the level of acceptance of illness of patients with epilepsy and associated quality of life in North-East Ethiopia. Methods. A cross-sectional study was conducted from January to June 2021 at the Debre Berhan Referral Hospital, North-East Ethiopia. A total of 78 patients with epilepsy aged more than 18 years were randomly selected and assessed using Quality of Life in Epilepsy Inventory 31 and acceptance of illness scale. In addition, authors owned questionnaire were used to evaluate the sociodemographic and clinical characteristics of the patients. P value < 0.05 at 95% confidence level was considered to be statistically significant in all the analysis. Result. The study participants' age varied between 18 and 67 years with the mean age of 28.9 years. Phenobarbital was the most used (73.9%) antiepileptic drug, and 68.7% (n = 66) of the patients seizure was controlled. 72.9% (n = 70) of the patients had medium acceptance of illness (scored 20-30), while 17.7% (n = 17) had low illness acceptance level (scored 8-19), and 9.4% (n = 9) had high acceptance of illness (scored 31-40). The mean of overall acceptance of illness among epileptic patients was 21.04 ± 7.21. The overall score of QOLIE-31 was 79.14 ± 25.46, and the highest mean score was for cognitive (83.5 ± 27.1), while the lowest mean score was that of medication effect (72.7 ± 28.7). Five of the seven QOLIE-31 components correlated significantly with level of acceptance of illness. Cognitive domain (r = 0.498, p < 0.001) demonstrated the highest correlation followed by overall quality of life (r = 0.489, p < 0.001), seizure worry (r = 0.433, p < 0.001), energy/fatigue (r = 0.342, p < 0.001), and emotional well-being (r = 0.278, p < 0.001). Conclusion. Patients with epilepsy in the study area had medium acceptance of illness, and nearly half of them had mean and more than the mean quality of life. The patients' acceptance of illness was significantly associated with overall quality of life, seizure worry, emotional well-being, and cognitive domain of the patients.
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Dual burdens of felt stigma and depressive symptoms in patients with epilepsy: Their association with social anxiety, marriage, and employment. Epilepsy Behav 2022; 134:108782. [PMID: 35914436 DOI: 10.1016/j.yebeh.2022.108782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The present study evaluated whether patients with epilepsy with dual conditions of felt stigma and depressive symptoms are more strongly associated with social anxiety, being unmarried, and being unemployed than those with depressive symptoms or felt stigma alone. METHODS This multicenter, cross-sectional study evaluated subjects using the Stigma Scale-Revised, the Patient Health Questionnaire-9, and the six-item versions of the Social Interaction Anxiety Scale, and the companion Social Phobia Scale. Subjects were grouped by depressive symptoms and felt stigma into four groups. Multivariate logistic regression analyses were performed. RESULTS The 298 subjects included 173 men and 125 women. Of these subjects, 35 (11.7%) had depressive symptoms alone, 33 (11.1%) had stigma alone, and 27 (9.1%) had both depressive symptoms and felt stigma. Multivariate logistic regression analyses showed that, compared with the control group having neither depressive symptoms nor felt stigma, the odds ratios (ORs) for social interaction anxiety and social phobia were highest in the group of dual conditions (OR 18.7 and 13.5, respectively), followed by the depression-alone (OR 7.7 and 4.6, respectively) and stigma-alone (OR 5.0 and 2.8, respectively) groups. Similarly, the ORs for being unmarried (OR 29.2) and unemployed (OR 3.1) were significant only in the group of dual conditions. In addition, male sex and younger age were independently associated with being unmarried whereas seizures recurring ≥1 per month were independently associated with being unemployed. CONCLUSIONS Dual conditions of felt stigma and depressive symptoms may be more strongly associated with social anxiety, being unmarried, and being unemployed than depressive symptoms or felt stigma alone in patients with epilepsy.
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Lee SA, Im K, Choi EJ. Felt stigma may potentiate the relationship between perceived stress and depressive symptoms in persons with epilepsy. Epilepsy Behav 2022; 134:108765. [PMID: 35908417 DOI: 10.1016/j.yebeh.2022.108765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Kayeong Im
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Choi
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hohmann L, Berger J, Kastell SU, Holtkamp M. Perceived epilepsy-related stigma is linked to the socioeconomic status of the residence. Front Public Health 2022; 10:952585. [PMID: 36091545 PMCID: PMC9459334 DOI: 10.3389/fpubh.2022.952585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/11/2022] [Indexed: 01/24/2023] Open
Abstract
Purpose Epilepsy is one of the most common neurological disorders with high costs for the healthcare systems and great suffering for patients. Beyond seizures, psychosocial comorbidities can have detrimental effects on the well-being of people with epilepsy. One source of social stress and reduced quality of life is epilepsy-related stigma that often occurs, e.g., due to public misconceptions or myths. Stigma has individual biological, psychological and social correlates. Moreover, environmental factors like living in remote areas are associated with stigma. However, little is known about the link between the social structure of the residence and stigma in epilepsy. Thus, we investigated the association between the structural socioeconomic status (SES) and perceived stigma in an urban epilepsy population. Methods This prospective, cross-sectional study examined 226 adult in-patients with epilepsy from Berlin. Multiple regression analyses were performed to check the relationship between structural SES and stigma controlling for individual-level demographic, clinical, psychological and social factors. Continuous social indices (SI) of the districts and neighborhoods ("SI district" and "SI neighborhood") of Berlin were used to measure different levels of structural SES. Non-linear relationships are tested by grouping the SI in quartiles. Results Both indicators of structural SES were independently linked to stigma (p = 0.002). For "SI district", we identified a non-linear relationship with patients from the most deprived quartile feeling less stigmatized compared to those in the second (p < 0.001) or least deprived quartile (p = 0.009). Furthermore, more restrictions of daily life (p < 0.001), unfavorable income (p = 0.009) and seizure freedom in the past 6 months (p = 0.05) were related to increased stigma. A lower "SI neighborhood" was associated with higher stigma (p = 0.002). Conclusion Strategies to reduce epilepsy-related stigma need to consider the sociostructural living environment on different regional levels. Unfavorable relations with the immediate living environment may be directly targeted in patient-centered interventions. Non-linear associations with the structural SES of broader regional levels should be considered in public education programs. Further research is needed to examine possible underlying mechanisms and gain insight into the generalizability of our findings to other populations.
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Affiliation(s)
- Louisa Hohmann
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany,Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany,*Correspondence: Louisa Hohmann
| | - Justus Berger
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Shirley-Uloma Kastell
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany,Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Epilepsy life skill education guidelines for primary school teachers and learners in Limpopo and Mpumalanga Provinces, South Africa: Multiphase mixed methods protocol. PLoS One 2022; 17:e0271805. [PMID: 35867650 PMCID: PMC9307198 DOI: 10.1371/journal.pone.0271805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023] Open
Abstract
Epilepsy is a disorder in which nerve cell activity in the brain is disturbed, causing seizures. It may result from a genetic condition and occurs mainly in children, especially at a primary level. Most people living with Epilepsy suffer from stigma and discrimination because of a lack of knowledge regarding Epilepsy. This study aims to develop life skills education guidelines for primary school learners of Limpopo and Mpumalanga provinces to educate learners about Epilepsy, thus decreasing stigma and discrimination. A multimethod research approach will be used in this study to fulfil its purpose. Both stages 1 and 2 of the empirical phase (phase 1) will employ an exploratory-descriptive study design focusing on the primary school teachers, life skills educational advisors and learners to obtain their perceptions or views regarding the need to include Epilepsy in life skills education. Data will be collected using individual interviews for life skill educational advisors and focus group discussions for teachers and learners at the sampled primary schools in Limpopo and Mpumalanga provinces. Phase two will conceptualise the phase 1 findings into the conceptual framework, and phase 3 will develop and validate the life skills guideline. This study will adhere to both internal and external ethical considerations. Recommendations will be made based on the findings of the study.
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Chediak L, Bedlington N, Gadson A, Kent A, Khalek AA, Rosen L, Rust M, Shaikh MF, Tan MY, Wiafe SA, Baynam G, Steward CA. Unlocking sociocultural and community factors for the global adoption of genomic medicine. Orphanet J Rare Dis 2022; 17:191. [PMID: 35549752 PMCID: PMC9097338 DOI: 10.1186/s13023-022-02328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/09/2022] [Indexed: 11/10/2022] Open
Abstract
Advances in genomic sequencing and genetic testing are increasingly transforming the diagnosis and treatment of diseases-specifically, rare diseases. However, the application and benefit of such technologies remain inequitable globally. There is a clear and urgent need to provide genomic sequencing to people across the global population, including people living in under-resourced areas and/or underrepresented populations. Financial considerations are the most obvious barriers to the adoption of genomic medicine, yet there are many other factors that are not so obvious, such as geography, language, communication, and culture. Herein, we use the lens of rare diseases and focus on firstly, selected socio-cultural factors, and in particular stigma; and secondly, empowering community factors such as education, advocacy and connectivity amongst people living with rare diseases globally. These are critical areas of need and opportunity if genomic medicine is to achieve equitable and global adoption in the patient best-interest across low- middle- and high-income country health systems. Furthermore, we touch on specific child health aspects and how they can point towards opportunities to build on specific infrastructures.
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Affiliation(s)
- Lynsey Chediak
- Patient Advocacy and Engagement Advisory Board, Congenica Ltd, Wellcome Genome Campus, Hinxton, CB10 1DR, UK. .,Rarebase PBC, 1804 Embarcadero Road, Palo Alto, CA, 94303, USA.
| | - Nicola Bedlington
- Patient Advocacy and Engagement Advisory Board, Congenica Ltd, Wellcome Genome Campus, Hinxton, CB10 1DR, UK
| | - Ayesha Gadson
- Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Perth, WA, Australia
| | - Alastair Kent
- Patient Advocacy and Engagement Advisory Board, Congenica Ltd, Wellcome Genome Campus, Hinxton, CB10 1DR, UK
| | - Aiedah Abdul Khalek
- Malaysia Immersion Hub, Monash University Malaysia, 47500, Bandar Sunway, Selangor, Malaysia
| | - Luke Rosen
- Patient Advocacy and Engagement Advisory Board, Congenica Ltd, Wellcome Genome Campus, Hinxton, CB10 1DR, UK.,KIF1A.ORG, 808 Columbus Avenue, New York, NY, 10025, USA
| | - Malisa Rust
- Patient Advocacy and Engagement Advisory Board, Congenica Ltd, Wellcome Genome Campus, Hinxton, CB10 1DR, UK
| | - Mohd Farooq Shaikh
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Selangor, Malaysia
| | - Meng Yoe Tan
- School of Arts and Social Sciences, Monash University Malaysia, 47500, Bandar Sunway, Selangor, Malaysia
| | | | - Gareth Baynam
- Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Perth, WA, Australia. .,Rare Care, Clinical Centre of Expertise for Rare and Undiagnosed Diseases, Perth Children's Hospital, Perth, WA, Australia.
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Singh A, Woelfle R, Chepesiuk R, Southward C, Antflick J, Cowan K, Hum K, Ng M, Burneo JG, Suller Marti A. Canadian epilepsy priority-setting partnership: Toward a new national research agenda. Epilepsy Behav 2022; 130:108673. [PMID: 35367726 DOI: 10.1016/j.yebeh.2022.108673] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Health research agendas are often set by researchers or by industry and may not reflect the needs and priorities of end users. This priority-setting partnership (PSP) for epilepsy was undertaken to identify the most pressing unanswered questions about epilepsy and seizures from the perspective of people with epilepsy (PWE) and their care providers. METHODS Using the methodology developed by the James Lind Alliance (JLA), evidence uncertainties were gathered via online surveys from stakeholders across Canada. Submissions were formed into summary questions and checked against existing evidence to determine if they were true uncertainties. Verified uncertainties were then ranked by patients, caregivers, and healthcare providers and a final workshop was held to reach a consensus on the top 10 priorities. RESULTS The final top 10 list reflects the priority areas of focus for research as identified by the Canadian epilepsy community, including genetic markers for diagnosis and treatment, concerns about living with the long-term effects of epilepsy, and addressing knowledge gaps in etiology and treatment approaches. CONCLUSION This project represents the first systematic evidence of patient- and clinician-centered research priorities for epilepsy. The results of this priority-setting exercise provide an opportunity for researchers and funding agencies to align their agendas with the values and needs of the epilepsy community in order to improve clinical outcomes and quality of life (QOL) for PWE.
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Affiliation(s)
- Amaya Singh
- EpLink - The Epilepsy Research Program of the Ontario Brain Institute, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada.
| | - Rebecca Woelfle
- EpLink - The Epilepsy Research Program of the Ontario Brain Institute, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Katherine Cowan
- The James Lind Alliance, The Wessex Institute, University of Southampton, Southampton, United Kingdom
| | - Kathryn Hum
- EpLink - The Epilepsy Research Program of the Ontario Brain Institute, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Marcus Ng
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Neuroepidemiology Unit, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ana Suller Marti
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Paediatrics Department, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Neurosciences Program, Western University, London, Ontario, Canada
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Huang K, Wu Y, He Q, Yang H, Du Y, Xiao B, Feng L. Validity and reliability of the Chinese version of the epilepsy stigma scale. Epilepsy Behav 2022; 127:108531. [PMID: 35030470 DOI: 10.1016/j.yebeh.2021.108531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/25/2021] [Accepted: 12/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study was conducted to test the validity and reliability of the Chinese version of the epilepsy stigma scale (ESS), which aims to better understand the stigma of patients with epilepsy (PWEs), lays the foundation for future investigation and explores appropriate strategies to mitigate PWEs' stigma in Chinese culture. METHODS The scale was translated following standard procedures. For psychometric validation, the Chinese version of the ESS was administered to 214 PWEs above the age of 16 who were diagnosed with epilepsy by two trained epileptologists and were taking anti-seizure drugs for at least a month. All of the patients were recruited from Xiangya Hospital of Central South University of China from August 2021 to September 2021. RESULTS The Cronbach's alpha coefficient was 0.893 for the entire scale, 0.903 for felt stigma, and 0.688 for enacted stigma. Exploratory and confirmatory factor analyses were conducted and showed that the scale was grouped under two dimensions, and the results of confirmatory factor analysis support the structure. CONCLUSION The Chinese version of the ESS is a valid and reliable tool to assess epilepsy-related stigma in Chinese culture.
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Affiliation(s)
- Kailing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Yuanxia Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Qiang He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Haojun Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Yangsa Du
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China.
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Turan GB, Özer Z, Özden B. The Effects of Perceived Stigma on the Concealment of Disease and Satisfaction with Life in Patients with Epilepsy: An Example in Eastern Turkey. Int J Clin Pract 2022; 2022:1064999. [PMID: 35685532 PMCID: PMC9159186 DOI: 10.1155/2022/1064999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Stigma and exclusion are common features of epilepsy in both developed and developing countries, and they cause a significant burden associated with the condition. At the same time, although it varies from country to country depending on cultural differences and economic conditions, having epilepsy causes significant social consequences. OBJECTIVE This study was conducted to examine the effects of perceived stigma on the concealment of disease and satisfaction with life in patients with epilepsy living in the east of Turkey. METHODS This cross-sectional and descriptive study was carried out with 150 patients who met the study criteria and who agreed to participate in the study between March and July 2021 in a university hospital in Elazığ, east of Turkey. The data were collected using a personal information form, an Epilepsy Stigma Scale (ESS), a Concealment of Epilepsy Scale (CES), and a Satisfaction with Life Scale (SWLS). RESULTS The total mean ESS score of the patients was 40.7 ± 9.04, the total CES mean score was 57.19 ± 12.57, and the total SWLS mean score was 6.68 ± 2.86. When the regression coefficients were examined, it was found that the ESS variable had a positive and significant effect on the CES, while the ESS and the CES had a negative and significant effect on satisfaction with life (p < 0.001). CONCLUSION It was found that the patients had high levels of perceived stigma and concealment of epilepsy and low satisfaction with life levels. It was also found that the patients concealed their disease for fear of stigma, which negatively affected their satisfaction with life.
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Affiliation(s)
| | - Zülfünaz Özer
- Department of Nursing, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
| | - Beyan Özden
- Firat University Health Sciences Institute, Nursing Department, Elazığ, Turkey
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Mayor R, Gunn S, Reuber M, Simpson J. Experiences of stigma in people with epilepsy: A meta-synthesis of qualitative evidence. Seizure 2021; 94:142-160. [PMID: 34915348 DOI: 10.1016/j.seizure.2021.11.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Stigma is reported to cause as much distress and effect on quality of life for individuals with epilepsy as the physical symptoms of seizures. Existing quantitative reviews have focused on describing levels of stigma in epilepsy, but no qualitative review has been undertaken despite the increasing number of relevant studies. We provide a qualitative synthesis to aid the understanding of stigma experiences in adults with epilepsy across different sociocultural contexts. METHODS A systematic database search yielded an initial set of 3,032 relevant papers, of which 28 were included. A meta-synthesis was conducted according to a meta-ethnographic approach which has been adapted for health research. RESULTS Five themes were generated: 1) Societal negative perceptions of epilepsy result in discrimination and rejection; 2) Internal attributions of blame lead to negative self-perception and shame; 3) Stigma impacts everyday life and contributes to reliance on others; 4) Stigma is managed through concealment and avoidance; 5) Support from others is beneficial but dependant on own and others' understandings of epilepsy. These themes highlighted the key individual experiences of epilepsy stigma, which appeared to some degree culture-specific. Culturally-informed misconceptions of epilepsy were readily internalised, resulting in emotional challenges and affecting participants' lives. Strategies for coping with this were also described. SIGNIFICANCE This synthesis characterised the experiences of stigma among adults with epilepsy and highlighted key similarities and differences in these experiences across sociocultural contexts. Educational programmes to inform communities about epilepsy hold importance going forward.
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Affiliation(s)
- Rebecca Mayor
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK
| | - Sarah Gunn
- Department of Neuroscience, Psychology and Behaviour, Leicester University, Leicester, LE1 7RH, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK
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Amoudi M, Nairat Q, Shawahna R. Knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy: A systematic scoping review. Epilepsy Behav 2021; 124:108367. [PMID: 34717245 DOI: 10.1016/j.yebeh.2021.108367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/21/2021] [Accepted: 09/25/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND In today's healthcare systems, physiotherapists are one of the most important providers of care services to patients with disabilities including those with epilepsy. The aims of this systematic scoping review were to identify, summarize, and present narrative synthesis of qualitative evidence on knowledge, attitudes, and practices of physiotherapists toward epilepsy and patients with epilepsy. METHODS Primary studies were searched in Medline/PubMed, Embase, Science Direct, SpringerLink, CInAHL/EBSCO, Cochrane library, and Scopus as late as July 02, 2021. Appraisal of the methodological quality was conducted for the studies included in this systematic scoping review. Due to the heterogenous nature of the collected data, results of this study are presented as narrative synthesis. RESULTS A total of 11 were finally included in the qualitative synthesis. The selected studies were published in the period between 2016 and 2020. The studies included in this review had acceptable methodological quality in many of the 11 domains of the quality assessment tool. Contents of the included studies were grouped into the 11 themes and 8 subthemes. The major themes were related education/access to information, interaction with patients, witnessing seizures, barriers and promoters of adequate knowledge and attitudes, and interventions to improve knowledge and attitudes. CONCLUSION Currently, high-quality interventional studies are needed to improve knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy. Future studies are still needed to investigate if improving knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy can improve health-related outcomes of the patients.
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Affiliation(s)
- Mosab Amoudi
- Health Sciences Department, Arab American University, Palestine
| | - Qais Nairat
- Department of Physical Education, Faculty of Educational Sciences and Teachers' Training, An-Najah National University, Nablus, Palestine
| | - Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
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Kuramochi I, Iwayama T, Horikawa N, Shimotsu S, Watanabe S, Yamanouchi H, Yoshimasu H. Development and validation of the Epilepsy Self-Stigma Scale. Epilepsia Open 2021; 6:748-756. [PMID: 34651460 PMCID: PMC8633466 DOI: 10.1002/epi4.12547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Self‐stigma is the internalization of negative public attitudes and is often experienced by patients with epilepsy (PWE). Greater self‐stigma is associated with lower self‐esteem and hinders therapeutic behavior. The study aims were to develop the Epilepsy Self‐Stigma Scale (ESSS) to assess self‐stigma in PWE and to examine the scale's reliability and validity. Methods We created a test scale based on items from an existing stigma scale and the results of a previous qualitative analysis we conducted. We recruited 200 outpatients from departments specializing in epilepsy (psychiatry, neurology, and pediatric neurology) at four facilities in Tokyo and Saitama prefecture, Japan, between September and December 2020. Participants also completed the Rosenberg Self‐Esteem Scale (RSES) and Beck Depression Inventory (BDI‐II). Results Questionnaires were returned from 102 participants (response rate: 51%). After excluding two participants with incomplete questionnaires, data for 100 participants were analyzed (53 women, 47 men; mean age [standard deviation]: 39.86 [17.45] years). Exploratory factor analysis extracted eight items loading on three factors: internalization of stigma, societal incomprehension, and confidentiality. Cronbach's α for all items and each factor demonstrated acceptable internal consistency (α = 0.76‐0.87). Test‐retest reliability was confirmed using data from 21 participants who completed the scale twice (r = 0.72 to 0.90). ESSS total scores and subscale scores correlated with RSES and BDI‐II scores (r = −0.30 to 0.55). The ESSS demonstrated substantial constructive validity. However, total scores did not significantly correlate with objective physician assessment of self‐stigma. Significance The results showed that the eight‐item ESSS has high reliability and validity. This scale could facilitate the examination of factors associated with self‐stigma in PWE, which could inform the development of effective interventions for reducing stigma.
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Affiliation(s)
- Izumi Kuramochi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan.,Saitama Medical University Comprehensive Epilepsy Center, Saitama, Japan
| | - Takayuki Iwayama
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan.,Department of Psychology, Showa Women's University, Tokyo, Japan
| | - Naoshi Horikawa
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Sakie Shimotsu
- Faculty of Human Development and Education, Kyoto Women's University, Kyoto, Japan
| | - Satsuki Watanabe
- Saitama Medical University Comprehensive Epilepsy Center, Saitama, Japan
| | - Hideo Yamanouchi
- Saitama Medical University Comprehensive Epilepsy Center, Saitama, Japan
| | - Haruo Yoshimasu
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Lee SA. Felt stigma in seizure-free persons with epilepsy: Associated factors and its impact on health-related quality of life. Epilepsy Behav 2021; 122:108186. [PMID: 34252827 DOI: 10.1016/j.yebeh.2021.108186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/15/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We investigated felt stigma in seizure-free persons with epilepsy with regard to associated factors and its impact on health-related quality of life (HRQoL). METHODS This cross-sectional study included 81 patients who had been seizure free for at least 2 years and 52 controls who had only had one seizure in the last 2 years. All patients completed the Stigma Scale, Quality of Life in Epilepsy Inventory-31 (QOLIE-31), short form of the Eysenck Personality Questionnaire-Revised (EPQ-RS), Hospital Anxiety Depression Scale (HADS), Rosenberg Self-esteem Scale, and the enacted stigma questionnaire. RESULTS The proportion of felt stigma was not significantly different between controls (25%) and patients in seizure remission (21%). A stepwise logistic regression analysis revealed that enacted stigma and higher EPQ-RS Neuroticism scores were more likely to be associated with felt stigma of patients in remission. Quality of Life in Epilepsy Inventory-31 scores were significantly higher in patients in seizure remission than in controls. In the stepwise linear regression analysis, felt stigma was not associated with the total QOILE-31 scores. Sobel tests showed that felt stigma had indirect effects on the QOLIE-31 scores through EPQ-RS Neuroticism scores, but its statistical significance was lost after controlling for the presence of enacted stigma, anxiety, and depressive symptoms. CONCLUSION One-fifth of seizure-free patients continued to feel stigmatized, even though they had not had a seizure in more than 2 years. Experience of enacted stigma and a neurotic personality trait were the most important correlates of felt stigma for these patients. Health-related quality of life was significantly better in patients in remission than in patients with rare seizures. Felt stigma was not a significant or independent factor associated with worse HRQoL in patients in remission.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Henning O, Buer C, Nakken KO, Lossius MI. People with epilepsy still feel stigmatized. Acta Neurol Scand 2021; 144:312-316. [PMID: 33961282 DOI: 10.1111/ane.13449] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/12/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Those affected with epilepsy have long been subject to stigmatization. This may have manifold negative effects, for example social isolation, low self-esteem, reduced quality of life and worsening of seizures. In Norway educational programs have been arranged at the National Centre for Epilepsy, aiming at reducing stigma and shame associated with epilepsy, and thereby increase the quality of life for those affected and their families. Thus, we wanted to explore the extent of self-reported perceived stigma and experienced discrimination in a Norwegian cohort with epilepsy. MATERIALS AND METHODS We conducted a web-based questionnaire survey in Norway. Participants were asked to provide background and epilepsy-related information. In addition, they were encouraged to answer questions regarding felt stigmatization in different situations and to rate stigma according to the Jacoby stigma scale. RESULTS Of 1182 respondents, 56% reported to have felt being stigmatized, and 35% reported to have experienced discrimination solely on the ground of the disease. 70% of respondents reported at least one type of perceived or experienced stigma. After controlling for gender, age, perceived depression and seizure freedom, reports of experienced stigmatization was a statistically significant independent predictor for reduced quality of life. CONCLUSIONS A considerable proportion of people with epilepsy in Norway feel stigmatized and/or subject to discrimination, which negatively affects their quality of life.
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Affiliation(s)
- Oliver Henning
- National Centre for Epilepsy Division of Clinical Neuroscience Oslo University Hospital Oslo Norway
| | | | - Karl O. Nakken
- National Centre for Epilepsy Division of Clinical Neuroscience Oslo University Hospital Oslo Norway
| | - Morten I. Lossius
- National Centre for Epilepsy Division of Clinical Neuroscience Oslo University Hospital Oslo Norway
- Clinical Medicine University of Oslo Oslo Norway
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Asadi-Pooya AA, Barzegar Z. Marital status in young adult patients with seizures: Epilepsy vs. functional seizures. Epilepsy Behav 2021; 121:108066. [PMID: 34052634 DOI: 10.1016/j.yebeh.2021.108066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We investigated the marital status (married vs. none) among patients with seizures [i.e., epilepsy or functional seizures (FS)]. METHODS This was a retrospective study of an electronic database of patients with seizures. All young adult patients, 18 to 45 years of age, with a diagnosis of either epilepsy or FS were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. The two groups were matched for their age at diagnosis. Age at onset, sex, the marital status, and the final diagnosis were registered routinely. RESULTS During the study period, 194 patients with FS and 455 patients with epilepsy fulfilled the inclusion criteria. The rates of the married status were not significantly different between the two groups; 101 patients with FS (52%) and 204 PWE (45%) were married (p = 0.103). In the general population in Iran, 42,399,792 out of 66,421,989 (64%) of all people older than 16 years of age were married. This rate is significantly higher than the rate of the married status among patients with FS (p = 0.0006) and also those with epilepsy (p = 0.00001). CONCLUSION While the rates of the married status were not significantly different between PWE and those with FS, these rates were significantly lower than that in the general population in Iran. There are intriguing cross-cultural similarities and differences between our observations and those from other nations. These should be investigated in large multicenter international studies in the future.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Zohreh Barzegar
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Stigma and associated factors among people with epilepsy in Ethiopia: A systematic review and meta-analysis. Epilepsy Behav 2021; 117:107872. [PMID: 33740494 DOI: 10.1016/j.yebeh.2021.107872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
This systematic review and meta-analysis was aimed to summarize the pooled prevalence of stigma and associated factors among people with epilepsy in Ethiopia. A systematic search of articles was conducted in PubMed, SCOPUS, African Journals Online (AJOL), and Journal Storage (JSTOR). A standardized data extraction format was used to extract data. The analysis was conducted using STATA version 11 software. Cochrane Q statistic was used to assess the presence of significant between-study heterogeneity. I2 was used to quantify between-study heterogeneity. A leave-one-out sensitivity analysis was done. Subgroup analysis was conducted. Funnel plot, Begg's test, and Egger's regression tests were used to measure the presence of publication bias. Since the studies showed heterogeneity, the pooled estimated prevalence of stigma of people with epilepsy was conducted using DerSimonian-Laird's random-effects model. The estimated pooled prevalence of stigma was 44.65(95%CI; 29.37-59.94). Begg's rank correlation test (Z = 0.15, P = 0.881) and Egger's linear regression test (t = 0.14, P = 0.894) showed the absence of publication bias. Factors associated with an increased likelihood of stigma were 6-10 years of duration of illness (p = 0.003), ≥11 years of duration of illness (p = 0.008), and ≥1/month of seizure frequency (p = 0.01). Comprehensive care that involves psychological, social, and medical components is required. Health education on effective coping mechanisms is recommended.
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The effect of a seminar on medical students' information acquisition of and attitudes toward epilepsy. Epilepsy Behav 2021; 116:107720. [PMID: 33485166 DOI: 10.1016/j.yebeh.2020.107720] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022]
Abstract
AIM The aim of the present study was to investigate the effect of a brief seminar focusing on medical and social aspects of epilepsy on information acquisition of and attitudes toward epilepsy among medical school students. METHOD The sample of this pretest-posttest study consisted of 57 fifth-grade medical students. The students participated in a one-hour seminar including medical and social aspects of epilepsy. An epilepsy-related awareness form developed by researchers and also the Epilepsy Attitude Scale were applied to the participants before and after the seminar. RESULTS It was determined that half of the students (50.9%) encountered an epileptic seizure and 12.3% of them applied first aid. The students had difficulty in describing the seizure type before education. Before education, the rate of describing the seizure was 47.4% for myoclonic seizure, 50.9% for simple partial seizure, and 64.9% for absence seizure, and after education, these rates increased to 82.5% (p < 0.001), 91.2% (p < 0.001), and 98.2% (p < 0.001), respectively. Students generally well described the seizure triggering factors; however, the rate of students reporting the menstrual period as triggering factors were lower (66.7%), and the rates increased after the education (93.0%) (p = 0.001). The percentages of correct answers increased also for the questions regarding seizure first aid. The percentage of students who felt competent for seizure first-aid management increased from 12.3% to 91.2% (p < 0.001) after the education. The correct response rates of students for social aspects of epilepsy was generally high. In our study, attitude toward epilepsy was also evaluated. After the education, a mild increase in the attitude score of students was found (p = 0.009). Although it is minimal, the number of students who marked more positive attitude increased for each item of the Attitude scale. CONCLUSION Although a lack of acquaintance was found in some areas, awareness of epilepsy in our sample was at a moderate level. This study showed a positive effect of the education given to students on information acquisition and attitude.
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Associations of individual and structural socioeconomic status with cognition and mental distress in pharmacoresistant focal epilepsy. Epilepsy Behav 2021; 116:107726. [PMID: 33493801 DOI: 10.1016/j.yebeh.2020.107726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Epilepsy is often associated with low socioeconomic status (SES). People with epilepsy (PWE) also suffer from cognitive dysfunction and mental distress. In the general population, these constraints are related to individual and structural SES. However, in PWE, cognitive dysfunction and mental distress have been mainly attributed to biological factors such as brain lesions or pharmacological treatment, whereas comprehensive studies on possible social determinants are missing. Here, we study associations of individual and structural SES with cognition and mental distress in PWE. METHODS We retrospectively studied 340 adult patients with pharmacoresistant focal epilepsy from Berlin treated at a tertiary epilepsy center. Individual SES (education, employment, and income), structural SES (social index of district and neighborhood), and their interactions were examined. Associations between social variables and verbal learning, psychomotor speed, and mental distress were analyzed with multiple regression analyses, controlling for demographic and medical variables and intelligence. RESULTS Our sample had lower educational levels and lived more frequently in low SES neighborhoods compared to the general population of Berlin. Thirty percent showed reduced verbal learning, 31% had deficits in psychomotor speed, and 20% revealed significant mental distress. Lower structural SES was related to lower psychomotor speed (ΔR2 = 0.9%) and higher mental distress (ΔR2 = 1.6%). Employment was related to verbal learning (ΔR2 = 0.7%) and psychomotor speed (ΔR2 = 1.2%). Income and education were linked to mental distress (ΔR2 = 5%). Neighborhood and individual SES covered more than half of the explained variance in mental distress. Furthermore, interactions between individual and structural SES were identified. CONCLUSION We confirm cognitive deficits, significant mental distress, and individual and structural social disadvantage in PWE. Our findings indicate that individual and structural SES are related to cognitive and emotional well-being beyond demographic and medical characteristics. As a clinical implication, individual and structural SES should be considered when interpreting neuropsychological findings.
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Gul ZB, Atakli HD. Effect of the COVID-19 pandemic on drug compliance and stigmatization in patients with epilepsy. Epilepsy Behav 2021; 114:107610. [PMID: 33243679 PMCID: PMC7685058 DOI: 10.1016/j.yebeh.2020.107610] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Pandemics like coronavirus disease 2019 (COVID-19) bring along many individual and social problems. We aimed to investigate what changes the COVID-19 pandemic can cause in patients with epilepsy on drug compliance and stigmatization. MATERIAL AND METHOD Modified Morisky Scale (MMS) and stigmatization scales were used between October and November 2019 to assess drug compliance and stigmatization in epilepsy patients. These scales were renewed in June and July 2020 in the same patient group to assess the impact of the epidemic on drug compliance and stigmatization in patients with epilepsy. Statistical analysis was performed using the statistical software SPSS 17.0 for Windows (SPSS, Inc). Demographic and clinical characteristics of the patients were recorded in SPSS. The interviews were conducted during the interictal period. Paired-samples t-test was used to compare the stigma scale results of epilepsy patients before and during COVID-19. The Wilcoxon test was used to compare MMS groups before and during COVID-19. RESULTS A total of 110 patients were included in the study. There was no significant difference between the pre-pandemic and pandemic period in epilepsy stigma scale used to evaluate stigmatization levels in patients. During the pandemic period, it was observed that patients had higher motivation and higher knowledge than before the pandemic (p = 0.048). There were seven patients (6.4%) whose seizure frequency increased during the pandemic period. There were two patients (1.8%) who had difficulty in accessing drugs during the pandemic period. In multivariate analysis, only parameter that predicted an increase in seizure frequency was the number of drugs used In the of COVID-19 period. In correlation analysis, a negative correlation was found between the stigma total score during COVID-19 period and education level. CONCLUSION A slight increase in the frequency of seizures was observed in our patients during the pandemic period, and no significant problem was experienced in accessing drugs. The COVID-19 pandemic made patients more motivated and informed in drug compliance in the patient group and had no effect on stigmatization.
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Affiliation(s)
- Zeynep Bastug Gul
- Department of Neurology, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, Istanbul, Turkey.
| | - Hayrunisa Dilek Atakli
- Department of Neurology, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, Istanbul, Turkey
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Leigh N, Simpson J, Eccles FJR. Does a lack of social support and perceived stigma influence the relationship between motor neurone disease-related stress and psychological distress? Br J Health Psychol 2020; 26:289-306. [PMID: 33026136 DOI: 10.1111/bjhp.12476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/02/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to investigate the mechanisms through which social support and felt stigma influence the relationship between motor neurone disease (MND)-related stress and psychological distress for people with MND. Although a lack of social support has been identified as a significant predictor of psychological distress for individuals with MND, the mechanisms through which this relationship exists have not been assessed, nor have the predictive nature of stigma. Furthermore, the theoretical model specifying the effects of enacted stigma on self-stigma has not been tested in individuals with MND. DESIGN A cross-sectional design utilizing an online survey method was used. It was hypothesized that social support would moderate the relationship between MND-related stress (operationalized as enacted stigma or physical functioning) and psychological distress (operationalized as depression, anxiety, and stress). Furthermore, felt stigma would significantly mediate the relationship between MND-related stress (enacted stigma) and psychological distress. METHODS Individuals with a diagnosis of MND were recruited internationally through social media and through various organizations and support services. Seventy-seven participants completed the online survey. RESULTS Significant correlations were identified between social support, felt, and enacted stigma and psychological distress. Moderation analysis was not significant. However, the mediation analyses identified felt stigma as a significant mediator of the relationship between enacted stigma and psychological distress. A direct relationship between enacted stigma and stress (but not depression and anxiety) was also evident. CONCLUSIONS A comprehensive approach to tackling stigma is important in ameliorating psychological distress for people with MND. Limitations of the current study are discussed, along with implications for clinical practice.
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Affiliation(s)
- Natalie Leigh
- Division of Health Research, Lancaster University, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, UK
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Sedney CL, Dekeseredy P, Haggerty T. Stigmatizing Diagnoses in Neurosurgery: A Narrative Review. World Neurosurg 2020; 145:25-34. [PMID: 32889195 DOI: 10.1016/j.wneu.2020.08.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022]
Abstract
Stigma is defined as a social process resulting in labeling, stereotyping, and separation that cause status loss, disapproval, rejection, exclusion, and discrimination of the labeled individuals. Stigma can be experienced by individuals or groups, can be real or perceived, and can include a wide array of characteristics (e.g., race/ethnicity, gender, and health conditions). It is well documented that stigma for health conditions is a barrier to treatment and leads to worse outcomes for vulnerable people. The purpose of this study is to examine the increasingly mature field of stigma theory and research, and how this relates to the practice of neurosurgery. This review provides an overview of stigma and its application in a neurosurgical setting, including diagnoses treated by neurosurgeons as well as diagnoses with impact on neurosurgical outcomes. Examples of stigmatizing diagnoses of relevance to neurosurgical practice include epilepsy, pain, smoking, obesity, and substance use disorder. This information is useful for the practicing neurosurgeon to understand the origins and higher-order effects of societal perceptions surrounding certain diagnoses, and the subsequent effects on health that those perceptions can create on a systemic level.
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Affiliation(s)
- Cara L Sedney
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
| | - Patricia Dekeseredy
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
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Kuramochi I, Horikawa N, Shimotsu S, Hiwatashi T, Watanabe M, Okazaki M, Yoshimasu H. The self-stigma of patients with epilepsy in Japan: A qualitative approach. Epilepsy Behav 2020; 109:106994. [PMID: 32447041 DOI: 10.1016/j.yebeh.2020.106994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
The mental health of patients with epilepsy represents a substantial public health concern in Japan. For instance, the Japanese term for epilepsy, "tenkan", has the negative meaning of "mad" and "a violent temperament that is apt to be infatuated". Although epilepsy is now understood as a disease caused by abnormal neuronal activity in the brain, discrimination and stigma against people with epilepsy remain deeply rooted in Japanese culture. Understandably, this stigma can have a serious impact on the psychology and behavior of individuals with epilepsy. To our knowledge, no studies have clarified the formation process or examined the treatment of self-stigma in patients with epilepsy in Japan. Characterizing coping strategies and examining methods for reducing self-stigma will increase our understanding of the experiences of patients and facilitate effective psychiatric rehabilitation. Accordingly, the purpose of our study was to investigate the quality and degree of cognition regarding self-stigma and to examine coping strategies in patients with epilepsy living in the community. The participants were psychiatric outpatients aged 20-65 years who had been diagnosed with epilepsy and visited our psychiatric outpatient clinic between October 1 and December 31, 2016. We conducted semi-structured interviews with 20 patients who consented to participate. For data analysis, we used the content analysis method proposed. Our study revealed details of self-stigma in patients with epilepsy. Patients and their families are often aware of the presence of this self-stigma, and many do not know how to address it. In this study, we qualitatively examined self-stigma in patients with epilepsy on the basis of patient narratives. Per our findings, we would like to examine intervention methods for reducing self-stigma in patients with epilepsy.
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Affiliation(s)
- Izumi Kuramochi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
| | | | - Sakie Shimotsu
- Department of Development of Education, Kyoto Women's University, Kyoto, Japan
| | - Toyohiko Hiwatashi
- Department of Psychiatry, The Maruki Memorial Medical and Welfare Center, Saitama, Japan
| | | | - Mitsutoshi Okazaki
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Haruo Yoshimasu
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Abstract
BACKGROUND Epilepsy and mental illness share similar problems in terms of stigma, as a result of centuries of superstition, ignorance and misbeliefs. Stigma leads not only to discrimination and civil and human rights violations but also to poor access to healthcare and non-adherence or decreased adherence to treatment, ultimately increasing morbidity and mortality. Despite continuous efforts in fighting stigma in these conditions, there is very limited knowledge on the phenomenon of double stigma, meaning the impact of having two stigmatised conditions at the same time. AIMS To discuss double stigma in mental health with special reference to epilepsy. METHOD Articles were identified through searches in PubMed up to 31 October 2019 using the search terms 'epilepsy', 'psychiatric disorders', 'stigma' and additional material was identified from the authors' own files and from chosen bibliographies. RESULTS Double stigma is gaining attention for other stigmatised medical conditions, such as HIV, however, the literature on epilepsy is almost non-existent and this is quite astonishing given that one in three people with epilepsy have a lifetime diagnosis of a psychiatric condition. Felt (perceived) stigma and psychiatric disorders, particularly depression, create a vicious circle in epilepsy maintaining both, as depression correlates with stigma and vice versa as well as epilepsy and depression serving as bidirectional risk factors. This phenomenon has no geographical and economic boundaries as similar data have been reported for low-income and high-income countries. CONCLUSIONS Governments and policymakers as well as health services, patients' organisations, families and the general public need to be aware of the phenomenon of double stigma in order to develop campaigns and interventions tailored for these patients.
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Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London, UK; and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, UK
| | - Kenneth R Kaufman
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, USA; and Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
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Overprotection and determinants of overprotection in adults with epilepsy. Seizure 2020; 79:14-19. [PMID: 32408105 DOI: 10.1016/j.seizure.2020.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To examine the perceived overprotection of adult people with epilepsy (PWE) by using a specifically developed novel scale. The study also investigated whether perceived overprotection is associated with particular demographic or clinical variables. METHODS This cross-sectional study is based on responses from 200 adult PWE. The participants completed a clinical-demographic questionnaire, the perceived overprotection scale, felt-stigma scale, concealment of epilepsy scale and epilepsy concern scale. RESULTS One-way ANOVA results show that perceived overprotection was significantly greater among participants with lower income and levels of education. The highest number of affirmative responses in the perceived overprotection scale were related to going out alone and being given fewer family responsibilities due to epilepsy. Hierarchical regression results show that concerns related to social life and to future and occupation were significant predictors of high perceived overprotection. CONCLUSION Psycho-social factors, specifically concerns, seem to be more important than epilepsy-related variables in explaining perceived overprotection in adult PWE.
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Hixson JD, Braverman L. Digital tools for epilepsy: Opportunities and barriers. Epilepsy Res 2020; 162:106233. [DOI: 10.1016/j.eplepsyres.2019.106233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/10/2019] [Accepted: 10/26/2019] [Indexed: 11/27/2022]
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Kleinstäuber M, Wolf L, Jones ASK, Dalbeth N, Petrie KJ. Internalized and Anticipated Stigmatization in Patients With Gout. ACR Open Rheumatol 2020; 2:11-17. [PMID: 31943969 PMCID: PMC6957912 DOI: 10.1002/acr2.11095] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/25/2019] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate the relationship between stigma perception and demographic, clinical, and psychosocial variables. Methods A sample of 50 patients with gout and prescribed urate‐lowering medication (84% were males, mean serum urate 0.34 mmol/l) completed questionnaires on internalized and anticipated stigma, demographics, clinical gout‐related variables, and psychosocial variables (illness perceptions, illness‐related disability, illness‐related body satisfaction, intentional nonadherence). Serum urate level was obtained from the most recent blood test. Results In this sample, 26% experienced internalized stigma, 26% expected to be stigmatized by friends or family members, and 14% by health care workers. Univariate regression analyses showed that younger age, ethnicity other than New Zealand European, increased severity of gout pain, cognitive and emotional illness perceptions, greater illness‐related disability, and increased intentional nonadherence to urate‐lowering medication were associated with increased internalized and anticipated stigma. Younger age, emotional illness response, and intentional nonadherence were the only variables explaining incremental variance of the experience of anticipated stigma in a multivariate regression model. Conclusion Internalized and anticipated illness‐related stigma was reported by a subgroup of patients with gout. The experience of stigma is associated with younger age, a negative emotional illness response, and intentions to not adhere with a medical treatment.
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Affiliation(s)
- Maria Kleinstäuber
- University of Otago, Dunedin, New Zealand, and Philipps-University, Marburg, Germany
| | | | | | - Nicola Dalbeth
- Auckland District Health Board, Auckland, New Zealand and University of Auckland, Auckland, New Zealand
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Mogal Z, Aziz H. Epilepsy treatment gap and stigma reduction in Pakistan: A tested public awareness model. Epilepsy Behav 2020; 102:106637. [PMID: 31805506 DOI: 10.1016/j.yebeh.2019.106637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/28/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
High epilepsy treatment gap (ETG) and stigma remain a major issue globally. Addressing the basic problems is necessary, for advances in management to be effective. According to the 1987 population-based study, prevalence of active epilepsy in Pakistan is 0.98% with 98.1% ETG in rural and 72.5% in urban population and the presence of stigma. These dismal figures were a stimulus for our reported activities. Recognizing the problems faced by 2.2 million people with epilepsy (PWE) in the country, a group of volunteers mostly from the medical community has attempted to address these issues with an ongoing sustained awareness program over the last 18 years, working within the constraints of prevailing healthcare system, with gratifying results. In 2001, under a nongovernmental organization (NGO), the Comprehensive Epilepsy Control Programme of Pakistan (CECP) was launched to address the various paucities in knowledge, attitude, and practice about epilepsy; especially ETG and stigma. The CECP has two primary components: Epilepsy Support Pakistan (CECP-ESP) for awareness and mass education and National Epilepsy Centre (CECP-NEC) for holistic management of PWE, professional education, and research. Both work in tandem, and there is an overlap of their activities. This article only evaluates the outcome of sustained awareness activities of the CECP-ESP, through direct and indirect measures after 5 years of its initiation. A significant reduction in ETG and stigma exclusively through public awareness has been possible. This model can be easily replicated by any country, with involvement of the local population.
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Affiliation(s)
- Zarine Mogal
- National Epilepsy Centre, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Pakistan.
| | - Hasan Aziz
- National Epilepsy Centre, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Pakistan
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Blixen C, Ogede D, Briggs F, Aebi ME, Burant C, Wilson B, Ponce Terashima J, Sajatovic M. Correlates of Stigma in People with Epilepsy. J Clin Neurol 2020; 16:423-432. [PMID: 32657063 PMCID: PMC7354984 DOI: 10.3988/jcn.2020.16.3.423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Epilepsy is often associated with substantial stigma. This study evaluated clinical correlates of stigma in a sample of people living with epilepsy (PLWE) considered high risk due to frequent seizures or other negative health events. Methods Data were derived from an epilepsy self-management clinical trial. Standardized measures assessed socio-demographics, epilepsy stigma, epilepsy severity, self-efficacy, self-management competency, health literacy, depressive symptoms severity, functional status, social support and quality of life. Results There were 120 individuals, mean age of 41.73 (SD=17.08), 81 men (66.9%), and 79 (65.3%) African-American. Individual factors correlated with worse stigma w ere indicative of more severe or poorly controlled seizures (frequent seizures, worse seizure severity scores, more antiepileptic drugs), mental health comorbidity (worse depression severity, other comorbidities) and factors related to individual functioning and perceived competency in managing their health (health literacy, health functioning, self-efficacy, quality of life). Multivariable linear regression found that worse quality of life, and having a mental condition were associated with more stigma (β=6.4 and 6.8, respectively), while higher self-efficacy, health literacy and social support were associated with less stigma (β=−0.06, −2.1, and −0.3, respectively). These five variables explained 50% of stigma variation. Conclusions Stigma burden can be substantial among PLWE and may vary depending on contextual factors such as mental health comorbidity. Care approaches that screen for psychiatric comorbidities, address low health literacy, institute promising self-management programs, and employ effective health communication strategies about epilepsy misconceptions, may reduce epilepsy related burden.
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Affiliation(s)
- Carol Blixen
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Daisy Ogede
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Farren Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Michelle E Aebi
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christopher Burant
- Frances Payne Bolton School of Nursing, Case Western Reserve University and Louis Stokes VAMC, Cleveland, OH, USA
| | - Betsy Wilson
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Javier Ponce Terashima
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Martha Sajatovic
- Department of Psychiatry and Neurology, Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
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Shegog R, Braverman L, Hixson JD. Digital and technological opportunities in epilepsy: Toward a digital ecosystem for enhanced epilepsy management. Epilepsy Behav 2020; 102:106663. [PMID: 31778878 DOI: 10.1016/j.yebeh.2019.106663] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 01/01/2023]
Abstract
This commentary details the implications of a growing body of literature supporting several categories of supportive digital tools for the self-management of epilepsy. Although many prior review articles have focused on specific forms of digital epilepsy solutions, we propose the concept of an integrated self-management digital ecosystem. This would include categories of tools including self-management education programs, electronic diaries for self-monitoring, and automated wearables for seizure detection. Within these categories, individual interventions have been studied and made available to patients for years, but the evolution of a digital ecosystem promises the potential to integrate these tools in a manner that can meaningfully benefit patients' health. This commentary presents a discussion of the possible concerns that are preventing more widespread adoption of these digital health resources. Barriers are identified at multiple positions of the healthcare system, including the individual, the organizational, the community, and the policy levels.
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Affiliation(s)
- Ross Shegog
- University of Texas School of Public Health, 7000 Fannin, Suite 2668, Houston, TX 77030, United States of America
| | | | - John D Hixson
- University of California San Francisco and the San Francisco VA Medical Center, 4150 Clement Street, 127E, San Francisco, CA 94121, United States of America.
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Vancampfort D, Ward PB. Physical activity correlates across the lifespan in people with epilepsy: a systematic review. Disabil Rehabil 2019; 43:1359-1366. [PMID: 31536383 DOI: 10.1080/09638288.2019.1665113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Understanding barriers and facilitators of physical activity (PA) participation in people with epilepsy is an essential first step to enable development of targeted and effective interventions. This systematic review examined that PA correlates in people with epilepsy across the lifespan. MATERIAL AND METHODS Major electronic databases were searched from inception until 1 April 2019. Keywords included "physical activity" or "exercise" and "epilepsy". RESULTS Out of 31 correlates from 10 studies (n = 495, 5-72 years) no consistent (i.e., reported in four or more studies) correlates were identified. In children and adolescents, membership of a sports club was a facilitator for being physically active (confirmed in one study: 1/1), while lower maternal educational level was a barrier (1/1). In adults, the most reported barrier was the presence of depression (3/3), followed by trait anxiety (2/3), state anxiety (1/1), side effects of medication (1/1), and perceived stigma (1/1). No studies focusing on middle-aged and old age people with epilepsy were available. CONCLUSIONS The current review found that quantitative research about PA barriers and facilitators in people with epilepsy is still in its infancy, but PA participation is associated with a range of biological, social, and psychological factors which should be considered in rehabilitation programs.Implications for rehabilitationMany people living with epilepsy do not engage in physical activity on a regular basis.Children with epilepsy who are member of a sports club are more physically active.Depression, anxiety, and perceived stigma are important barriers for being active in adults with epilepsy.Side-effects of antiepilepstic drugs are a barrier for being active in adults with epilepsy.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, Australia
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Tombini M, Assenza G, Quintiliani L, Ricci L, Lanzone J, De Mojà R, Ulivi M, Di Lazzaro V. Epilepsy-associated stigma from the perspective of people with epilepsy and the community in Italy. Epilepsy Behav 2019; 98:66-72. [PMID: 31299536 DOI: 10.1016/j.yebeh.2019.06.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to assess the stigma related to epilepsy from the perspective of people with epilepsy (PWE) and from the Italian community (Rome and central Italy); moreover, the impact of the perceived stigma on the mood and quality of life of patients was also evaluated. MATERIALS AND METHODS We consecutively enrolled 100 PWE and 202 nonepileptic subjects (NES). Both PWE and NES completed an Italian version of the Stigma Scale of Epilepsy (SSE), a 24-items questionnaire that has been demonstrated to allow the quantification of the stigma perception by patients and people from the community. Moreover, the PWE fulfilled a 3-item Jacoby's Stigma Scale, the Quality of Life in Epilepsy-31 (QOLIE-31 [Q3])), and Beck Depression Inventory II (BDI-II) questionnaires for the evaluation of the quality of life and depressive symptoms. The results of the SSE were correlated with clinical and demographic details of PWE and NES, as well as the Q31 and BDI-II scores in PWE. RESULTS The SSE scores were significantly higher in NES with respect to PWE (respectively 47.1 vs 39.5, p < .001). Forty-two percent of PWE reported feeling stigmatized, with 5% reporting feeling highly stigmatized. In PWE, the perceived stigma was not correlated with seizure frequency but was significantly associated with worse quality of life, more severe depressive symptoms, and higher number of AEDs. The multiple regression analysis showed that the quality-of-life overall score and Q31 subscale exploring "social function" are the most significant predictors of stigma. CONCLUSIONS By using an Italian translation of the SSE questionnaire, even if we cannot consider our sample representative of the whole Italian community our study evidenced higher rates of stigma related to epilepsy in NES than in PWE. The PWE still experience feelings of stigmatization strongly correlated with higher depressive symptoms and worse quality of life that has proven to be the most significant predictor of stigma. Finally, seizure frequency does not affect the perceived stigma, which is instead significantly influenced by antiepileptic therapy.
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Affiliation(s)
- Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy.
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Livia Quintiliani
- Psicologia Clinica, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Jacopo Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Roberta De Mojà
- Psicologia Clinica, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy
| | - Martina Ulivi
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Rome, Italy
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Pitkänen A, Henshall DC, Cross JH, Guerrini R, Jozwiak S, Kokaia M, Simonato M, Sisodiya S, Mifsud J. Advancing research toward faster diagnosis, better treatment, and end of stigma in epilepsy. Epilepsia 2019; 60:1281-1292. [DOI: 10.1111/epi.16091] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/09/2019] [Accepted: 05/27/2019] [Indexed: 12/27/2022]
Affiliation(s)
| | - David C. Henshall
- Royal College of Surgeons in Ireland Dublin Ireland
- FutureNeuro Research Centre, RCSI Dublin Ireland
| | - J. Helen Cross
- UCL Great Ormond Street Institute of Child Health London UK
| | - Renzo Guerrini
- Children's Hospital A. Meyer‐University of Florence Florence Italy
| | - Sergiusz Jozwiak
- Warsaw Medical University Warsaw Poland
- The Children's Memorial Health Institute Warsaw Poland
| | | | - Michele Simonato
- University of Ferrara and University Vita‐Salute San Raffaele Milan Italy
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Tayeb HO. Epilepsy stigma in Saudi Arabia: The roles of mind-body dualism, supernatural beliefs, and religiosity. Epilepsy Behav 2019; 95:175-180. [PMID: 31071640 DOI: 10.1016/j.yebeh.2019.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/25/2019] [Accepted: 04/14/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The stigma of epilepsy continues to negatively impact people with epilepsy (PWE) in many Arab Middle Eastern countries, including Saudi Arabia. Socioreligious, cultural, and philosophical ideas prevalent in the region may contribute to the underpinnings of stigma toward PWE, but this has not been sufficiently studied. MATERIALS AND METHODS This study recruited a convenience sample of people without epilepsy from clinic waiting rooms and through social media. Participants completed a questionnaire with questions about demographics, mind-body dualism (MBD), supernatural beliefs (SB), attitudes toward epilepsy (ATE), and religiosity. RESULTS A total of 210 participants were recruited. Analysis of variance (ANOVA) showed a significant difference in the mean total ATE scores, indicating better ATE with higher education (p < 0.001). Despite the relatively high level of education and a high proportion of participants with medical training, only slightly more than half rejected the possibility that demonic possession may be a cause of epilepsy. Attitudes toward epilepsy were correlated with MDB and SB but not with religiosity. Mind-body dualism and religiosity correlated significantly with negative attitudes toward PWE (p < 0.05). A linear regression model using ATE as the dependent variable and MDB, SB, and educational level as independent variables significantly predicted ATE (F = 15.6, p < 0.001, R2 = 0.24), although SB dropped out as a predictor of ATE in that model. Another regression used SB as the dependent variable, and MBD, religiosity, and educational level as independent variables were also significant with all three variables predicting SB (F = 64.0, p < 0.001). CONCLUSIONS Mind-body dualism was related to the cognitive process leading to supernatural misconceptions about epilepsy and negative attitudes toward PWE in Saudi Arabia. Although misconceptions that supernatural possession was the cause of epilepsy (justifying treatment by religious healing) and was likely derived from prevalent religious beliefs of the region, religiosity was not associated with negative attitudes toward PWE. The merits and efficacy of an intervention focused on reducing the negative effects of MBD and SB on ATE warrants further investigation.
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Affiliation(s)
- Haythum O Tayeb
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia.
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Giuliano L, Cicero CE, Padilla S, Rojo Mayaregua D, Camargo Villarreal WM, Sofia V, Zappia M, Bartoloni A, Crespo Gómez EB, Nicoletti A. Knowledge, stigma, and quality of life in epilepsy: Results before and after a community-based epilepsy awareness program in rural Bolivia. Epilepsy Behav 2019; 92:90-97. [PMID: 30634158 DOI: 10.1016/j.yebeh.2018.11.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Epilepsy represents around 0.7% of the overall global burden of diseases and is particularly prevalent and associated with significant disability in low- and middle-income countries (LMIC) in Latin American Countries (LAC). A community-based epilepsy awareness program was carried out by our group in the rural areas of the Chaco region, Plurinational state of Bolivia, to improve the knowledge about epilepsy, with a first part directed toward general practitioners and a second part toward nurses and community health workers (CHWs) of the rural communities with a positive outcome. The objective of the study was to assess the level of knowledge, attitudes, and practices toward epilepsy, the stigma related to epilepsy and the quality of life in people with epilepsy (PWE) before and after the interventional campaign directed toward representative members of the rural communities in the Chaco region in Bolivia. METHODS The study was conducted in three areas of Bolivia. Key subjects from each community were randomly selected. Before and after the courses they answered a questionnaire to assess their knowledge, attitudes, beliefs, and practices about epilepsy, a validated Stigma Scale of Epilepsy (SSE) and Quality of Life in Epilepsy Inventory-10 (QOLIE-10). RESULTS Two hundred sixteen subjects were involved in the program. Only 133 (61.6%) subjects completed the questionnaires a month after the educational program. A significant improvement was recorded in knowledge, attitudes, and practices toward epilepsy, and a significant reduction was found in the mean SSE total score (38.3 ± 14.7 vs. 28.5 ± 12.3; p < 0.01), reflecting a reduction of stigma levels. Regarding the quality of life, after the training, PWE stated to experience less depression, memory difficulties, work or social issues, and seizure worry. CONCLUSION Our study confirms that continuous educational campaigns can lead to a significant change in the social perception and attitudes toward epilepsy.
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Affiliation(s)
- Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Sandra Padilla
- Center of Anthropological Researches of the Teko Guaraní, Gutierrez, Bolivia
| | | | | | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, University of Florence, Florence, Italy
| | | | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
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Holmes E, Bourke S, Plumpton C. Attitudes towards epilepsy in the UK population: Results from a 2018 national survey. Seizure 2019; 65:12-19. [DOI: 10.1016/j.seizure.2018.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/07/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022] Open
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Baker DA, Caswell HL, Eccles FJR. Self-compassion and depression, anxiety, and resilience in adults with epilepsy. Epilepsy Behav 2019; 90:154-161. [PMID: 30557784 DOI: 10.1016/j.yebeh.2018.11.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Research suggests that people with epilepsy (PWE) are more likely to experience depression and anxiety than the general population. Given the adversity associated with the condition, resilience may also be important. However, to date, resilience has been largely overlooked in the epilepsy literature. Self-compassion has been widely associated with improved psychological wellbeing and, to a lesser extent, resilience. However, the relationship between self-compassion and depression, anxiety, and resilience in PWE has not been examined. OBJECTIVES Using a quantitative cross-sectional survey design, the aim of the present study was to examine the extent to which self-compassion predicted depression, anxiety, and resilience when controlling for demographic and illness-related variables. METHODS Adults with epilepsy were invited to take part in a survey online or in epilepsy or neurology clinics. Two-hundred and seventy participants completed the survey, and data were analyzed using hierarchical multiple regression models. RESULTS In this sample of PWE, self-compassion significantly predicted lower depression and anxiety and higher resilience when other significant sociodemographic and illness-related variables had been taken into account. CONCLUSIONS The findings of the present study indicate that self-compassion could be an important factor in determining psychological outcomes for adults with epilepsy, and its role is worthy of further exploration to help improve psychological outcomes for PWE.
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Affiliation(s)
- David A Baker
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, UK
| | - Helen L Caswell
- Department of Clinical Neuropsychology, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, UK.
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Lee SA, Jeon JY, No SK, Park H, Kim OJ, Kwon JH, Jo KD. Factors contributing to anxiety and depressive symptoms in adults with new-onset epilepsy. Epilepsy Behav 2018; 88:325-331. [PMID: 30340902 DOI: 10.1016/j.yebeh.2018.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE We investigated factors contributing to anxiety and depressive symptoms over a 1-year period in Korean adults with new-onset epilepsy. METHODS This longitudinal multicenter study included adults diagnosed with epilepsy within 12 months of a first seizure. Using stepwise regression analyses, we determined whether Hospital Anxiety Depression Scale (HADS) scores could be predicted by demographic, clinical, and psychosocial variables at baseline and at 12 months. RESULTS Of 141 patients included at baseline, 63 (44.7%) and 60 (42.6%) had Hospital Anxiety Depression Scale-Anxiety (HADS-A) and Hospital Anxiety Depression Scale-Depression (HADS-D) scores >7, respectively. Of 98 patients who completed the 12-month study, the corresponding figures decreased to 32.7% and 36.7%, respectively. Higher HADS-A scores both at baseline and 12 months were predicted by higher neuroticism, stigma, and lower self-esteem (p < 0.05). Higher HADS-D scores at baseline were predicted by higher neuroticism, lower self-esteem, marital status, and lower extroversion (p < 0.05) whereas those at 12 months were predicted by self-esteem, seizure recurrence, and age at epilepsy onset (p < 0.05). Neuroticism or self-esteem was the strongest predictor of psychological distress. CONCLUSIONS Anxiety and depressive symptoms are common at the time of diagnosis in Korean adults with new-onset epilepsy. While these decrease over time, they remained high 12 months after epilepsy diagnosis. Psychological factors, particularly neuroticism and self-esteem, may be the most important risk factors. Epilepsy variables, such as seizure recurrence and age at onset, may also be important factors for depressed mood at 12 months.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Ji Ye Jeon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon-Kee No
- Department of Neurology, Bong-Seng Memorial Hospital, Pusan, Republic of Korea
| | - Hyungkook Park
- Department of Neurology, SoonChunHyang University College of Medicine, Cheonan, Republic of Korea
| | - Ok-Joon Kim
- Department of Neurology, CHA University, Seongnam, Republic of Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan College Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Kwang-Deog Jo
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
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Yeni K, Tulek Z, Simsek OF, Bebek N. Relationships between knowledge, attitudes, stigma, anxiety and depression, and quality of life in epilepsy: A structural equation modeling. Epilepsy Behav 2018; 85:212-217. [PMID: 30032810 DOI: 10.1016/j.yebeh.2018.06.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Epilepsy not only is a medical disorder characterized by seizures, but is also associated with stigma and a neurological disorder that affects quality of life. Insufficient knowledge and misconceptions about epilepsy that causes the development of negative attitudes towards patients with epilepsy increase the stigmatization and psychosocial problems and impact the quality of life. The aim of this study was to examine the relationship between epilepsy knowledge, attitude, stigma, anxiety and depression, and quality of life within the framework of structural equation modeling. METHOD This research was carried out between May 2015 and May 2016 at the Epilepsy Outpatient Clinic of Istanbul University Istanbul Faculty of Medicine. The Epilepsy Knowledge Scale, Epilepsy Attitude Scale, Stigma Scale, Hospital Anxiety and Depression Scale, and Quality of Life in Epilepsy Scale-10 (QOLIE-10) were used. To determine the relationship between the concepts, research hypotheses were created, and structural equation modeling was made. RESULTS Two hundred five patients were included in the study, 53.7% were women, and the mean age was 32.5. It was found that 72.2% had generalized seizures, and 46.3% had more than one seizure per month. According to our proposed model, knowledge had a moderate relationship with attitude (including stigma) (r = 0.50) that, in turn, had a strong relationship with mental health (r = -0.62) while a moderate relationship with quality of life (r = 0.45). Our findings revealed that proposed model accounted for 20% of the variance in quality of life and 39% of the variance in mental health (anxiety and depression). CONCLUSION Mental health and quality of life of patient with epilepsy are closely related to the knowledge, attitude, and perceived stigma of the patients. Therefore, educating/supporting patients can help increase the mental health and quality of life.
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Affiliation(s)
- Kubra Yeni
- Ondokuz Mayis University, Faculty of Health Sciences, Turkey
| | - Zeliha Tulek
- Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Turkey.
| | - Omer Faruk Simsek
- Istanbul Arel University, Faculty of Science and Letters, Department of Psychology, Turkey
| | - Nerses Bebek
- Istanbul University, Istanbul Medical Faculty, Department of Neurology, Turkey
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