Depression and quality of life among African Americans with epilepsy: Findings from the Managing Epilepsy Well (MEW) Network integrated database

First epileptic seizure and quality of life - A prospective study

OBJECTIVE

Impaired QoL and depression are common in patients with chronic epilepsies; however, data on the impact of a first seizure on QoL are sparse. According to the current ILAE-definition of epilepsy, patients may be diagnosed with epilepsy immediately after the first seizure, if EEG and/or imaging findings are abnormal. Patients with normal findings in imaging and EEG are not diagnosed as having epilepsy. We investigated QoL in patients after a first seizure with and without a consecutive diagnosis of epilepsy to detect differences between groups within the first year after seizure.

METHODS

We examined patients (n = 152) after a first epileptic seizure and six and 12 months thereafter using demographic, clinical and QoL-related questionnaire data (Short Form-36 Health Survey (SF-36), Quality of Life in Epilepsy Inventory-31 (QOLIE-31), Beck's depression inventory II (BDI-II)).

RESULTS

Patients diagnosed with epilepsy after the first seizure showed a tendency of reduced mental health-related QoL six (p =.098) and 12 months (p =.092) after the first seizure compared to patients who were not diagnosed with epilepsy, but were diagnosed as having had a single first seizure. There were no significant differences between the two groups in physical health-related QoL. Multiple regression analyses showed that especially depressive symptoms explained 22.0 - 48.7 % of the variance in mental health-related QoL six (p <.001) and 12 months (p <.001) after the first seizure. Physical health-related QoL was especially predicted by age (p <.001), group (p =.002) and recurrent seizures (p = < 0.001). In PWE, there was a statistical trend with improving QOLIE-31 overall scores from six to 12 months (p =.086).

CONCLUSION

Our results suggest that QoL may be impaired in patients diagnosed with epilepsy early, immediately after the onset of disease. Early follow-up monitoring from the beginning of patient career is important for possible interventions and to improve patients' daily life in the long term.

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

BACKGROUND AND OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

We identified a long-term bidirectional relationship between depression and epilepsy in a large-scale cohort study. Risk estimates were higher than those of epilepsy or depression after asthma.

Point prevalence of depression in persons with active epilepsy and impact of methodological moderators: A systematic review and meta-analysis

OBJECTIVES

The aim of this study was to determine the pooled prevalence of depression in persons with epilepsy and assess the methodological moderators affecting the prevalence estimates.

METHODS

Five electronic databases PubMed, The Cochrane Library, EMBASE, WHO Global Index Medicus, and Clinicaltrial.gov were searched for studies reporting prevalence of depression in PWE ≥ 18 years of age in any setting.

RESULTS

Out of 13,873 studies, after deduplication and screening, 56 studies with 10,527 PWE met the eligibility criteria. The overall pooled prevalence of depression in PWE was 32% (95%confidence interval [CI] 28-35%) and significant heterogeneity (Chi-square = 1171.53, p = 0.00; τ² = 0.02; I² = 94.36%). Prevalence has doubled in the recent years (16% in 2000-2005 vs. 35% in 2016-2020), was higher in Asia than in Europe (coefficient 0.899, 95%CI: 0.809-0.999; p = 0.049). Among assessment methods, prevalence was highest in HAM-D scale (54%, 95%CI: 27-82%) and lowest in MINI (22%, 95%CI: 19-26%). Sensitivity analysis also corroborated findings when MINI was excluded (35%, 95%CI: 31-38%).

CONCLUSIONS

A significant proportion of PWE have depression. Though there is substantial heterogeneity due to various methodological moderators, it is unlikely to affect the routine screening of PWE for depression. Use of a screening tool should be based on ease of administration, and cutoff selection should ensure identification of minimal depression as well.

The impact of social factors, especially psychological worries on anxiety and depression in patients with epilepsy

BACKGROUND

Social factors are believed to affect mental health in patients with epilepsy (PWE). However, there is still a lack of sufficient manifest proof, given the difficulty of exposing PWE to relatively consistent natural social environments with a low or high level of social interaction to study their significant role.

METHODS

This single-center, longitudinal study was conducted via online questionnaires during the coronavirus disease 2019. PWE were recruited from downtown Wuhan and surrounding areas. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 were used to assess psychological status.

RESULTS

We analyzed 588 questionnaires completed by 294 PWE who participated in the dual survey. Under lockdown and reopening, the prevalence of anxiety was 13.6%/22.5%, and the prevalence of depression was 19.4%/34.0%. Raising children and seizure-related characteristics, including uncontrolled seizures, seizure exacerbation, seizure frequency ≥ 2/m, and changes in drug regimen, were risk factors in the first and second surveys. A high education level (OR = 1.946, 95% CI = 1.191-3.182), low life satisfaction (OR = 1.940, 95% CI = 1.007-3.737), worry about unanticipated seizures (OR = 2.147, 95% CI = 1.049-4.309), and worry about purchasing medication outside (OR = 2.063, 95% CI = 1.060-4.016) were risk factors for higher scores after reopening. Worry about unanticipated seizures (OR = 3.012, 95% CI = 1.302-6.965) and in-person medical consultation (OR = 2.319, 95% CI = 1.262-4.261) were related to newly diagnosed patients with psychological disorder after reopening.

CONCLUSIONS

We identified an association between social variables and epileptic psychiatric comorbidities.

Depression and suicidality among Hispanics with epilepsy: Findings from the Managing Epilepsy Well (MEW) Network integrated database

OBJECTIVE

Although psychiatric disorders are more common among people with epilepsy,² depression and suicidal ideation among Hispanics with epilepsy remain understudied. We examined the prevalence and correlates of depression and suicidal ideation among Hispanic adults with epilepsy who participated in self-management studies in the Managing Epilepsy Well³ Network.

METHODS

This cross-sectional analysis of pooled data from ten studies used the Patient Health Questionnaire-9⁴ or Neurological Disease Depression Inventory-Epilepsy⁵ to examine the prevalence of elevated depressive symptoms (PHQ ≥ 10, NDDI-E ≥ 15) and suicidal ideation (PHQ-9 item 9 ≥ 1, NDDI-E item 4 ≥ 2). Multilevel mixed-effects logistic regression models examined associations between ethnicity, elevated depressive symptoms, and suicidal ideation among PWE. Secondary analyses examined correlates of elevated depressive symptoms and suicidal ideation among Hispanic PWE.

RESULTS

Of 559 participants, 49.6% (n = 277) were Hispanic. Elevated depressive symptoms were endorsed by 38.1% (n = 213) of all participants (32.5% of Hispanics); suicidal ideation was endorsed by 18.4% (n = 103) of all participants (16.3% of Hispanics). After adjustment for sociodemographic and health attributes, Hispanic PWE had a 44% lower prevalence of elevated depressive symptoms (OR = 0.56, CI 0.37-0.84, p = 0.0056) compared to non-Hispanics but similar rates of suicidal ideation (OR = 0.84, CI 0.45-1.58, p = 0.59). Acculturation measures were available for 256 (92.4%) of Hispanic PWE: language preference was Spanish for 62.9%, 46.1% were foreign-born. Spanish-speaking Hispanics were less likely than English-speaking Hispanics to report elevated depressive symptoms (OR = 0.43, CI 0.19-0.97, p = 0.041); however, Hispanics who reported fair or poor health status had a four-fold higher depression prevalence compared to those who reported excellent or very good health status [reference group] (OR = 4.44, CI 1.50-13.18, p = 0.0071). Of the Hispanics who provided prior 30-day seizure data, ≥1 monthly seizure was independently associated with higher depression prevalence (OR = 3.11, CI 1.29-7.45, p = 0.01). Being foreign-born was not associated with elevated depressive symptoms or suicidal ideation prevalence.

CONCLUSIONS

In a large, geographically diverse sample of PWE, elevated depressive symptoms were significantly lower in Hispanics compared to non-Hispanics. Spanish language preference was associated with a lower prevalence of elevated depressive symptoms among Hispanic PWE. Future studies should include acculturation data to better screen for depression and suicidal ideation risk and optimize interventions for Hispanic PWE.

Factors contributing to comorbid depressive symptoms in adult people with newly diagnosed epilepsy: A 12-month longitudinal study

OBJECTIVES

We aimed to investigate the point prevalence of comorbid depressive symptoms from the time of newly diagnosed epilepsy to 12 months and to identify the factors contributing to comorbid depressive symptoms over a 12-month period in patients with newly diagnosed epilepsy (PWNDE).

METHODS

A consecutive cohort of PWNDE from the First Hospital of Jilin University was recruited. Depressive symptoms were evaluated using the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy scale (C-NDDI-E). Multivariate stepwise logistic regression models were used to confirm the factors contributing to depressive symptoms in patients.

RESULTS

The point prevalence of depressive symptoms among PWNDE slightly decreased from 24.8% at baseline to 22.3% at 12 months. A MoCA score < 26 was identified as an independent risk factor contributing to depressive symptoms at baseline (OR = 2.419, 95% CI: 1.093-5.350, P = 0.029) and at 12 months (OR = 3.007, 95% CI: 1.223-7.390, P = 0.016). The adjusted OR for depressive symptoms in female patients was 0.365 (95% CI: 0.171-0.779, P = 0.009) compared with male patients. Depressive symptoms at baseline (OR = 4.539, 95% CI: 1.973-10.445, P < 0.001) were identified as significant predictors of depressive symptoms at 12 months.

CONCLUSION

There was a slight decrease in the prevalence of comorbid depressive symptoms in PWNDE over the 12-month period after epilepsy diagnosis. Cognitive impairment and baseline depressive symptoms were independent risk factors for comorbid depressive symptoms at 12 months.

Sex-based differences in the prevalence of and risk factors for depression in adult patients with epilepsy in Northeast China

OBJECTIVES

To confirm whether the prevalence of depression in patients with epilepsy (PWE) is different between the sexes, whether risk factors for depression vary between the sexes, and whether the association between cognitive function and depression in PWE is influenced by patient sex.

METHODS

A cohort of consecutive PWE from the First Hospital of Jilin University (Changchun, China) was recruited. Depressive symptoms were evaluated using the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy scale, and multivariate logistic regression analyses were used to identify independent risk factors for depression in both male and female PWE.

RESULTS

Female PWE experienced more serious depressive symptoms (p = 0.001) than male PWE. Risk factors affecting comorbid depression varied according to sex. Among male PWE, per capita monthly family income (odds ratio [OR] 0.515 [95% confidence interval (CI) 0.311-0.851]; P = 0.01), seizure frequency over the past year (OR 1.586 [95% CI 1.019-2.468], P = 0.041), polytherapy (OR 0.446 [95% CI 0.214-0.931]; P = 0.032), and Montreal Cognitive Assessment (MoCA) scale score (OR 0.926 [95% CI 0.873-0.982]; P = 0.011) were independent risk factors for depression. Among female PWE, educational level (OR 0.604 [95% CI 0.364-1]; P = 0.05) and MoCA scale score (OR 0.921 [95% CI 0.859-0.987]; P = 0.02) were independent risk factors for depression.

CONCLUSION

Depression was a common psychiatric comorbidity among PWE, and the prevalence of and risk factors for depression differed between males and females.

Relationships among illness representations and depressive symptom severity in predominantly African-American and Caribbean-American people with epilepsy

Objective: Depression is the most common psychiatric comorbidity among people with epilepsy (PWE) and tends to be more prevalent among people of color (POC) and those with intractable seizures. However, the extent to which illness-related perceptions are associated with depressive symptom severity among POC with intractable seizures is unclear. Method: This cross-sectional study examined relationships among illness representations and self-rated depressive symptoms in 55 PWE (M Age = 41; 61.8% female) with intractable seizures (M seizures per month = 2) who identified as Black/African-American (52.7%), Black/Caribbean-American (27.3%), and/or Hispanic/Latino (21.8%). Epilepsy-related illness perceptions were assessed with the Illness Perception Questionnaire-Revised and depression was measured via the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Results: Nearly half of the sample (41.8%) scored above the NDDI-E depression cut-off. PWE endorsing more severe depressive symptoms indicated that their epilepsy had more negative consequences, was hard to comprehend, was insufficiently controlled by treatment, and had a negative emotional impact (p's ≤ 0.02). Controlling for sex, these four illness representations accounted for 48% of the variance in depression severity. Interestingly, participants with probable major depressive episodes were more likely to endorse several psychological causes of seizures compared to non-depressed PWE. Conclusions: Worse depression symptom severity was associated with negative illness perceptions and a tendency to attribute one's epilepsy to psychological causes. Future research is needed to understand how the relationship between negative illness perceptions and depression symptoms unfold over time and whether interventions aimed at modifying illness representations reduce psychological distress in diverse PWE.

The Managing Epilepsy Well (MEW) network database: Lessons learned in refining and implementing an integrated data tool in service of a national U.S. Research Collaborative

Epilepsy self-management (ESM) is the summative set of behaviors that people with epilepsy use to cope with seizures and optimize health. This report describes the implementation and evolution of the Managing Epilepsy Well Network Database (MEW DB), an integrated data resource intended to advance knowledge on ESM. The MEW DB utilizes a three-tiered (Tier 1-3) system of data organization, with tiers of data generally increasing in ascending complexity or collection burden. A MEW DB Steering Committee (SC) establishes consensus on planned analyses using a standardized new analysis request template. The data management structure facilitates harmonization and integration of additional data, or to update the database as new data become available. The current MEW DB comprises 1,563 people with epilepsy. Mean age was 39.9 years, 64.9% women (N = 1006), 12.8% African American (N = 170), 22.2% Hispanic (N = 306). On average, individuals have lived with epilepsy since their early 20s and are prescribed between 1 and 2 antiepileptic drugs. The MEW DB spans multiple socio-ecological levels to provide a robust multi-tiered framework for studying ESM. A total of 41 common data elements have been identified through iterative consensus. This integrated database takes advantage of an extensive collective background of archival evidence in ESM and brings together engaged investigators to build a dataset that represents diverse types of individuals with epilepsy, targets health domains important to ESM, and facilitates analyses that would not be possible with sites operating independently. Overall, the MEW DB serves the greater mission of this research collaborative and has potential to advance ESM research.

Depression in persons with epilepsy: A comparative study of different tools in Indian population

OBJECTIVE

Depression is an important co-morbidity in persons with epilepsy (PWE) and its timely identification is essential. The aim of the study was to assess and compare the psychometric properties of potentially suitable screening tools of depression in PWE in a tertiary care setting in India.

METHODS

After ethical clearance, 449 PWE above 18 years of age, on anti-seizure drugs (ASDs), attending epilepsy clinic in neurology outpatient department (OPD) of All India Institute of Medical Sciences, New Delhi, India, were recruited and evaluated for depression using different tools namely: Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Patient Health Questionnaire (PHQ-9) and Hamilton Depression Rating Scale (HAM-D). Mini International Neuropsychiatric Interview (MINI: Module A, version 6.0.0) was used as reference standard. The association if any of depression with PWE variables was also determined.

RESULTS

A variable percentage of PWE were positive for depression- 40.1% with MINI, 40.5% with NDDI-E, 44.3% with HAM-D and 45.4% with PHQ-9. Suicidal ideation was present in 4.5% of PWE. The sensitivity and specificity of scales using MINI as a reference standard were found to be maximal at scores ≥5, ≥8 and >11 for PHQ-9, HAM-D, and NDDI-E, respectively. The ROC analysis revealed a statistically significant difference among NDDI-E and PHQ-9 (p = 0.0268). Polytherapy in PWE had significant association with risk of depression (p < 0.01) and female PWE had 1.5 times the odds of depression as compared with males (95% CI, 1.02-2.2).

CONCLUSION

All the tools used in this study were found to be appropriate for use in PWE if cut-off points are validated. The choice of tool can be based on the clinical setting.

Epilepsy self-management behaviors among African Americans with epilepsy

PURPOSE

Although self-management practices are heavily studied in the general population of adults with epilepsy, African American people with epilepsy (PWE) have been understudied. Improving understanding about epilepsy self-management among African Americans is warrantedbecause of the significantly greater mortality rates among this population compared withPWE from other racial/ethnic groups. The purpose of this study was to assess the reliability and validity of the Adult Epilepsy Self-Management Measurement Instrument (AESMMI) for Black/African American adults and describe their self-management behaviors.

METHODS

This study was a cross-sectional survey of self-identified Black/African American adults who reported that a health provider diagnosed them as having epilepsy or a seizure disorder. Participants completed a cross-sectional survey between spring 2017 and fall 2018. The survey measured self-management behaviors (65-itemAESMMI), quality of life, depression, seizure severity, epilepsy history, and demographics. We ran descriptive analyses, computed scales, and ran reliability statistics for the AESMMI. Correlations were run between total AESMMI score and depression symptoms and quality of life to assess construct validity.

RESULTS

Generally, participants (N = 114) were male (58.6%), from urban/suburban settings (90.5%), at least high school graduates (86.4%), and of lowerincome (90.3%). Their ages ranged from 19 to 64 years with a mean age of 53 years (standard deviation [SD] = 10.9). Participants had general (72.8%) and focal seizures (55.3%) primarily. Many were diagnosed at a young age (M = 10.9), were on antiepileptic medications (91.2%), and had seen a primary care doctor (68.4%) or general neurologist for treatment (54.4%). Sixty percent had visited a neurologist in the past year. African American participants had a low score on quality of life (Quality of Life in Epilepsy [QOLIE], M = 1.86) and low depression symptoms (Patient Health Questionnaire [PHQ-8], M = 3.13). Participants reported conducting self-management behaviors in the following domains more frequently: proactivity (M = 4.11), medication adherence (M = 3.92), healthcare communications (M = 3.91), and social support (M = 3.90). In contrast, they performed self-management behaviors related to treatment (M = 3.34), stress management (M = 3.56), and safety (M = 3.58) less frequently. The overall reliability of the AESMMI was 0.88. Adult Epilepsy Self-Management Measurement Instrument score was correlated with quality of life (r = 0.151).

CONCLUSION

Findings are clinically relevant as knowing patients'self-management behaviors enables healthcare clinicians to support and encourage adults to improve the management of their epilepsy. Services or interventions related to coping with stress, safety, and adherence with treatment and medication may be warranted for African Americans with epilepsy.

Exploring perceived benefits, motives, barriers, and recommendations for prescribing yoga exercises as a nonpharmacological intervention for patients with epilepsy: A qualitative study from Palestine

OBJECTIVES

Yoga is believed to play a role in stabilizing the electroencephalogram and the autonomic nervous system, thus might help control seizures in people with epilepsy (PWE). This qualitative study was conducted to explore experiences of Palestinian PWE with regard to benefits, motives, barriers, and recommendations of prescribing yoga exercises as a nonpharmacological intervention.

METHODS

Purposive and snowball sampling techniques were used to recruit PWE who practiced yoga. Semi-structured in-depth interviews (n = 18) were conducted with the study participants. The interpretive description method was used to qualitatively analyze the data collected during the interviews.

RESULTS

Following the thematic analysis adopted for this study, four major themes emerged. These themes were as follows: perceived benefits of yoga, motives to practice yoga, barriers to practice yoga, and recommendations on effective yoga practice for PWE. The perceived benefits included improvements in management of seizures, psychological, physical, and social well-being. People with epilepsy were motivated by the health benefits of yoga. Barriers of adherence to practice included personal and logistic factors. The interviewees recommended tailoring yoga sessions to the needs of PWE.

CONCLUSION

This explorative qualitative study reported perceived benefits, motives, barriers, and recommendations of yoga as a nonpharmacological intervention for PWE. People with epilepsy used yoga as a beneficial nonpharmacological intervention to improve their health and reduce the negative effects of epilepsy on their physical and psychosocial well-being. Future studies are needed to investigate the health benefits of yoga when sessions are tailored to the needs of PWE.