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Iwayama T, Mizuno K, Yildiz E, Lim KS, Yi SM, Lynn YJ, Hin CW, Jean JCZ, Fong SL, Xuen Y, Qian OZ, Kuramochi I. A multicultural comparative study of self-stigma in epilepsy: Differences across four cultures. Epilepsia Open 2024. [PMID: 39325044 DOI: 10.1002/epi4.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 08/10/2024] [Accepted: 09/02/2024] [Indexed: 09/27/2024] Open
Abstract
OBJECTIVE Epilepsy is a neurological disorder characterized by recurrent seizures, exhibiting variance in prevalence and treatment availability across diverse geopolitical contexts and cultural milieus. The stigma associated with epilepsy is a significant global issue affecting the quality of life (QOL) of people with epilepsy (PWE). This study aims to examine the relationship between self-stigma and depressive symptoms in PWE, with a particular emphasis on understanding the manifestations of these across different cultural contexts. We aim to enhance the provision of customized care to diverse cultural settings, fostering the adoption of healthier lifestyles for PWE. METHODS We recruited PWE who received treatment at specialized medical facilities for epilepsy in Japan, Malaysia (Chinese, Malay), and Turkey from February to October 2023. The Epilepsy Self-Stigma Scales (ESSS), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and Generalized Anxiety Disorder 7 (GAD-7) in local languages were used to assess self-stigma, depressive symptoms, and anxiety. RESULTS The ESSS total scores were significantly higher among the Turkish and Japanese cohorts (F [3, 406] = 6.57, p < 0.001, η2 = 0.05). In addition, the self-stigma observed moderate positive correlations for depressive symptoms (rs = 0.41-0.50, Ps < 0.001) and anxiety (rs = 0.42-0.44, Ps < 0.001). The ANCOVA findings suggested that the notable variations in self-stigma, as found in the one-way ANOVA conducted across four cultures, were reduced when taking into consideration depressed symptoms. Our finding highlights the potential influence of mental health factors over cultural factors concerning self-stigma. SIGNIFICANCE The manifestation of self-stigmatization within epilepsy exhibits distinctions across diverse cultural cohorts, regardless of the demographic and clinical variation, yet demonstrates a significant correlation with psychological factors. In subsequent research endeavors, we should comprehensively investigate these subtle differences, their potential impact on patient care, and the development of supportive approaches. PLAIN LANGUAGE SUMMARY This cross-cultural study reveals significant variations in self-stigma among people with epilepsy across different cultural contexts, with Turkish and Japanese cohorts showing higher levels. Self-stigma demonstrated moderate positive correlations with depressive symptoms and anxiety across all cultures. Notably, differences in self-stigma were reduced when accounting for depressive symptoms, suggesting that mental health factors may have a stronger influence than cultural factors. These findings underscore the importance of considering both cultural and psychological aspects in developing targeted interventions to address self-stigma in epilepsy care.
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Affiliation(s)
- Takayuki Iwayama
- Department of Psychology, Showa Women's University, Tokyo, Japan
| | - Kimihito Mizuno
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Esra Yildiz
- Faculty of Nursing, Atatürk University, Erzurum, Turkey
| | - Kheng-Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soon Ming Yi
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yee Joe Lynn
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ching Woon Hin
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jason Chia Zhi Jean
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Si-Lei Fong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yu Xuen
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ong Zhi Qian
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Izumi Kuramochi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Mesraoua B, Brigo F, Abou-Khalil B, Ali M, Lattanzi S. Risk of suicide and suicide-related events in subjects treated with antiseizure medications. Expert Rev Neurother 2024; 24:865-878. [PMID: 38978408 DOI: 10.1080/14737175.2024.2376110] [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: 10/30/2023] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION In the United States, it is reported that 1.4% of the general population commits suicide. It has been postulated that antiseizure medications (ASMs) can lead to the development of suicidal ideation and suicidal behavior; however, this risk is still very low and has yet to be precisely established. AREAS COVERED This narrative review evaluates the risk of suicide-related events (SREs) in subjects taking ASMs for various neurological disorders. Screening tools for suicidal ideation and suicidal behavior are also discussed. References for this article were found using PubMed/MEDLINE. EXPERT OPINION Although some ASMs can be associated with SREs, this is not yet clearly established. The mechanisms involved in suicide risk in subjects taking ASMs are multifactorial. The bidirectional relationship between depression and epilepsy, as well as other associations, should be kept in mind when interpreting any impact of ASMs in PWE. Screening for SREs, close monitoring of subjects taking ASMs are the most appropriate strategies to minimize suicide risk. More efforts should be made to achieve accurate risk stratification through prognostic models that could be applied to subjects taking ASMs. Studies exploring the association between ASMs and suicide should consider ASMs individually and control for prior SREs.
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Affiliation(s)
- Boulenouar Mesraoua
- Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | | | - Musab Ali
- Neurosciences Department, Hamad Medical Corporation, Doha, Qatar
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
- Neurological Clinic, AOU of Marche, Ancona, Italy
- Neurology Department, IRCCS INRCA, Ancona, Italy
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Zhang Y, Wang H, Liu L. Risk factors of suicide-related events in patients with epilepsy: A systematic review and meta-analysis. Seizure 2024; 120:72-82. [PMID: 38908144 DOI: 10.1016/j.seizure.2024.06.016] [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: 01/12/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024] Open
Abstract
PURPOSE This systematic review and meta-analysis examined the risk factors for suicide-related events (SRE) in patients with epilepsy (PWE). METHODS The PubMed, Embase, Cochrane Online Library, and ClinicalTrials.gov databases were searched for relevant articles published from 1946 to August 30, 2022. The quality of the extracted articles was assessed using the Newcastle-Ottawa scale. Subsequently, a meta-analysis of PWE was performed to calculate the random-effects pooled odds ratios (ORs) for studies investigating the association between suicide and its associated risk factors. All statistical analyses were performed using R version 4.1.0. RESULTS A total of 2,803 studies were screened, of which 23 articles comprising 6,723 PWE were included in our meta-analysis. Female sex (odds ratio [OR]=1.24, 95 % confidence interval [CI]: 1.08-1.43), low quality of life (QOL) scores (standardized mean difference [SMD]= -0.89, CI: -1.17 - -0.61), poor social support (OR=3.44, CI: 1.83-6.46), unemployment (OR=1.82, CI: 1.40-2.38), unmarried status (OR=1.48, CI: 1.12-1.97), low income (OR=1.37, CI: 1.07-1.76), low education (OR=1.33, CI: 1.04-1.68), use of antidepressant drugs (OR=7.77, CI: 3.17-19.03), uncontrolled seizures (OR=2.28, CI: 1.63-3.18), use of multiple antiepileptic drugs (OR=1.70, CI: 1.33-2.18), early age at onset of epilepsy (SMD= -0.15, CI: -0.30 - -0.0002), depression (OR=6.85, CI: 4.88-9.62), and anxiety (OR=3.76, CI: 2.92-4.84) were identified as significant risk factors of SRE. SIGNIFICANCE There are many risk factors for SRE in PWE, as outlined above. Interventions targeting these risk factors may help reduce the risk of SRE in PWE.
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Affiliation(s)
- Yu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu 610041, Sichuan, PR China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Shang Jin Road 253 Chengdu 610000, Sichuan, PR China
| | - Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu 610041, Sichuan, PR China; Department of Neurology, Third Xiangya Hospital, Central South University, No.138 Tong Zipo Road, Yuelu District, Changsha City, PR China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu 610041, Sichuan, PR China.
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Shi W, Sun H, Peng W, Chen Z, Wang Q, Lin W, Ding M, Sun H, Wang X, Wang T, Wang X, Liu Y, Chen Y, Zhu G, Zhou D, Li J. Prevalence and risk factors of anxiety and depression in adult patients with epilepsy: a multicenter survey-based study. Ther Adv Neurol Disord 2023; 16:17562864231187194. [PMID: 37663409 PMCID: PMC10469248 DOI: 10.1177/17562864231187194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/22/2023] [Indexed: 09/05/2023] Open
Abstract
Background Depression and anxiety are the most common psychiatric comorbidities in patients with epilepsy (PWE). However, they are often unrecognized and consequently untreated. Objective The study was conducted to evaluate the prevalence and risk factors of anxiety and depression among Chinese adult PWE. Design Cross-sectional study. Methods Adult PWE were recruited from 13 tertiary epilepsy centers from February to September 2022. Generalized Anxiety Disorder-7 and Neurological Disorders Depression Inventory for Epilepsy were applied to evaluate anxiety and depression, respectively. Both univariate and multivariate logistic regression analyses models were performed to explore the risk factors of anxiety and depression. Results A total of 1326 PWE were enrolled in this study. The prevalence of anxiety and depression was 31.45% and 27.30%, respectively. Being female [odds ratio (OR) = 1.467, 95% CI: 1.134-1.899; p = 0.004], focal and focal to bilateral tonic-clonic seizures (TCSZ) (OR = 1.409, 95% CI: 1.021-1.939; p = 0.036), and seizure occurrence in the last 3 months (OR = 1.445, 95% CI: 1.026-2.044; p = 0.036) were the risk factors for anxiety. Focal and focal to bilateral TCSZ (OR = 1.531, 95% CI: 1.094-2.138; p = 0.013) and seizure occurrence in the last 3 months (OR = 1.644, 95% CI: 1.130-2.411; p = 0.010) were the risk factors for depression. In addition, for every 1-year increment of age, the odds of developing depression were decreased by 3.8% (p = 4.12e-5). Nevertheless, up to 70% of PWE did not receive any treatment for comorbidity. Conclusion There were approximately 30% of PWE screened positive for anxiety or depression. Both focal and focal to bilateral TCSZ and seizure occurrence in the last 3 months were estimated as risk factors for anxiety and depression. However, the current status of treatment was not optimal.
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Affiliation(s)
- Wenyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hanlin Sun
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ziyi Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Meiping Ding
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Hongbin Sun
- Department of Neurology, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Xiangqing Wang
- Department of Neurology, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Tiancheng Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yonghong Liu
- Department of Neurology, Air Force Medical University Xijing Hospital, Xi’an, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoxing Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan, 610041, China
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan, 610041, China
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Puteikis K, Mameniškienė R. Psychometric properties of the Lithuanian version of the NDDI-E in persons with epilepsy and suicidal ideation. Epilepsy Behav 2022; 136:108913. [PMID: 36155364 DOI: 10.1016/j.yebeh.2022.108913] [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: 05/12/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Suicidality and depression are associated with worse epilepsy outcomes, but their screening in routine clinical practice remains insufficient and may improve with the validation of brief and accessible psychometric tools. We explored the psychometric properties of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) in the Lithuanian population, which has one of the highest suicide rates globally. METHODS We conducted a cross-sectional anonymous survey among adult outpatients visiting a tertiary epilepsy clinic in Vilnius, Lithuania. People with epilepsy (PWE) provided demographic and clinical information and completed the Geriatric depression scale (GDS), the Hospital anxiety and depression scale (HADS), the Beck depression inventory (BDI), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the Generalized anxiety scale-7 (GAD-7). Suicidal ideation was defined as a non-zero score on the suicide item of the BDI and clinically relevant levels of depression - as a total BDI score of >16. Psychometric properties of the NDDI-E were evaluated by measuring its internal consistency, dimensionality, correlation with other depression scales, and by conducting receiver operating characteristic analysis for the detection of suicidal ideation and symptoms of depression. RESULTS The study sample consisted of 246 PWE (average age 39.9 ± 16.3 years, 101 [41.1%] male), of them 31 (12.6%) and 41 (19.5% of those who completed the BDI) were identified with suicidal ideation or significant symptoms of depression, respectively. On average, PWE scored 10.4 ± 4.2 points on the NDDI-E. The instrument had good internal consistency (Cronbach's alpha = 0.863, n = 235), item-item and item-total correlation (>0.30). In factor analysis, its items comprised a single factor distinct from the GAD-7. The NDDI-E strongly correlated with other depression scales (r = 0.657 [GDS, n = 201], r = 0.657 [BDI, n = 201], r = 0.623 [HADS-D, n = 231], p < 0.001 for all). The NDDI-E had good diagnostic properties in discerning suicidal ideation (AUC = 0.858, 95%CI = 0.791-0.925). The isolated suicide item of the NDDI-E had acceptable properties in detecting suicidal ideation (AUC = 0.821, 95%CI = 0.724-0.918) as well. CONCLUSION The Lithuanian NDDI-E was shown to have good psychometric properties comparable to other versions of this scale. The NDDI-E is endorsed as a short and accessible instrument for estimating suicidal ideation among Lithuanian PWE.
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Affiliation(s)
| | - Rūta Mameniškienė
- Centre for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
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Tedrus GMDAS, Souza DDCMD. I would be better off dead: investigating suicidal ideation in people with epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:718-724. [PMID: 36254445 PMCID: PMC9685829 DOI: 10.1055/s-0042-1755230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND It is known that the risk of suicidal behavior in adult people with epilepsy (PWEs) is high. However, the associated clinical and psychosocial factors are still being discussed. OBJECTIVE To assess the risk of suicide in PWEs and relate it to resilience and quality of life (QoL) as well as with clinical variables. METHODS The item "I'd be better off dead" of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was related to the resilience scale, clinical aspects, the presence of depression, and the Quality of Life in Epilepsy Inventory (QOLIE-31) scores of PWEs, with a p < 0.05. RESULTS A total of 271 PWEs were assessed, 50.6% were female, with a mean age of 46.6 (± 15.8) years, and a mean age at 1st seizure of 24.1 (± 18.5) years. Risk for suicide occurred in 50 (19.3%) cases. In multiple logistic regression, the factors that explain the risk of suicide were female sex, depression, and lower scores on the QOLIE-31 and on the resilience scale. In the classification and regression trees, the order of importance of the variables was depression > resilience > age > QoL > age at 1st seizure. CONCLUSION The risk of suicide was high, and it was associated with demographic aspects, clinical variables, QoL, and resilience. A higher risk of suicide was associated with lower resilience regardless of the presence or absence of depression. In the presence of depression, a higher risk of suicide was associated with the early onset of epilepsy. In the absence of depression, the risk of suicide was associated with low QoL in young adults.
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Validation of items on the NDDIE and PHQ-9 associated with suicidal ideation during suicidality screening in patients with epilepsy. Seizure 2022; 99:99-104. [DOI: 10.1016/j.seizure.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/22/2022] Open
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Validation of the Russian version of neurological disorders depression inventory for epilepsy (NDDI-E). Epilepsy Behav 2020; 113:107549. [PMID: 33246233 DOI: 10.1016/j.yebeh.2020.107549] [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: 08/03/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To translate and validate the English version of the Neurologic Depression Disorders Inventory in Epilepsy (NDDI-E) into the Russian language as an instrument for rapid detection of major depressive episodes (MDE) for patients with epilepsy (PWE) from Russian Federation. METHODS One hundred and 75 consecutive PWE were included in the study. All patients were assessed with Mini-International Neuropsychiatric Interview (MINI 6.0.0), Hospital Anxiety and Depression Scale (HADS) and the Russian version of NDDI-E. Chi-square, Fisher's exact and Mann-Whitney tests were used to compare PWE with and without MDE. We analyzed internal structural validity, external validity, and receiver operator characteristics. RESULTS None of the participants had any difficulties in understanding the questions of NDDI-E. The internal consistency of the inventory was satisfactory (Cronbach's ά = 0.856). Correlation between the NDDI-E and the HADS scores was moderate (r = 0.64, P < 0.001), indicating acceptable external validity. NDDI showed good capacity to detect MDE, with area under the curve of 0.919 (95% CI = 0.868-0.955; standard error: 0.019; P < 0.001). An optimal cut-off point with the highest Yuden's index (J = 0.699) was > 12. At this point NDDI-E showed sensitivity of 88.16% (95% CI = 78.7%-94.4%), specificity of 81.82% (95% CI = 72.8%-88.9%), positive predictive value of 59.3% (95% CI = 48.8%-69.0%), negative predictive value of 95.8% (95% CI = 92.5%-97.7%). CONCLUSION Russian version of NDDI-E is an affordable and fast screening tool with a good combination of sensitivity and specificity.
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