Validity and reliability of the Turkish version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)

A multicultural comparative study of self-stigma in epilepsy: Differences across four cultures

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.

Validity and reliability study of the turkish version epilepsy self-stigma scale (ESSS-T)

AIM

We translated the Epilepsy Self-stigma Scale (ESSS) into Turkish and aimed to examine the Turkish version ESSS (ESSS-T) validity and reliability.

MATERIALS AND METHOD

From April to August 2023, patients with epilepsy (PWE) were recruited from the neurology outpatient clinic of Ataturk University Hospital in the eastern Turkish city of Erzurum (inclusion criteria: age 18 years or older and adequate reading and speaking ability in Turkish). We conducted our survey using a self-administered questionnaire. The questionnaire consisted of the ESSS-T after appropriate translation by back-translation, and self-esteem (the Rosenberg's Self-Esteem Scale, RSES), depression (the Neurological Disorders Depression Inventory for Epilepsy, NDDI-E), and general stigma (the Stigma Scale for Epilepsy, ESE) for construct validity. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to test factorial validity. Also, Cronbach's alpha coefficient was calculated to verify reliability.

RESULTS

Of the 126 patients, 106 agreed to give informed consent and responded to the questionnaire (84.1 % response rate). The results of EFA suggested the same three-factor structure as in the original version, but CFA showed some limitations in interpreting the three-factor structure and it may be safer to understand it as a unifactorial structure. The alpha coefficients were also validated by the ESSS-T. The alpha coefficients were α = 0.74 for the ESSS-T scale as a whole and α = 0.69-0.74 for each subscale, which were generally acceptable values.

CONCLUSION

The Turkish version of the ESSS proved valid and reliable. It is a measurement tool with a three-dimensional structure. It can be used to assess the self-stigmatization of patients with epilepsy in Turkey.

Yoga and aerobic exercise in epilepsy: Study protocol for a randomized controlled trial

BACKGROUND

There has been a growing interest in demonstrating the health benefits of exercise among people with epilepsy in recent years. Although exercise is recommended for people with epilepsy, there is uncertainty concerning the effects of yoga and aerobic exercise on multiple health outcomes in epilepsy.

PURPOSE

The aim of this trial was to examine the effects of yoga and aerobic exercise training on physical activity, seizure frequency, health-related physical fitness, mental, emotional, and psychological health status, and quality of life.

METHODS

This study was designed as a single-center, 8-week, randomized controlled trial in a three-arm parallel group. Participants will be randomly allocated to yoga, aerobic exercise, or wait-list control groups. The primary outcome is physical activity/sedentary behavior measured by the ActiGraph GT9X accelerometer and seizure frequency. Secondary outcomes include functional capacity, lower extremity strength, balance, body composition, waist and hip circumference, cognition, depression, anxiety, perceived stress, fatigue, sleep quality, and quality of life. The outcomes will be evaluated at baseline and at 8 weeks of follow-up.

IMPLICATIONS OF PHYSIOTHERAPY PRACTICE

This study is the first randomized controlled trial comparing the effects of yoga and aerobic exercise among people with epilepsy. The findings of this study could provide important information about the effects of yoga and aerobic exercise training on a variety of health conditions in people with epilepsy.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05066880, registered October 4, 2021.

Psychometric properties of the Lithuanian version of the NDDI-E in persons with epilepsy and suicidal ideation

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.

Difficulties in emotion and social support in people with epilepsy: relationship with depression levels

Amaç: Bu çalışmada epilepsili bireylerde depresyon düzeyi ile duygu düzenleme güçlükleri ve sosyal destek arasındaki ilişkiyi incelemeyi amaçladık. Gereç ve Yöntem: Fokal epilepsi tanısı ile takip edilmekte olan hastalara Nörolojik Bozukluklarda Depresyon Ölçeği-Epilepsi (NDDI-E), Duygu Düzenleme Güçlükleri Ölçeği (DDGÖ) ve İki Yönlü Sosyal Destek Ölçeği (2-YSDÖ) verilmiştir. Bulgular: Çalışmaya 109 hasta dahil edilmiştir. Hastaların %25’inde depresyon saptanmıştır. Depresyonu olan olguların DDGÖ median değeri 45 (28-55), depresyon saptanmayan grubun ise 24 (18-33,5)’dür. Depresyonu olan grubun DDGÖ skorunun depresyonu olmayan gruba kıyasla anlamlı derecede yüksek olduğu tespit edilmiştir. Tüm çalışma popülasyonunda yapılan 2-YSDÖ (92 (69,5-102,5)) ve DDGÖ (27 (19-41)) skorlarının korelasyon analizinde sosyal destek ve duygu düzenleme güçlükleri arasında negatif bir ilişki mevcuttur. Regresyon analizine göre ise duygu düzenleme güçlükleri depresyonun ana belirleyicisidir ve depresyonu %16,8 oranında açıklamaktadır. Sonuç: Epilepsili bireylerde duygu düzenleme güçlükleri depresyonun ana belirleyicilerinden biridir ve yetersiz sosyal destek duygu düzenleme güçlükleri ile ilişkilidir. Epilepsili bireylerde depresyon sıklığını azaltmak için duygu düzenleme stratejilerini güçlendirecek rehabilitasyon programlarına ihtiyaç vardır.

Turkish validity and reliability of the Personal Impact of Epilepsy Scale

AIM

This study evaluated the validity and reliability of the Turkish Personal Impact of Epilepsy Scale (PIES).

MATERIALS AND METHOD

This methodological study was carried out at a university hospital in Erzurum, eastern Turkey between January and April 2021. The data were collected from 126 patients who agreed to participate in the study within these dates via face-to-face interviews, a personal information form, and the Turkish PIES. The PIES consists of 25 items, scored between 0 and 4, and three subscales. The scale itself is a 5-point, Likert-type scale. Following the scale's translation process, its content and construct validity were evaluated. Exploratory and confirmatory factor analysis were conducted for construct validity and item analysis, and internal consistency analysis took place to confirm the scale's reliability.

RESULTS

As a result of the evaluations and analyses, the Turkish PIES's content validity index was 0.94. In the exploratory analysis, the scale's total variance rate was 70.82%. The Cronbach's alpha value of the Seizures subscale was 0.728, that of the Medication Side Effects subscale was 0.947, for the Comorbidities subscale it was 0.929, and the total scale's Cronbach's alpha value was 0.954. The results of the EFA (Exploratory Factor Analysis) and CFA (Confirmatory Factor Analysis) showed that the Turkish PIES, per its 25 items and three-factor structure, is a sufficient measurement instrument. Good fit index values were also obtained as a result of the CFA.

CONCLUSION

The Turkish version of the PIES is a valid and reliable instrument to evaluate the effects of seizures, medication side effects, mood/social state, and quality of life of patients with epilepsy.

Validation of the Russian version of neurological disorders depression inventory for epilepsy (NDDI-E)

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.