Gender differences in factors associated with resilience for health-related quality of life in persons with epilepsy

General self-efficacy differentially moderates depressive symptoms in adults with epilepsy depending on seizure severity

PURPOSE

We evaluated whether the relationship between general self-efficacy and depressive symptoms in patients with epilepsy differed depending on age, sex, and seizure status.

METHODS

This multicenter, cross-sectional study was conducted on 299 adults with epilepsy, using the Beck Depression Inventory (BDI) and the General Self-efficacy Scale (GSES). We performed stepwise linear regression analysis and analysis of covariance with interaction terms.

RESULTS

The stepwise linear regression analysis showed that BDI scores were negatively correlated with GSES scores and positively correlated with age ≥ 40 years, unemployed status, recurrence of generalized or focal to bilateral tonic-clonic seizures (GTCS or FBTCS), and antiseizure medication polytherapy. The final model explained 38.9% of the variance in BDI scores. The analysis of covariance revealed that the moderating effect of GSES scores on BDI scores was less in subjects who had seizure freedom for at least 1 year than in those who did not. In contrast, the moderating effect of GSES scores on BDI scores was greater in subjects who had an age ≥ 40 years and those who experienced GTCS or FBTCS during the previous year than in those who did not. The negative relationship between GSES and BDI scores tended to be stronger in men than in women, but it did not reach statistical significance (p = 0.098). All models were adjusted by significant factors in the linear regression analysis of BDI scores.

CONCLUSIONS

The negative relationship between general self-efficacy and depressive symptoms may be stronger in older patients and patients with poorer seizure outcomes.

Factors affecting how parents cope with their preterm infant's pain: A cross-sectional study

AIMS AND OBJECTIVES

This study examined the relationships between parents' catastrophising about their infants' pain, parental self-efficacy in the management of their infants' pain, perceived social support and the parental coping strategies for their infants' pain-related stress.

BACKGROUND

Preterm infants hospitalised in the neonatal intensive care unit experience painful procedures causing stress to their parents. Coping with stress may be emotion- or problem-focused. Adults' coping with their own pain has been associated with pain catastrophising, pain management self-efficacy and social support. However, little is known about the associations between parents' catastrophising, their self-efficacy to manage, their perceived social support and their coping strategies when dealing with their infants' pain.

DESIGN

This was a cross-sectional, correlational study design.

METHODS

The STROBE guidelines for cross-sectional studies were followed. Participants included 149 parents of preterm infants hospitalised in a neonatal intensive care unit. They completed measures to assess infant pain catastrophising, self-efficacy regarding infant pain management, social support and emotion- and problem-focused coping.

RESULTS

Positive associations were found between parental self-efficacy regarding infant pain management, social support, parental catastrophising about their infants' pain and problem-focused coping. Parental catastrophising was positively associated with emotion-focused coping. Gender moderated the relationships between parental self-efficacy regarding infant pain management and emotion-focused coping. Specifically, amongst mothers, the higher their level of self-efficacy, the lower their emotion-focused coping. Amongst fathers, the relations were reversed.

CONCLUSIONS

Parents coping with their preterm infants' pain were associated with catastrophising about their infants' pain, self-efficacy regarding infant pain management and social support. Mothers had different ways to cope emotionally to that of fathers in relation to their self-efficacy in managing their infants' pain.

RELEVANCE TO CLINICAL PRACTICE

Nursing interventions that provide support to parents and promote parental self-efficacy in managing their infants' pain may allow parents to more effectively cope with their infants' pain.

PATIENT OR PUBLIC CONTRIBUTION

Patients or public were not involved in setting the research question, the outcome measures and the design or implementation of the study. Parents of preterm infants answered the research questionnaires.

Gender differences in concerns about planning to have children and child-rearing among patients with epilepsy: A prospective, multicenter study with 477 patients from Germany

OBJECTIVE

To analyze the concerns and worries about planning to have children and being a parent as a person with epilepsy and investigate gender differences in these perceptions.

METHODS

The Epi2020 study was a large multicenter study focusing on different healthcare aspects of adult patients with epilepsy in Germany. In addition to basic clinical and demographic characteristics, patients were asked to answer a questionnaire regarding their plan to have children, if they had children, and concerns about their children's health. Data were analyzed to detect differences between men and women with epilepsy according to age group.

RESULTS

In total, 477 patients with epilepsy with a mean age of 40.5 years (SD = 15.5, range: 18-83 years) participated in this study; 280 (58.7%) were female and 197 (41.3%) were male. Both women and men frequently reported concerns and worries about having children: In the age group below 45 years of age, 72.5% of women and 58.2% of men described being worried to some extent that their children may also suffer from epilepsy (p = .006). Furthermore, 67.3% of women and 54.2% of men below the age of 45 years reported being worried that their children may be disabled (p = .003). Women were more likely to have family members who are reluctant to support their desire to have children (p = .048).

CONCLUSION

Women with epilepsy of childbearing age are significantly more likely to report major concerns that their children might be disabled or also have epilepsy than men with epilepsy and, therefore, express more concerns about choosing to have a child. However, men also report frequent concerns and worries, and this should be addressed not only on request but should be included in the provision of general information on epilepsy.

Impulsivity in persons with epilepsy: Association with seizure severity and suicide risk

PURPOSE

Clinical research regarding impulsivity in patients with epilepsy is limited. The present study investigated the associations between impulsivity and seizure-related factors or suicidality in patients with epilepsy, independent of depression and anxiety.

METHODS

The multicenter study included 146 subjects (63% men). We utilized the Barratt Impulsiveness Scale-11 (BIS-11), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and suicidality module of the Mini International Neuropsychiatric Interview (MINI). Stepwise regression analyses and an analysis of covariance with interaction terms were performed.

RESULTS

The mean BIS-11 score was 59.3 (SD = 10.7). Psychiatric pathologies, including suicidality, were reported in relatively large proportions of patients, including PHQ-9 score ≥ 10 in 29 (19.9%) patients, GAD-7 score ≥ 7 in 35 (24.0%) patients, and MINI suicidality score ≥ 6 in 15 (10.3%) patients. Stepwise linear regression revealed that BIS-11 score was positively associated with the PHQ-9 scores (p < 0.001), antiseizure medication polytherapy (p < 0.001), use of lamotrigine (p = 0.009), and recurrence of generalized or focal to bilateral tonic clonic seizures (p = 0.010). The coefficient of determination for the model was 0.397. Generalized or focal to bilateral tonic clonic seizure recurrence tended to be positively associated with total BIS-11 scores in men but not in women. In subscale analyses, somewhat different variables were associated with different BIS-11subscales. A trend for a positive association between BIS-11 score and suicidality was found (p = 0.066).

CONCLUSIONS

This study identified a positive association between clinical seizure severity and impulsivity, and found that this association tended to be sex-specific, occurring only in males. Impulsivity could potentially be weakly associated with suicidality in patients with epilepsy.

Sex differences in seizure effects on social anxiety in persons with epilepsy

PURPOSE

We investigated sex differences in the effect of seizures on social anxiety in persons with epilepsy.

METHOD

In this cross-sectional multicenter study, social anxiety was measured using the short forms of the Social Phobia Scale (SPS-6) and Social Interaction Anxiety Scale (SIAS-6). SPS-6 scores ≥ 9 and SIAS-6 scores ≥ 12 were considered to indicate social phobia and social interaction anxiety, respectively. The Patient Health Questionnaire-9, Stigma Scale-Revised, and Family Adaptation-Partnership-Growth-Affection-Resolve scale were also completed. A logistic regression analysis with an interaction term was used to analyze the data.

RESULTS

Out of 285 participants, a SPS-6 score ≥ 9 and a SIAS-6 score ≥ 12 were noted in 62 (21.8%) and 36 (12.6%) of participants, respectively. There was no difference in the prevalence of social anxiety between men and women. Intractable seizures and lack of seizure freedom were associated with a SPS-6 score ≥ 9 and a SIAS-6 score ≥ 12, but statistical significance was lost in the adjusted models. However, intractable seizures and lack of seizure freedom significantly interacted with sex for a SPS-6 score ≥ 9 (p = 0.018) and a SIAS-6 score ≥ 12 (p = 0.048) in both the separate and adjusted models. Specifically, intractable seizures tended to be positively associated with SPS-6 scores ≥ 9 than non-intractable seizures in men only (odds ratio = 2.602, p = 0.068), whereas lack of seizure freedom tended to be negatively associated with SIAS-6 scores ≥ 12 than seizure freedom in women only (odds ratio = 4.804, p = 0.053).

CONCLUSION

We found significant sex differences in seizure effects on social anxiety. Intractable seizures were associated with social phobia in men, whereas lack of seizure freedom in the last year was associated with social interaction anxiety in women.

Sex differences in factors associated with quality of life in patients with epilepsy in Northeast China

OBJECTIVE

We aimed to investigate sex differences in factors associated with poor quality of life (QOL) in a cohort of patients with epilepsy (PWE) in Northeast China.

METHODS

A consecutive cohort of 221 PWE from the First Hospital of Jilin University was recruited. The Chinese versions of the Patient Health Questionnaire-9 (PHQ-9), the Beck Anxiety Inventory (BAI), and the Quality of Life in Epilepsy Inventory (QOLIE-31) were used to measure depressive symptoms, anxiety symptoms, and the QOL.

RESULTS

A total of 221 adult PWE participated in this study. In the multivariate regression model, three independent factors were found to be significantly associated with the total QOLIE-31 score in men: epilepsy duration (p = 0.007), the PHQ-9 score (p < 0.001), and the BAI score (p < 0.001). As for the subscale domain of QOL, marital status showed a relationship with cognitive function (p = 0.047), and residence was related with medication effects (p = 0.034). Two independent factors were found to be significantly associated with the total QOLIE-31 score in women: the PHQ-9 score (p < 0.001) and the BAI score (p < 0.001). The education level of women was positively associated with three subdomain scores of QOL, including overall QOL (p < 0.001), emotional well-being (p = 0.028), and energy/fatigue (p = 0.025).

CONCLUSION

We found that high levels of depressive and anxiety symptoms are strong predictors of a poor QOL in both men and women. Sex differences also occur in several demographic and clinical factors influencing the overall QOL or subscale domain scores such as epilepsy duration, marital status, and educational level. Timely diagnosis and treatment of psychiatric comorbidities might be crucial for improving the QOL in both men and women.