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Sajatovic M, Ghearing GR, Tyrrell M, Black J, Krehel-Montgomery J, McDermott G, Yala J, Barigye R, Adeniyi C, Briggs F. Clinical correlates of perceived stigma among people living with epilepsy enrolled in a self-management clinical trial. Epilepsy Behav 2024; 160:110025. [PMID: 39288652 DOI: 10.1016/j.yebeh.2024.110025] [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: 07/02/2024] [Revised: 08/16/2024] [Accepted: 08/21/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND AND PURPOSE Stigma is a pervasive barrier for people living with epilepsy (PLWE) and can have substantial negative effects. This study evaluated clinical correlates of perceived stigma in a research sample of PLWE considered to be at high risk due to frequent seizures or other negative health events. METHODS Analyses were derived from baseline data from an ongoing Centers for Disease Control and Prevention (CDC)-funded randomized controlled trial (RCT) testing an epilepsy self-management approach. Standardized measures assessed socio-demographics, perceived epilepsy stigma, epilepsy-related self-efficacy, epilepsy self-management competency, health literacy, depressive symptom severity, functional status, social support and epilepsy-related quality of life. RESULTS There were 160 individuals, mean age of 39.4, (Standard deviation/SD=12.2) enrolled in the RCT, 107 (66.9 %) women, with a mean age of epilepsy onset of 23.9 (SD 14.0) years. The mean seizure frequency in the prior 30 days was 6.4 (SD 21.2). Individual factors correlated with worse perceived stigma were not being married or cohabiting with someone (p = 0.016), lower social support (p < 0.0001), lower self-efficacy (p < 0.0001), and lower functional status for both physical health (p = 0.018) and mental health (p < 0.0001). Perceived stigma was associated with worse depressive symptom severity (p < 0.0001). Multivariable linear regression found significant independent associations between stigma and lower self-efficacy (β -0.05; p = 0.0096), lower social support (β -0.27; p = 2.4x10-5, and greater depression severity (β 0.6; p = 5.8x10-5). CONCLUSIONS Perceived epilepsy stigma was positively correlated with depression severity and negatively correlated with social support and self-efficacy. Providers caring for PLWE may help reduce epilepsy stigma by screening for and treating depression, encouraging supportive social relationships, and providing epilepsy self-management support. Awareness of epilepsy stigma and associated factors may help reduce some of the hidden burden borne by PLWE.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry and of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Gena R Ghearing
- Department of Neurology, Carver College of Medicine and Iowa Health Care, Iowa City, IA, USA
| | - Maegan Tyrrell
- Department of Neurology, Carver College of Medicine and Iowa Health Care, Iowa City, IA, USA
| | - Jessica Black
- Department of Psychiatry and of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Jacqueline Krehel-Montgomery
- Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Grace McDermott
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joy Yala
- Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Richard Barigye
- Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Clara Adeniyi
- Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Farren Briggs
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Ghearing GR, Tyrrell M, Black J, Krehel-Montgomery J, Yala J, Adeniyi C, Briggs F, Sajatovic M. Clinical correlates of negative health events and disparities among adults with epilepsy enrolled in a self-management clinical trial. Epilepsy Res 2024; 203:107366. [PMID: 38669777 DOI: 10.1016/j.eplepsyres.2024.107366] [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: 09/06/2023] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
AIMS Despite advances in care, people with epilepsy experience negative health events (NHEs), such as seizures, emergency department (ED) visits and hospitalizations. This analysis using baseline data from an epilepsy self-management clinical trial targeting people from rural regions and other underserved populations assessed the relationship between demographic and clinical variables vs. NHEs. METHODS Data to evaluate disparities and clinical correlates was collected using patient surveys from a baseline sample of 94 participants in a larger prospective study of 160 individuals with epilepsy who experienced an NHE within the last six months. Demographic characteristics, mental and physical functional status assessed using 36-Item Short Form Health Survey questionnaire version 2 (SF-36v2), depression assessed with the 9-item Patient Health Questionnaire (PHQ-9), quality of life assessed with the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), self-efficacy assessed the Epilepsy Self-Efficacy Scale (ESES), social support assessed with the Multidimensional Scale of Perceived Social Support (MSPSS), self-management assessed with the Epilepsy Self-Management Scale (ESMS), and stigma assessed with the Epilepsy Stigma Scale (ESS) were all examined in association with past 6-month total NHE frequency as well as NHE sub-categories of past 30-day and 6-month seizure counts, self-harm attempts, ED visits and hospitalizations. An exploratory evaluation of NHE correlates in relation to the Rural Urban Continuum Code (RUCC) residence classification compared 3 subgroups of increasing rurality. Descriptive statistics were generated for demographic and clinical variables and NHEs, and exploratory analyses compared the distribution of demographic, clinical, and NHE variables by RUCC categorization. RESULTS The mean age was 38.5 years (SD 11.9), predominantly female (N= 62, 66.0%) and white (N=81, 86.2%). Just a little under half (N=43, 45.7%) of participants had annual incomes of less than $25,000, and 40% (N=38) were rural residents (RUCC >3). The past 6-month NHEs count was 20.4 (SD 32.0). Seizures were the most common NHE with a mean 30-day seizure frequency = 5.4 (SD 11.8) and 6-month seizure frequency of 18.7 (SD 31.6). Other NHE types were less common with a past 6-month self-harm frequency of 0.16 (SD 1.55), ED visit frequency of 0.72 (SD 1.10), and hospitalization frequency of 0.28 (SD 1.02). There were few significant demographic and clinical correlates for total and sub-categories of NHEs. Worse physical health status, as measured by the physical component summary (PCS) of the SF-36v2, was significantly associated with 6-month seizure counts (p=.04). There were no significant differences between the 3 RUCC subgroups on demographic variables. However, past 30-day seizure count, past 6-month seizure count and total past 6-month NHE counts were all higher among individuals from more rural settings (p-values <.01 for each). CONCLUSIONS Rural adults with epilepsy were more likely to have a greater number of seizures and more epilepsy complications in general. Worse physical health function was also associated with more epilepsy complications. However, this analysis found few other demographic and clinical correlates of cumulative NHEs among adults with epilepsy. Additional efforts are needed to investigate health disparities among people with epilepsy who live in rural regions or who have poor physical health function.
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Affiliation(s)
- Gena R Ghearing
- Department of Neurology, Carver College of Medicine University of Iowa Health Center, Iowa City, LA, USA.
| | - Maegan Tyrrell
- Department of Neurology, Carver College of Medicine University of Iowa Health Center, Iowa City, LA, USA
| | - Jessica Black
- Department of Psychiatry and of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Jacqueline Krehel-Montgomery
- Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Joy Yala
- Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Clara Adeniyi
- Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Farren Briggs
- Department of Public Health Services, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Martha Sajatovic
- Department of Psychiatry and of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine University Hospitals Case Medical Center, Cleveland, OH, USA
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Panda PK, Ramachandran A, Tomar A, Elwadhi A, Kumar V, Sharawat IK. Prevalence, nature, and severity of the psychiatric comorbidities and their impact on quality of life in adolescents with Juvenile myoclonic epilepsy. Epilepsy Behav 2023; 142:109216. [PMID: 37088064 DOI: 10.1016/j.yebeh.2023.109216] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Adults with Juvenile myoclonic epilepsy (JME) are at increased risk for psychiatric comorbidities, personality traits, and abnormality in executive function. But studies on adolescents and their impact on quality of life are scarce in the literature. MATERIALS AND METHODS This cross-sectional study was performed between August 2019 and October 2022 to compare the prevalence of psychiatric comorbidities in adolescents with JME and age and gender-matched healthy controls. After completing DSM-5 Structured Clinical Interview (SCID-5) initially in all patients, we measured the severity of individual psychiatric problems like anxiety, depression, and somatic symptoms by using an appropriate psychometric scale. We also measured both groups' intelligence quotient (IQ), executive function, and quality of life. RESULTS One hundred patients with JME (14.3 ± 2.5 years, 48 boys) and 100 controls were enrolled. Psychiatric disorders were observed in 46% of JME and 6% of controls (p < 0.01). Psychiatric comorbidities noted in the patients with JME were: somatic symptom and related disorders(n = 14), anxiety (n = 13), adjustment disorders (n = 12), depression (n = 11), oppositional defiant disorder (n = 6), conduct disorder (n = 5), anorexia nervosa (n = 3), narcissistic (n = 3), histrionic (n = 1), substance-related disorder (n = 1), borderline (n = 2) and antisocial personality disorder (n = 2). The prevalence of depressive disorders, anxiety disorders, adjustment disorders, somatic symptoms, related disorders, and any personality disorder was significantly more in the JME group (p < 0.01 for all). Female gender, higher Epilepsy Stigma Scale score, and lower Epilepsy Outcome Expectancy Scale were significantly associated with depressive disorders (p = 0.04, 0.03, 0.03 respectively). Similarly, for anxiety, only female gender and lower Epilepsy Outcome Expectancy Scale were significant associated factors (p = 0.03, 0.02 respectively). CONCLUSIONS Psychiatric disorders like anxiety, depression, and personality disorders are more frequent in adolescents with JME than in controls.
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Affiliation(s)
- Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Aparna Ramachandran
- Department of Neurology, IQRAA International Hospital and Research Centre, Kozhikode, Kerala 673009, India
| | - Apurva Tomar
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Aman Elwadhi
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Vinod Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India.
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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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Ogawa M, Fujikawa M, Tasaki K, Jin K, Kakisaka Y, Nakasato N. Development and validation of the Japanese version of the Epilepsy Stigma Scale in adults with epilepsy. Epilepsy Behav 2022; 134:108832. [PMID: 35863139 DOI: 10.1016/j.yebeh.2022.108832] [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: 03/22/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Self-stigma is considered to have immensely negative influences on the living and psychological states in patients with epilepsy. Understanding the stigma experienced by patients with epilepsy is essential considering its negative impact on their treatment and quality of life (QOL). However, few sufficiently validated self-report instruments are available to evaluate self-stigma in patients with epilepsy. The Epilepsy Stigma Scale (ESS) is one of the most commonly used self-reported questionnaires available to evaluate self-stigma in patients with epilepsy. The present study translated the ESS into Japanese to validate the Japanese version of the ESS (ESS-J) in Japanese adults with epilepsy. METHODS The study included 338 patients with epilepsy (166 men, aged 18-75 years) who underwent comprehensive assessment including long-term video-electroencephalography monitoring, neuroimaging studies, and neuropsychological and psychosocial assessments in the Tohoku University Hospital Epilepsy Monitoring Unit. This study consisted of two phases: (1) translation of the ESS into Japanese using the back-translation technique; and (2) statistical analysis of the ESS-J to evaluate the factor structure, reliability, and validity. RESULTS The 2-factor model achieved acceptable fit to the data: χ2 = 161.27, df = 34, p < 0.01, comparative fit index = 0.929, root mean square error of approximation = 0.105, standardized root mean squared residual = 0.047, Akaike's information criterion = 203.27 and, Bayesian information criterion = 283.56. These two subscales were named enacted stigma and felt stigma based on the theoretical model of self-stigma. We found the ESS-J to have acceptable internal consistency as follows: enacted (7 items; α = 0.88) and felt stigma subscale (3 items; α = 0.82). The concurrent validity was confirmed by adequate correlation with other related instruments. Both enacted and felt stigma had positive and moderate correlations with depression as measured by the Neurological Disorders Depression Inventory for Epilepsy (r = 0.44, p < 0.01; r = 0.41, p < 0.01, respectively) and with anxiety as measured by the Generalized Anxiety Disorder -7 (r = 0.48, p < 0.01; r = 0.38, p < 0.01, respectively). CONCLUSION The ESS-J demonstrated acceptable validity and reliability. The present study provided preliminary evidence about the psychometric properties of the ESS-J, indicating the reliable factorial structure, adequate internal consistency, and satisfactory construct and concurrent validity. Measurement of the two types of self-stigma may offer a useful tool for clinical interpretation of patients' psychological state throughout epilepsy care, and as one of the patient-reported outcomes in QOL research.
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Affiliation(s)
- Maimi Ogawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mayu Fujikawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Katsuya Tasaki
- Department of International Communication, Aoyama Gakuin University, Tokyo, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Impact of exercise as a complementary management strategy in people with epilepsy: A randomized controlled trial. Epilepsy Behav 2022; 129:108616. [PMID: 35219171 DOI: 10.1016/j.yebeh.2022.108616] [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: 08/28/2021] [Revised: 01/13/2022] [Accepted: 02/05/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To measure the impact of 12 weeks of physical exercise as complementary management strategy on quality of life (QOL) in people with epilepsy (PWE). METHODS In a parallel-group, randomized controlled study with blinded outcome assessment, PWE of 18-65 years old, smartphone users were randomized into two groups. The exercise group was advised minimum 150 min per week of moderate-intense aerobic activity, as per current WHO recommendation [1], in addition to standard medical care; the control group received only standard medical care. QOL was assessed using Quality of Life in Epilepsy (QOLIE-31) inventory [2,3]; physical activity, with Global Physical Activity Questionnaire version 2 (GPAQ), and Pedometer Step Counter (a smartphone-based activity tracker application), at baseline and after 12 weeks. Body weight, body mass index, seizure frequency, and stigma scores (Epilepsy Stigma Scale Austin and colleagues) [4] were also noted. RESULTS One hundred and seventeen PWE were recruited (58 exercise, 59 control). Although there was an improvement in the physical activity correlates after 12 weeks compared to mean values at baseline, the differences were not significant between the groups. The total QOL mean scores at baseline in the exercise and control groups were 64.9 and 63.7 (p = 0.597) and after 12 weeks, 68.4 and 66.9 (p = 0.660), respectively. However, intragroup comparison of energy/fatigue score in the exercise group showed significant change with a p value of 0.009 and intragroup comparison of Overall QOL score in the control group showed a significant change with a p value of 0.003. Similar improvement was seen in stigma scores (p = 0.500) and seizure frequency (p = 0.388) at 12 weeks in exercise and control groups. After 12 weeks, mean values of METS ((metabolic equivalents) were 794.81 and 714.27 (p = 0.159), steps per day were 4018.32 and 3730.0 (p = 0.314), calories spent per day were 173.85 and 159.68 (p = 0.320 and distance walked per day in meters were 2576.52 and 2198.42 (p = 0.072), in the exercise and control groups, respectively. SIGNIFICANCE Regular physical activity for at least 150 min per week, in the form of moderate-intense aerobic exercises resulted in positive yet non-significant improvement of QOL, seizure frequency, and stigma in PWE.
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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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Ogawa M, Fujikawa M, Jin K, Kakisaka Y, Ueno T, Nakasato N. Acceptance of disability predicts quality of life in patients with epilepsy. Epilepsy Behav 2021; 120:107979. [PMID: 33962248 DOI: 10.1016/j.yebeh.2021.107979] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Acceptance of disability (AOD) is a key concept in rehabilitation psychology that enhances psychosocial adjustment of individuals with disability. However, the impact of AOD on well-being has never been examined for patients with epilepsy. The present study investigated whether AOD affects quality of life (QOL) in patients with epilepsy in the presence of other multiple aspects of epilepsy based on the biopsychosocial model. METHODS We retrospectively reviewed 151 consecutive patients with epilepsy (77 men, aged 18-74 years) who underwent comprehensive assessment including long-term video-EEG monitoring, neuroimaging studies, and neuropsychological and psychosocial assessment in our epilepsy monitoring unit. Data were obtained from medical records and self-reported questionnaires. The outcome variable was QOL. Predictive variables included demographic characteristics, seizure-related variables (i.e., duration of epilepsy, seizure frequency, and number of antiepileptic drugs), psychological factors (i.e., AOD, depression, and self-stigma), and social factors (i.e., social support and education level). Acceptance of disability was measured by the Adaptation of Disability Scale-Revised (ADS-R), which we translated into Japanese with the original author's approval, and examined its internal consistency reliability. Data were analyzed using four hierarchical multiple regression analysis models. RESULTS The mean ADS-R score was 80 (range 45-115). The predictors accounted for 42% of the variance in QOL (R2 = 0.45, ΔR2 = 0.42, F[8, 141] = 14.47, p = 0.00). Higher AOD (p < 0.01), higher social support (p < 0.01), and lower depression scores (p = 0.02) were found to contribute significantly to higher overall QOL. CONCLUSION The present study revealed AOD as an important psychological concept, in addition to social support and depression as previously reported, to improve the QOL of patients with epilepsy. Acceptance of disability should be incorporated in the intervention to increase QOL of patients with epilepsy.
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Affiliation(s)
- Maimi Ogawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mayu Fujikawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Ueno
- Faculty of Comprehensive Welfare, Tohoku Fukushi University, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Beesley RE, Walton C, Hindley D, Jameson H, Panwar N, Lew AR. Carer evaluations of paediatric epilepsy services with and without epilepsy specialist nurse provision. Seizure 2021; 91:174-180. [PMID: 34174691 DOI: 10.1016/j.seizure.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare paediatric epilepsy services with and without Epilepsy Specialist Nurse (ESN) provision on measures of carer satisfaction and accessibility of service. METHODS In Study 1, carers in Northern England (n = 69 with an ESN, n = 27 without an ESN), completed the Parent Report of Psychosocial Care Scale to measure satisfaction with service provision. A measure of accessibility of service was also included. In Study 2, in depth semi-structured interviews with 58 carers (51 of whom had also participated in Study 1) were examined for talk related to accessibility of service. RESULTS In Study 1, Satisfaction with service levels were high across all areas, (ESN areas Mdn = 9.04, IQR = 1.48, non-ESN areas Mdn = 8.29, IQR = 2.41; maximum score = 10), but with carers from ESN areas over 3 times more likely to endorse scores at the median or above relative to non-ESN areas (OR = 3.28). For accessibility, carers in ESN areas were over 5 times more likely to have a median score or higher (ESN areas Mdn = 10, IQR = 0.45, non-ESN areas Mdn = 8.4, IQR = 5, OR = 5.43). In study 2 a majority of all carers reported having made at least one attempt to contact services between appointments, for a wide range of reasons, with timely resolution reported in ESN areas, but more variable resolution occurring in non-ESN areas. CONCLUSION Paediatric ESNs provide a critical and timely service to children with epilepsy and their carers.
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Affiliation(s)
- Rebekah E Beesley
- Psychology Department, Fylde College, Lancaster University, Lancaster LA1 4YF, United Kingdom.
| | - Chris Walton
- Psychology Department, Fylde College, Lancaster University, Lancaster LA1 4YF, United Kingdom.
| | - Daniel Hindley
- Bolton NHS Foundation Trust, Breightmet Health Centre, Breightmet Fold Lane, Bolton BL2 6NT, United Kingdom.
| | - Helen Jameson
- Bolton NHS Foundation Trust, Breightmet Health Centre, Breightmet Fold Lane, Bolton BL2 6NT, United Kingdom.
| | - Nitin Panwar
- Manchester University Foundation Trust, 1st Floor, Universal Sq., Devonshire St. North, Manchester, M12 6JH, United Kingdom.
| | - Adina R Lew
- Psychology Department, Fylde College, Lancaster University, Lancaster LA1 4YF, United Kingdom.
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10
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Wojewodka G, McKinlay A, Ridsdale L. Best care for older people with epilepsy: A scoping review. Seizure 2021; 85:70-89. [PMID: 33450705 DOI: 10.1016/j.seizure.2020.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/28/2022] Open
Abstract
There are two peaks of diagnosis of epilepsy: in childhood and in people over 65. Older people may have complex needs like co-morbidity, polypharmacy, frailty, and social isolation. This scoping review focusses on the care of older people with epilepsy beyond diagnosis and medical treatment. We sought to identify areas within the UK health service needing development either in clinical practice or through further research. The search returned 4864 papers with 33 papers included in the review. The papers were grouped into psychosocial, self-management and services themes. Only one randomised controlled trial was found. Research was mainly based on cohort and case-control studies. Older people require more information to self-manage epilepsy and more psychological support to help with symptoms of anxiety and depression. People reported experiencing stigma and a reluctance to disclose their condition. This may increase the risk of isolation and difficulties in managing epilepsy. Studies reported that older people are referred less to neurologists, suggesting there may be a gap in care provision compared to younger people. Generalist health professionals may be better placed to provide holistic care, but they may need additional training to alleviate uncertainties in managing epilepsy. Care plans could help provide information, particularly for co-morbidity, but few had one. Our findings highlight psychological and self-management needs for managing epilepsy in older people. Health service staff may require upskilling to shift epilepsy management from neurologists to generalists. More research is needed regarding psychological and self-management interventions, particularly in the form of randomised controlled trials.
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Affiliation(s)
- Gabriella Wojewodka
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, 16 de Crespigny Park, PO Box 57, London, SE5 8AF, UK.
| | - Alison McKinlay
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, 16 de Crespigny Park, PO Box 57, London, SE5 8AF, UK
| | - Leone Ridsdale
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, 16 de Crespigny Park, PO Box 57, London, SE5 8AF, UK
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11
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Tutar Güven Ş, İşler Dalgiç A, Duman Ö. Evaluation of the efficiency of the web-based epilepsy education program (WEEP) for youth with epilepsy and parents: A randomized controlled trial. Epilepsy Behav 2020; 111:107142. [PMID: 32702651 DOI: 10.1016/j.yebeh.2020.107142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND When youth with epilepsy and their parents have insufficient information about the disease, they are known to have more problems with disease management, and they show poor compliance. Providing accurate, reliable, and accessible information with no time and space limitations is extremely important for individuals with epilepsy as well as for their caregivers. AIM In this study, we aimed to evaluate the content, quality, usability, and efficacy of our web-based epilepsy education program (WEEP) that we developed for youth with epilepsy and their parents. METHODS The sample of this randomized controlled trail was composed of youth with epilepsy who were between the ages of 9 and 18 years and their parents who had applied to the Pediatric Neurology Unit of a tertiary healthcare hospital in Turkey between November 2017 and April 2018. This study was conducted in two stages: (1) the preparation phase, during which we developed a WEEP for epilepsy, and tested its content, quality, and usability; and (2) the implementation phase, during which we evaluated the efficacy of the website by assessing users' knowledge of epilepsy, seizure self-efficacy, attitudes, and e-health literacy. Before the implementation phase, data collection tools were used to test the prior knowledge of epilepsy of the participants and control groups. Next, the youth and their parents were asked to use the WEEP for 12 weeks, while a control group was not provided with additional education tools. Written consent was obtained from the participants prior to the study in addition to obtaining approval from the ethics committee and permission from the institution where the research was conducted. The data were finally analyzed using SAS 9.4 software. RESULTS During the preparation phase, the website was developed and tested for content, quality, and usability. The WEEP was graded 72.7 ± 3.4 points by experts, 92.4 ± 1.63 by youth with epilepsy, and 92.31 ± 1.94 by the parents. During the implementation phase, the efficacy of the web site was evaluated through the assessment of participants' scores. We found that the mean knowledge, seizure self-efficacy, attitude, and e-health literacy scores of youth with epilepsy in the experimental group had significantly increased after the WEEP (p < 0.05). An increase in the scores of knowledge, anxiety, self-management, and e-health literacy scale was also found among the parents in the intervention group (p < 0.05). CONCLUSION The content, quality, and usability of the WEEP were adequate and effective in improving knowledge, self-efficacy, attitudes, and e-health literacy of youth with epilepsy as well as those of their parents.
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Affiliation(s)
- Şerife Tutar Güven
- Department of Pediatric Nursing, Faculty of Health Sciences, Süleyman Demirel University, Isparta, Turkey.
| | - Ayşegül İşler Dalgiç
- Department of Pediatric Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Özgür Duman
- Department of Pediatric Neurology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
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12
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Deleo F, Quintas R, Pastori C, Pappalardo I, Didato G, Di Giacomo R, de Curtis M, Villani F. Quality of life, psychiatric symptoms, and stigma perception in three groups of persons with epilepsy. Epilepsy Behav 2020; 110:107170. [PMID: 32512366 DOI: 10.1016/j.yebeh.2020.107170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The current study aimed to describe quality of life (QoL) levels, psychiatric symptoms prevalence, and perceived stigma levels in persons with either drug-resistant epilepsy (DRE) or drug-sensitive epilepsy (DSE) and in persons with epilepsy (PwE) with DRE that underwent epilepsy surgery (DREES). METHODS Persons with epilepsy diagnosed as having DRE according to International League Against Epilepsy (ILAE) criteria, DSE, and DREES were enrolled at the Epilepsy Unit of the Neurological Institute Carlo Besta of Milan. Sociodemographic and clinical data, Quality of Life in Epilepsy Inventory (QOLIE-31), Symptom Checklist-90 (SCL-90), and the Epilepsy Stigma Scale (ESS) were collected based on self-reported information and on medical records. RESULTS Sociodemographic, medical, and psychological data were obtained from 181 PwE: 80 with DRE, 31 with DSE, and 70 with DREES. We found that QoL is higher and psychiatric symptoms are lower in persons with DSE compared with DRE and that patients with DREES, who were drug-resistant before surgery, are in between DSE and DRE for both measures. Perceived stigma level is different in DSE and in DRE, that report the highest levels of stigma, and is between the other two groups in DREES. SIGNIFICANCE This study suggests that low QoL levels and high psychiatric symptoms prevalence in drug-resistant PwE may be significantly improved after epilepsy surgery and suggests the importance of a biopsychosocial approach when planning therapeutic intervention.
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Affiliation(s)
- Francesco Deleo
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Rui Quintas
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Chiara Pastori
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Irene Pappalardo
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy; Neurology Department, ASL AL, Casale Monferrato, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Roberta Di Giacomo
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Marco de Curtis
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Flavio Villani
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy; Division of Clinical Neurophysiology and Epilepsy Center, IRCCS Ospedale San Martino, Largo R. Benzi 10, 16132 Genova, Italy
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13
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Kisiel MA, Zhou X, Sundh J, Ställberg B, Lisspers K, Malinovschi A, Sandelowsky H, Montgomery S, Nager A, Janson C. Data-driven questionnaire-based cluster analysis of asthma in Swedish adults. NPJ Prim Care Respir Med 2020; 30:14. [PMID: 32249767 PMCID: PMC7136224 DOI: 10.1038/s41533-020-0168-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/03/2020] [Indexed: 01/02/2023] Open
Abstract
The aim of this study was to identify asthma phenotypes through cluster analysis. Cluster analysis was performed using self-reported characteristics from a cohort of 1291 Swedish asthma patients. Disease burden was measured using the Asthma Control Test (ACT), the mini Asthma Quality of Life Questionnaire (mini-AQLQ), exacerbation frequency and asthma severity. Validation was performed in 748 individuals from the same geographical region. Three clusters; early onset predominantly female, adult onset predominantly female and adult onset predominantly male, were identified. Early onset predominantly female asthma had a higher burden of disease, the highest exacerbation frequency and use of inhaled corticosteroids. Adult onset predominantly male asthma had the highest mean score of ACT and mini-AQLQ, the lowest exacerbation frequency and higher proportion of subjects with mild asthma. These clusters, based on information from clinical questionnaire data, might be useful in primary care settings where the access to spirometry and biomarkers is limited.
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Affiliation(s)
- Marta A Kisiel
- Department of Medical Sciences: Environmental and Occupational Medicine, Uppsala University, Uppsala, Sweden.
| | - Xingwu Zhou
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Hanna Sandelowsky
- NVS, Section for Family Medicine and Primary Care, Karolinska Institute, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anna Nager
- NVS, Section for Family Medicine and Primary Care, Karolinska Institute, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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14
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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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15
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O'Toole S, Gallagher P, Benson A, Shahwan A, Austin JK, Lambert V. Exploring the relationship between parent-child communication about epilepsy and psychosocial well-being. J Health Psychol 2019; 26:1207-1221. [PMID: 31448626 DOI: 10.1177/1359105319871642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This study examined the relationship between parent-child communication and psychosocial well-being of 47 children living with epilepsy and 72 parents of children living with epilepsy. Open communication was associated with positive illness attitude, positive self-perception and greater health-related quality of life for children living with epilepsy; positive response to illness for parents; and more perceived social support and less need for epilepsy-related support for children living with epilepsy and parents. By contrast, closed communication was associated with poorer psychosocial well-being in children living with epilepsy and parents. Healthcare professionals should provide guidance for families living with childhood epilepsy on the importance of open communication in promoting greater psychosocial well-being.
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Affiliation(s)
| | | | | | - Amre Shahwan
- Children's Health Ireland at Temple Street, Ireland
| | - Joan K Austin
- Indiana University-Purdue University Indianapolis, USA
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16
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Sajatovic M, Colon-Zimmermann K, Kahriman M, Fuentes-Casiano E, Burant C, Aebi ME, Cassidy KA, Lhatoo S, Einstadter D, Chen P. One-year follow-up of a remotely delivered epilepsy self-management program in high-risk people with epilepsy. Epilepsy Behav 2019; 96:237-243. [PMID: 31126825 PMCID: PMC7370541 DOI: 10.1016/j.yebeh.2019.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE "Self-management for people with epilepsy and a history of negative health events" (SMART) is a novel group-format epilepsy self-management intervention demonstrated to reduce negative health events (NHEs) such as accidents, emergency department visits, and seizures in adults with epilepsy in a 6-month prospective randomized controlled trial (RCT); SMART also reduced depressive symptoms and improved health functioning and quality of life. This report describes the longer-term (12-month) post-efficacy RCT outcomes in adults with epilepsy who received SMART. METHODS After completing a 6-month, prospective RCT that demonstrated efficacy of SMART vs 6-month waitlist control (WL), adults ≥18 years of age with epilepsy were followed for an additional 12 months. Individuals originally randomized to WL received the 8-week SMART intervention immediately following the conclusion of the RCT. For this long-term extension analysis, assessments were conducted at 24 weeks (the 6-month primary outcome time-point of the efficacy RCT), at 32 weeks for individuals originally randomized to WL, and at 48 weeks and 72 weeks for all individuals. Outcomes assessed included past 6-month NHE counts, depressive symptoms assessed with the 9-item Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS), and quality of life assessed with the 10-item Quality of Life in Epilepsy (QOLIE-10). RESULTS At the beginning of this long-term observational period (24-week follow-up time point for the original RCT), there were 50 individuals in the group originally randomized to SMART and 52 originally randomized to WL. Mean age was 41.4 years, 70% women (N = 71), 64% (N = 65) African-American, and 8% Hispanic (N = 8). Study attrition from week 24 to week 72 was 8% in the arm originally randomized to SMART and 17% in the arm originally randomized to WL. During the 12-month observation period (24 weeks to 72 weeks), there were a total of 44 serious adverse events and 4 deaths, none related to study participation. There was no significant change in total past 6-month NHE counts in the group originally randomized to SMART, although the group had significantly reduced 6-month seizure counts. The group originally randomized to WL, who received SMART during this observational period, had a reduction in total NHE counts. The group originally randomized to SMART had relatively stable levels on other outcome variables except for a trend for improved MADRS (p = 0.08). In the group originally randomized to WL, there were significant improvements in PHQ-9 (p = 0.01), MADRS (p ≤ 0.01), and QOLIE-10 (p = 0.004). CONCLUSIONS This post-RCT extension study suggests that adults with epilepsy who participate in the SMART intervention sustain clinical effects at 1-year follow-up and may have incremental improvements in seizure frequency and mood. Future research needs to identify opportunities for scale-up and outreach to other high-risk groups with epilepsy.
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Affiliation(s)
- Martha Sajatovic
- Department of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Kari Colon-Zimmermann
- Department of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mustafa Kahriman
- Department of Neurology, Louis Stokes Cleveland VAMC, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Edna Fuentes-Casiano
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christopher Burant
- Case Western Reserve University School of Nursing, Louis Stokes Cleveland VAMC, 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
| | - Kristin A Cassidy
- Department of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Samden Lhatoo
- Department of Neurology, University of Texas Houston, Houston, TX, USA
| | - Douglas Einstadter
- Case Western Reserve University and Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH, USA
| | - Peijun Chen
- Department of Psychiatry, Louis Stokes Cleveland VAMC, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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17
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Gersamiya AG, Parfenova EV, Yakovlev AA, Zharkinbekova NA, Rider FK. [Psychometric properties of the Stigma Scale of Epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:29-33. [PMID: 32207728 DOI: 10.17116/jnevro201911911229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess the psychometric properties of the Stigma Scale of Epilepsy, a short simple to complete questionnaire to quickly and reliably determine the presence and the level of perceived stigma in a particular patient, as well as to assess the prevalence, socio-demographic, clinical and socio-psychological factors associated with this phenomenon. MATERIAL AND METHODS The study included 398 patients with epilepsy. Exploratory (EFA) and confirmatory factor analysis (CFA) were used to assess the psychometric characteristics of the scale. RESULTS AND CONCLUSION The EFA showed a two-factor scale structure explaining 57.25% of the variance. Values of GFI 0.948, CFI 0.927 and RMSEA 0.057 after the data correction show a good conformity of the model to the empirical data. Cronbach's alpha coefficient was 0.862 for the scale, 0.815 for factor 1, 0.809 for factor 2, which indicates a high consistency of both the entire scale and its subscales. The Russian-language variant of the Stigma Scale of Epilepsy is a short, economical to use tool with good psychometric properties for assessing perceived stigma in patients with epilepsy.
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Affiliation(s)
- A G Gersamiya
- Moscow Research and Clinical Center for Neuropsychiatry,Healthcare Department of Moscow, Moscow, Russia
| | - E V Parfenova
- Moscow Research and Clinical Center for Neuropsychiatry,Healthcare Department of Moscow, Moscow, Russia
| | - A A Yakovlev
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | | | - F K Rider
- Moscow Research and Clinical Center for Neuropsychiatry,Healthcare Department of Moscow, Moscow, Russia
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18
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Sajatovic M, Colon-Zimmermann K, Kahriman M, Fuentes-Casiano E, Liu H, Tatsuoka C, Cassidy KA, Lhatoo S, Einstadter D, Chen P. A 6-month prospective randomized controlled trial of remotely delivered group format epilepsy self-management versus waitlist control for high-risk people with epilepsy. Epilepsia 2018; 59:1684-1695. [PMID: 30098003 DOI: 10.1111/epi.14527] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Despite advances in care, many people with epilepsy have negative health events (NHEs) such as accidents, emergency department visits, and poor quality of life. "Self-management for people with epilepsy and a history of negative health events" (SMART) is a novel group format epilepsy self-management intervention. A community participatory approach informed the refinement of SMART, which was then tested in a 6-month randomized controlled trial of SMART (n = 60) versus waitlist control (WL, n = 60). METHODS Participants were adults aged ≥18 years with epilepsy and an NHE within the past 6 months (seizure, accident, self-harm attempt, emergency department visit, or hospitalization). Assessments were conducted at screening, baseline, 10 weeks, and 24 weeks (6 months). Primary outcome was 6-month change in total NHE count. Additional outcomes included depression on the nine-item Patient Health Questionnaire and Montgomery-Asberg Depression Rating Scale, quality of life on the 10-item Quality of Life in Epilepsy, functioning on the 36-item Short-Form Health Survey, and seizure severity on the Liverpool Seizure Severity Scale. RESULTS Mean age was 41.3 years (SD = 11.82), 69.9% were African American, 74.2% were unemployed, and 87.4% had an annual income < US$25 000; 57.5% had a seizure within 30 days of enrollment. Most NHEs were seizures. Six-month study attrition was 14.2% overall and similar between arms. Individuals randomized to SMART had greater reduction in total median NHEs from baseline to 6 months compared to WL (P = 0.04). SMART was also associated with improved nine-item Patient Health Questionnaire (P = 0.032), Montgomery-Asberg Depression Rating Scale (P = 0.002), 10-item Quality of Life in Epilepsy (P < 0.001), and 36-item Short-Form Health Survey (P = 0.015 physical health, P = 0.003 mental health) versus WL. There was no difference in seizure severity. SIGNIFICANCE SMART is associated with reduced health complications and improved mood, quality of life, and health functioning in high-risk people with epilepsy. Additional efforts are needed to investigate potential for scale-up.
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Affiliation(s)
- Martha Sajatovic
- Department of Neurology, Neurological & Behavioral Outcomes Center, Cleveland, Ohio.,Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio
| | - Kari Colon-Zimmermann
- Department of Neurology, Neurological & Behavioral Outcomes Center, Cleveland, Ohio.,Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio
| | - Mustafa Kahriman
- Department of Neurology, Lois Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Edna Fuentes-Casiano
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio
| | - Hongyan Liu
- Department of Neurology, Neurological & Behavioral Outcomes Center, Cleveland, Ohio
| | - Curtis Tatsuoka
- Department of Neurology, Neurological & Behavioral Outcomes Center, Cleveland, Ohio
| | - Kristin A Cassidy
- Department of Neurology, Neurological & Behavioral Outcomes Center, Cleveland, Ohio.,Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio
| | - Samden Lhatoo
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Douglas Einstadter
- MetroHealth Medical Center, Case Western Reserve University School of Medicine and Center for Health Care Research and Policy, Cleveland, Ohio
| | - Peijun Chen
- Department of Psychiatry, Lois Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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19
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Baker D, Eccles FJR, Caswell HL. Correlates of stigma in adults with epilepsy: A systematic review of quantitative studies. Epilepsy Behav 2018; 83:67-80. [PMID: 29660506 DOI: 10.1016/j.yebeh.2018.02.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/16/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The aim of this review was to identify quantitative correlates, predictors, and outcomes of stigma in adults with epilepsy living in Western countries. METHODS To identify relevant literature, four academic databases (PsycINFO, CINAHL, PubMed, and Scopus) were systematically searched using key terms related to stigma and epilepsy. RESULTS Thirty-three research papers reporting findings from 25 quantitative studies of correlates of stigma in epilepsy were identified. The findings suggest that stigma can be predicted by demographic, illness-related, and psychosocial factors, although associations were found to be highly culturally specific. Outcomes of stigma in people with epilepsy were replicated more consistently across cultures, and its impact was significant. Detrimental effects included both worse physical health, including less effective management of the condition, and reduced psychological well-being, including difficulties such as depression and anxiety. IMPLICATIONS Educational initiatives and therapeutic interventions that aim to address stigma in people with epilepsy are recommended; however, these need to be culturally informed to ensure that they are valid and effective.
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Affiliation(s)
- David Baker
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, United Kingdom
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, United Kingdom.
| | - Helen L Caswell
- Department of Clinical Neuropsychology, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, United Kingdom
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Kumar N, Colon-Zimmermann K, Fuentes-Casiano E, Liu H, Tatsuoka C, Cassidy KA, Kahriman M, Chen P, Sajatovic M. Clinical correlates of negative health events in a research sample with epilepsy. Epilepsy Behav 2018; 79:225-229. [PMID: 29279188 PMCID: PMC6231550 DOI: 10.1016/j.yebeh.2017.11.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/26/2017] [Accepted: 11/29/2017] [Indexed: 11/19/2022]
Abstract
AIMS In spite of advances in care, people with epilepsy experience negative health events (NHEs), such as seizures, emergency department (ED) visits, and hospitalizations. Being able to identify characteristics that are associated with NHE risk can help inform care approaches that reduce complications and burden. This analysis using baseline data from a larger randomized epilepsy self-management clinical trial assessed the relationship between demographic and clinical variables vs. seizure-related complications among people with epilepsy. METHODS Data were derived from a baseline sample of a larger prospective study of 120 individuals with epilepsy who experienced an NHE within the last 6months. Demographic characteristics, depression assessed with the 9-item Patient Health Questionnaire (PHQ-9) and the Montgomery-Asberg Depression rating scale (MADRS), quality of life assessed with the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), self-efficacy assessed the Epilepsy Self-Efficacy Scale (ESES), social support assessed with the Multidimensional Scale of Perceived Social Support (MSPSS), self-management assessed with the Epilepsy Self-Management Scale (ESMS), and stigma assessed with the Epilepsy Stigma Scale (ESS) were all examined in association with past 6-month NHE frequency and 30-day seizure frequency. RESULTS Except for lower levels of education and lower levels of income being associated with higher 30-day and 6-month seizure frequency, demographic variables were generally not significantly associated with NHEs. Higher 30-day seizure frequency was associated with greater depression severity on PHQ-9 (p<0.01) and MADRS (p<0.01). Higher 6-month seizure frequency was also associated with greater depression severity on PHQ-9 (p<.001) and MADRS (p=0.03). Both 30-day and 6-month seizure frequency were significantly negatively associated with QOLIE-10 (p<0.001). Both 30day (p=0.01) and 6-month (p=0.03) seizure frequency were associated with worse stigma on ESS. Total NHE count was associated with more severe depression on PHQ-9 (p=0.02), and MADRS (p=0.04), worse quality of life on QOLIE-10 (p<0.01), and more stigma on ESS (p=0.03). CONCLUSIONS Consistent with previous literature, more frequent seizures were associated with worse depression severity and quality of life. A finding that is less established is that higher seizure frequency is also associated with worse epilepsy-related stigma. Epilepsy self-management approaches need to address depression and stigma as well as seizure control.
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Affiliation(s)
- Neha Kumar
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kari Colon-Zimmermann
- Department of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Edna Fuentes-Casiano
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Hongyan Liu
- Department of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Curtis Tatsuoka
- Department of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kristin A Cassidy
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Mustafa Kahriman
- Department of Neurology, Lois stokes Cleveland VAMC, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Peijun Chen
- Department of Psychiatry, Lois Stokes Cleveland VAMC, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Martha Sajatovic
- Department of Psychiatry and of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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21
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Smith G, Modi AC, Johnson EK, Shegog R, Austin JK, Wagner JL. Measurement in pediatric epilepsy self-management: A critical review. Epilepsia 2018; 59:509-522. [PMID: 29322489 DOI: 10.1111/epi.13992] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 11/30/2022]
Abstract
Given the paucity of information available regarding self-management, the aims of this paper are to synthesize the literature on factors associated with and measures to assess self-management in pediatric epilepsy. INCLUSION CRITERIA youth birth to 18 years with a seizure disorder or an epilepsy diagnosis and/or their caregivers, published 1985-2014 in English, and conducted in countries with a very high human development index. The review was conducted in 6 phases: (1) identification of bibliographical search criteria and databases; (2) abstract assessment; (3) full article review; (4) organization of final citations into categories; (5) identification of predictors, potential mediators/moderators, and outcomes associated with self-management factors and categorization of factors as influences, processes, or behaviors across individual, family, community, and health care domains; and (6) critique of self-management instrument studies. Twenty-five studies that evaluated factors associated with self-management were identified. Individual and family-focused factors were the most commonly studied predictors of self-management, with psychosocial care needs and self-efficacy for seizure management identified as key factors associated with pediatric epilepsy self-management. Few studies have included mediator and moderator analyses. Measures of adherence were the most commonly used outcome. There has been a predominant focus on pediatric epilepsy influences and processes that are modifiable in nature, potentially at the expense of evidence for the role of community and health systems in pediatric epilepsy self-management. The 6 self-management instrument tools reported scientific rationale and good psychometric properties. Results highlight several key modifiable cognitive and behavioral targets for skills development: adherence, self-efficacy for seizure management, attitudes toward epilepsy, and family variables. Moving forward, a comprehensive pediatric epilepsy self-management model, well-validated measures of self-management behaviors, mediator/moderator designs to examine the complex relationships between predictors and pediatric epilepsy self-management outcomes, and studies examining the community and health care domains of self-management are necessary.
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Affiliation(s)
- Gigi Smith
- College of Nursing, Department of Pediatrics, Comprehensive Epilepsy Center, Medical University of South Carolina, Charleston, SC, USA
| | - Avani C Modi
- Center for Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Erica K Johnson
- School of Public Health, Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, UT Health School of Public Health, Houston, TX, USA
| | - Joan K Austin
- School of Nursing, Indiana University-Purdue University Indianapolis, Bloomington, IN, USA
| | - Janelle L Wagner
- College of Nursing, Department of Pediatrics, Comprehensive Epilepsy Center, Medical University of South Carolina, Charleston, SC, USA
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22
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Turan Gürhopur FD, Işler Dalgiç A. The effect of a modular education program for children with epilepsy and their parents on disease management. Epilepsy Behav 2018; 78:210-218. [PMID: 29203274 DOI: 10.1016/j.yebeh.2017.07.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy of Modular Education Program for Children with Epilepsy and Their Parents on disease management. The program was prepared by researchers in an interdisciplinary team. METHOD Children with epilepsy and their parents were included in a randomized controlled study using a pre-posttest design. All participants of the modular education program (n=184 (92 children and their 92 parents')) answered a lot of scales immediately before the program. The researcher presented the modular education program, which included eight modules (four for the children and four for the parents), to the children and parents in the intervention group using interactive teaching methods. And all participants of the modular education program answered all scales immediately after the program and one-month, three-month follow-ups. The control group not participating in the modular education program (n=100 (50 children, 50 parents)) also answered all scales in all follow-ups. Scales used the study comprised epilepsy-specific outcome measures (e.g., knowledge, self-efficacy related to seizures, quality of life and anxiety). The statistical analyses of the study data were performed using SAS 9.3 software. RESULTS Children in intervention group significantly improved in knowledge (p<0.001), self-efficacy about seizures (p<0.001), and quality of life (p<0.001) compared with the control group. The parents in the intervention group also significantly improved in knowledge about epilepsy (p<0.001) compared with the control group. However, anxiety of the parents in the intervention group significantly increased (p<0.001). CONCLUSION The efficacy of the Modular Education Program for Children with Epilepsy and Their Parents on disease management was confirmed. The results indicate that using interactive teaching methods help children with epilepsy and their parents in improving knowledge, self-efficacy about seizures and quality of life. All health professionals who work with children with epilepsy and their parents should provide these modular education programs regularly.
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Affiliation(s)
| | - Ayşegül Işler Dalgiç
- Akdeniz University, Nursing Faculty, Pediatric Nursing Department, Antalya, Turkey.
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23
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Ramsey RR, Ryan JL, Fedele DA, Mullins LL, Chaney JM, Wagner JL. Child Attitude Toward Illness Scale (CATIS): A systematic review of the literature. Epilepsy Behav 2016; 59:64-72. [PMID: 27096812 DOI: 10.1016/j.yebeh.2016.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to systematically review the literature utilizing the Child Attitude Toward Illness Scale (CATIS) as a measure of illness attitudes within pediatric chronic illness, including epilepsy, and provide recommendations for its use. This review includes an examination of the psychometric properties of the CATIS and the relationship between the CATIS and psychological, academic, behavioral, and illness variables. METHOD Electronic searches were conducted using Medline and PsychINFO to identify twenty-two relevant publications. RESULTS The CATIS was identified as a reliable and valid self-report assessment tool across chronic illnesses, including pediatric epilepsy. Although originally developed for children ages 8-12, the CATIS has demonstrated reliability and validity in youth ages 8-22. The CATIS scores were reliably associated with cognitive appraisal variables and internalizing symptoms. Initial support exists for the relation between illness attitudes and externalizing behavior, academic functioning, and psychosocial care needs. Mixed findings were reported with regard to the relation between illness attitudes and demographic and disease variables, as well as both social and family functioning. CONCLUSION The CATIS is a psychometrically sound self-report instrument for measuring illness attitudes and demonstrates clinical utility for examining adjustment outcomes across chronic illnesses, particularly pediatric epilepsy.
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Affiliation(s)
- Rachelle R Ramsey
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jamie L Ryan
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - David A Fedele
- Department of Clinical and Health Psychology, University of Florida, United States
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - John M Chaney
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Janelle L Wagner
- Comprehensive Epilepsy Center, College of Nursing, Department of Pediatrics, Medical University of South Carolina, United States.
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24
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Ramsey RR, Loiselle K, Rausch JR, Harrison J, Modi AC. Predictors of trajectories of epilepsy-specific quality of life among children newly diagnosed with epilepsy. Epilepsy Behav 2016; 57:202-210. [PMID: 26974247 PMCID: PMC4828263 DOI: 10.1016/j.yebeh.2016.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/23/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of this study was to identify two-year trajectories of epilepsy-specific health-related quality of life (HRQOL) among children newly diagnosed with epilepsy and to evaluate the predictive value of a comprehensive set of medical, psychosocial, and family factors. METHODS Ninety-four children with epilepsy (8.14 ± 2.37 years of age and 63% male) and their caregivers participated in this study. Caregivers completed the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) and measures of psychological and family functioning at one month postdiagnosis. The QOLCE was also given at eight additional time points during the subsequent two years as a part of a large observational study in children with epilepsy. Adherence data were collected via MEMS TrackCaps, and medical information was collected through chart review. RESULTS Unique trajectories were identified for the overall QOLCE scale, as well as the subscales. Most trajectory models for the QOLCE subscales contained at least one at-risk trajectory for children, indicating that there is a subgroup of children experiencing poor long-term HRQOL. Health-related quality-of-life trajectories remained predominantly stable during the two-year period following treatment initiation. The number of AEDs, internalizing problems, and externalizing problems emerged as the most consistent predictors across the HRQOL domains. SIGNIFICANCE Medical and psychosocial interventions, such as cognitive-behavioral strategies, should target modifiable factors (e.g., internalizing symptoms, externalizing symptoms, number of AEDs trialed) shortly after diagnosis to improve HRQOL for children with epilepsy over the course of their disease.
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Affiliation(s)
- Rachelle R. Ramsey
- Center for Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 7039, Cincinnati, OH, 45229, USA
| | - Kristin Loiselle
- Center for Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 7039, Cincinnati, OH, 45229, USA
| | - Joseph R. Rausch
- Center for Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 7039, Cincinnati, OH, 45229, USA
| | - Jordan Harrison
- Thomas E. Cook Counseling Center, Virginia Tech, 895 Washington St. SW, Blacksburg, VA, 24061, USA
| | - Avani C. Modi
- Center for Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 7039, Cincinnati, OH, 45229, USA
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Loiselle KA, Ramsey RR, Rausch JR, Modi AC. Trajectories of Health-Related Quality of Life Among Children With Newly Diagnosed Epilepsy. J Pediatr Psychol 2016; 41:1011-21. [PMID: 27017987 DOI: 10.1093/jpepsy/jsw019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/25/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify two-year trajectories of health-related quality of life (HRQOL) among children with newly diagnosed epilepsy, and evaluate key predictors of HRQOL trajectories. METHODS This study is part of a prospective study of adherence and HRQOL outcomes in children with epilepsy. Caregivers completed an HRQOL questionnaire at one month post diagnosis and every three months thereafter for two years. Chart review and additional questionnaires were used to collect medical variables and seizure outcomes. RESULTS Participants included 120 children with epilepsy and their caregiver. Unique trajectories for overall HRQOL and PedsQL™ subscales were identified and were predominantly stable. A total side effects score emerged as a consistent predictor of all HRQOL domains. Other variables (i.e., socioeconomic status, seizures, internalizing and externalizing problems) uniquely predicted HRQOL domains. CONCLUSIONS Medical and psychosocial interventions should be implemented soon after treatment initiation to target modifiable factors (e.g., side effects, anxiety symptoms), which could improve HRQOL.
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Affiliation(s)
- Kristin A Loiselle
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and
| | - Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and
| | - Joseph R Rausch
- Center for Biobehavioral Health, Nationwide Children's Hospital
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and
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26
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The Relationship between Self-Efficacy and Psychosocial Care in Adolescents with Epilepsy. EPILEPSY RESEARCH AND TREATMENT 2016; 2015:756849. [PMID: 26881070 PMCID: PMC4736004 DOI: 10.1155/2015/756849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 11/18/2022]
Abstract
Introduction. Studies about epilepsy are more associated with physiological aspects and drug therapy and far too little attention has been paid to psychological and social care, especially in teens. Hence, the present study aimed to assess relationship between self-efficacy and psychosocial care in adolescents with epilepsy. Methods. A cross-sectional association study was conducted on 74 consecutive adolescents aged 10 to 18 years with general attacks of epilepsy referred to Pediatric Neurology Clinics affiliated with the Tabriz University of Medical Sciences in 2013. Data were collected by interview using multisegment tools including demographic characteristics, self-efficacy scaling in children with epilepsy, and reporting tools for children psychosocial care. Results. Our study showed a significant association of self-efficacy with “information received” (P < 0.02) and also with “need for information or support” (P < 0.01) as well as “concerns and fears” (P < 0.01). The comments of doctor or nurse were directly associated with higher self-efficacy and patients' information needs were inversely associated with higher self-efficacy. Conclusion. For adolescents with epilepsy, providing educational materials such as pamphlets and booklets, designing especial websites, and setting especial meetings with and without parents separately are recommended. Scheduling psychosocial supports and collecting more information about this disorder for adolescents will be helpful.
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Austin JK, Haber LC, Dunn DW, Shore CP, Johnson CS, Perkins SM. Children with new onset seizures: A prospective study of parent variables, child behavior problems, and seizure occurrence. Epilepsy Behav 2015; 53:73-7. [PMID: 26520879 PMCID: PMC4674332 DOI: 10.1016/j.yebeh.2015.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/29/2015] [Accepted: 09/15/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Parent variables (stigma, mood, unmet needs for information and support, and worry) are associated with behavioral difficulties in children with seizures; however, it is not known how this relationship is influenced by additional seizures. This study followed children (ages 4-14 years) and their parents over a 24-month period (with data collected at baseline and 6, 12, and 24 months) and investigated the effect of an additional seizure on the relationship between parenting variables and child behavior difficulties. METHODS The sample was parents of 196 children (104 girls and 92 boys) with a first seizure within the past 6 weeks. Child mean age at baseline was 8 years, 3 months (SD 3 years). Data were analyzed using t-tests, chi-square tests, and repeated measures analyses of covariance. RESULTS Relationships between parent variables, additional seizures, and child behavior problems were consistent across time. Several associations between parent variables and child behavior problems were stronger in the additional seizure group than in the no additional seizure group. CONCLUSIONS Findings suggest that interventions that assist families to respond constructively to the reactions of others regarding their child's seizure condition and to address their needs for information and support could help families of children with continuing seizures to have an improved quality of life.
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Affiliation(s)
- Joan K. Austin
- Indiana University School of Nursing, Indianapolis, IN,Corresponding Author: Joan K. Austin, 3040 N Ramble Road West, Bloomington, IN, 47408,
| | | | - David W. Dunn
- Department of Psychiatry and Department of Neurology, Indiana University School of Medicine, Indianapolis, IN
| | | | - Cynthia S. Johnson
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Susan M. Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
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Loiselle K, Rausch JR, Modi AC. Behavioral predictors of medication adherence trajectories among youth with newly diagnosed epilepsy. Epilepsy Behav 2015. [PMID: 26209946 PMCID: PMC4562817 DOI: 10.1016/j.yebeh.2015.06.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to identify psychosocial predictors of two-year antiepileptic drug (AED) adherence trajectories among youth with newly diagnosed epilepsy, controlling for known demographic and medical factors. METHOD This study is part of a large, prospective, longitudinal observational study of AED adherence and medical outcomes in youth with newly diagnosed epilepsy. Parents completed questionnaires of psychosocial and family functioning at one month and one year following diagnosis. Chart review and questionnaires were used to collect medical variables and seizure outcomes. Previously established two-year AED adherence trajectories (Severe Early Nonadherence, Variable Nonadherence, Moderate Nonadherence, High Adherence) were used as the outcome variable. RESULTS Participants were 91 parents of youth with epilepsy (7.3±2.8years of age; 60% male) and their families. Early (one month following diagnosis) predictors of two-year adherence trajectories included socioeconomic status, epilepsy knowledge, family problem-solving, and family communication. Significant predictors one year following diagnosis included socioeconomic status, parent fears and concerns, and parent life stress. CONCLUSION There are modifiable parent and family variables that predict two-year adherence trajectories above and beyond known medical (e.g., seizures, side effects) factors. Psychosocial interventions delivered at key points during the course of epilepsy treatment could have a positive impact on adherence outcomes.
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Affiliation(s)
- Kristin Loiselle
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
| | - Joseph R. Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
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Abstract
PURPOSE The aim of the study is to determine whether certain demographic, clinical, and psychosocial traits are associated with higher levels of felt stigma among persons with epilepsy (PWE) patients followed at a level 4 epilepsy center. METHODS We performed a direct survey of 182 consenting patients that included the Epilepsy Stigma Scale. RESULTS On univariate analysis, higher levels of perceived stigma were associated with age, marital status, race, driving, work status, seizure etiology, Quality of Life in Epilepsy-10 (QOLIE-10) scores, and health literacy. Among coping reactions, the use of denial, behavioral disengagement and venting were also associated with higher degrees of felt stigma. Using multiple linear regression, being single, poorer QOLIE-10 scores, difficulties understanding written information, and the use of behavioral disengagement were independently associated with poorer scores on the Epilepsy Stigma Scale. CONCLUSION Our study paints a compelling profile of a PWE who has greater perceived stigma. Programs that increase the level of social support, improve health literacy, and enhance quality of life may also help decrease the amount of felt stigma among PWE.
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30
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Leaffer EB, Hesdorffer DC, Begley C. Psychosocial and sociodemographic associates of felt stigma in epilepsy. Epilepsy Behav 2014; 37:104-9. [PMID: 25010324 DOI: 10.1016/j.yebeh.2014.06.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/01/2014] [Accepted: 06/04/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lack of a sufficient range in socioeconomic status (SES) in most prior studies of felt stigma and epilepsy has hampered the ability to better understand this association. METHODS We assessed the burden and associates of felt stigma in 238 individuals with prevalent epilepsy aged 18 and older, comparing low SES with high SES. RESULTS Reported levels of stigma were higher in low SES than in high SES (p<0.0001), and all psychosocial variables were associated with stigma, including depression severity (p<0.0001), knowledge of epilepsy (p=0.006), quality of life (p<0.0001), social support (p<0.0001), and self-efficacy (p=0.0009). Stigma was statistically significantly associated with quality of life in the low SES group and with depression severity and social support in the high SES group. CONCLUSIONS Low SES alone did not account for felt stigma; rather, we found that quality of life, depressive symptoms, and social support have the greatest impact on reported felt stigma in individuals with prevalent epilepsy.
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Affiliation(s)
- Emily B Leaffer
- GH Sergievsky Center, Columbia University, New York, NY, USA
| | - Dale C Hesdorffer
- GH Sergievsky Center, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Charles Begley
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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31
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Austin JK, Perkins SM, Dunn DW. A model for internalized stigma in children and adolescents with epilepsy. Epilepsy Behav 2014; 36:74-9. [PMID: 24866252 PMCID: PMC4096577 DOI: 10.1016/j.yebeh.2014.04.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 04/19/2014] [Accepted: 04/21/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Perceptions of stigma in children and adolescents with epilepsy are associated with higher rates of mental health problems. The purpose of this study was to test relationships in a model that identified variables most strongly associated with perceptions of stigma in children and adolescents with epilepsy. Our ultimate goal is to develop a theoretical foundation for future intervention research by identifying variables associated with perceptions of stigma that are potentially amenable to psychosocial interventions. METHODS Participants were 173 children and adolescents with epilepsy who were between 9 and 14 years of age. Data were collected in telephone interviews. Stigma was measured using a self-report scale. Data were analyzed using structural equation modeling. RESULTS Greater need for information and support, more fear and worry related to having epilepsy, greater seizure severity, and younger age were significantly associated with greater perceptions of stigma. Female gender, greater need for information and support, having at least one seizure in the past year, and lower self-efficacy for seizure management were significantly associated with more fear and worry related to having epilepsy. CONCLUSIONS Findings suggest that perceptions of stigma are associated with two variables that are amenable to psychosocial interventions: fear and worry about having epilepsy and need for information and support. Future research should test the efficacy of interventions that reduce fear and worry, provide information about epilepsy, and reduce need for support.
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Affiliation(s)
- Joan K. Austin
- Corresponding author; Joan K. Austin, PhD, RN, FAAN, Indiana University School of Nursing, 3040 N Ramble Road West, Bloomington, IN 47408, Tel: 812-332-8278,
| | - Susan M. Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - David W. Dunn
- Departments of Psychiatry and Neurology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
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Stafford M, Gavriel S, Lloyd A. Patient-reported outcomes measurements in epilepsy. Expert Rev Pharmacoecon Outcomes Res 2014; 7:373-84. [DOI: 10.1586/14737167.7.4.373] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Buelow JM, Johnson CS, Perkins SM, Austin JK, Dunn DW. Creating Avenues for Parent Partnership (CAPP): an intervention for parents of children with epilepsy and learning problems. Epilepsy Behav 2013; 27:64-9. [PMID: 23376338 DOI: 10.1016/j.yebeh.2012.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 12/11/2012] [Accepted: 12/12/2012] [Indexed: 11/26/2022]
Abstract
Caregivers of children with both epilepsy and learning problems need assistance to manage their child's complex medical and mental health problems. We tested the cognitive behavioral intervention "Creating Avenues for Parent Partnership" (CAPP) which was designed to help caregivers develop knowledge as well as the confidence and skills to manage their child's condition. The CAPP intervention consisted of a one-day cognitive behavioral program and three follow-up group sessions. The sample comprised 31 primary caregivers. Caregivers reported that the program was useful (mean = 3.66 on a 4-point scale), acceptable (mean = 4.28 on a 5-point scale), and "pretty easy" (mean = 1.97 on a 4-point scale). Effect sizes were small to medium in paired t tests (comparison of intervention to control) and paired analysis of key variables in the pre- and post-tests. The CAPP program shows promise in helping caregivers build skills to manage their child's condition.
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Affiliation(s)
- Janice M Buelow
- Indiana University School of Nursing, Indianapolis, IN 46202, USA.
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Valizadeh L, Barzegar M, Akbarbegloo M, Zamanzadeh V, Rahiminia E, Ferguson C. The relationship between psychosocial care and attitudes toward illness in adolescents with epilepsy. Epilepsy Behav 2013; 27:267-71. [PMID: 23453530 DOI: 10.1016/j.yebeh.2012.11.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 11/08/2012] [Accepted: 11/10/2012] [Indexed: 10/27/2022]
Abstract
Epilepsy is a significant health problem in Iran and other countries. Previous epilepsy studies conducted in Iran have often focused on physiological aspects and pharmacological therapy, and little attention has been paid to the psychological and social aspects of care, particularly in adolescence. This paper aims to fill this gap by assessing the relationship between psychosocial care and attitudes toward illness in adolescents with epilepsy. A descriptive correlational design was adopted, and 74 adolescents who experienced generalized seizures and were treated at the neurology clinic affiliated with the Tabriz University of Medical Sciences in 2010 were examined. The data were collected using instruments including (1) the patient demographic characteristics, (2) the Child Report of Psychosocial Care Scale, and (3) the Child's Attitude Toward Illness Scale. There was a significant positive correlation between psychosocial care and attitudes toward illness (p<.05). There is no evidence for routine psychological consultation for our sample; it would be helpful if psychological consultation with and without parents made available to adolescents with epilepsy.
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Affiliation(s)
- Leila Valizadeh
- Tabriz Pediatric Health Research Center, Nursing and Midwifery College, Tabriz University of Medical Sciences, Iran.
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Whatley AD, DiIorio CK, Yeager K. Examining the relationships of depressive symptoms, stigma, social support and regimen-specific support on quality of life in adult patients with epilepsy. HEALTH EDUCATION RESEARCH 2010; 25:575-584. [PMID: 20167608 PMCID: PMC2905921 DOI: 10.1093/her/cyq001] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 01/08/2010] [Indexed: 05/28/2023]
Abstract
Epilepsy research efforts have primarily focused on medical treatment and physical management of epilepsy; however, to provide comprehensive care, efforts cannot focus solely on physical manifestations of epilepsy. Research findings show that people with epilepsy face many challenges that can negatively affect quality of life (QOL). In this descriptive study, we examined the individual relationships between depressive symptoms, stigma, social support and regimen-specific support and QOL in adults with epilepsy. Study data were obtained from a subset of patients (N = 147) who participated in a longitudinal study of adult patients with epilepsy. Measures of QOL, depressive symptoms, stigma, social support and regimen-specific support were analyzed to answer the research questions. The results of correlational analyses revealed statistically significant negative correlations between depressive symptoms, stigma and sometimes regimen-specific support and QOL and statistically significant positive correlations between social support and QOL. A hierarchical multiple linear regression model revealed that depressive symptoms accounted for the most variance in QOL. Psychosocial variables measured 3 months prior to QOL were entered into a hierarchical multiple linear regression model, revealing that depressive symptoms, stigma and social support can be used to predict QOL at a later time.
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Affiliation(s)
- A D Whatley
- Division of Global Migration.uarantine, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Jones JE, Siddarth P, Gurbani S, Shields WD, Caplan R. Cognition, academic achievement, language, and psychopathology in pediatric chronic epilepsy: Short-term outcomes. Epilepsy Behav 2010; 18:211-7. [PMID: 20471326 PMCID: PMC2902590 DOI: 10.1016/j.yebeh.2010.03.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 03/22/2010] [Accepted: 03/26/2010] [Indexed: 11/29/2022]
Abstract
Children with epilepsy and control children were followed over a 2-year interval. Comorbidities of epilepsy, often defined as problems related to IQ, academic achievement, language, and psychopathology, were evaluated prospectively. It was hypothesized that over time (1) the presence of comorbidities would predict worse outcomes, and (2) epilepsy variables would negatively impact comorbidities. The study included 39 children with complex partial seizures (CPS), 25 children with childhood absence epilepsy (CAE), and 27 healthy children, aged 7.6-16.1years. The findings were notable for stability over the interval in all three groups. Additionally, baseline seizure variables and change over the interval appear to play a role in IQ and math achievement scores of children with epilepsy with average IQ and in the reading achievement scores of those with below-average IQ. However, seizure variables at baseline and follow-up were not predictors of DSM-IV diagnoses, depression, anxiety, or behavioral problems.
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Affiliation(s)
- Jana E. Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Prabha Siddarth
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, CA
| | - Suresh Gurbani
- Department of Pediatrics, University of California Irvine, CA
| | | | - Rochelle Caplan
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, CA
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Continuing Psychosocial Care Needs in Children With New-Onset Epilepsy and Their Parents. J Neurosci Nurs 2009; 41:244-50. [PMID: 19835237 DOI: 10.1097/jnn.0b013e3181b2c721] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Individual, seizure-related, and psychosocial predictors of depressive symptoms among people with epilepsy over six months. Epilepsy Behav 2009; 15:196-201. [PMID: 19303457 PMCID: PMC2693361 DOI: 10.1016/j.yebeh.2009.03.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 03/05/2009] [Accepted: 03/13/2009] [Indexed: 11/24/2022]
Abstract
Depression is the most frequently diagnosed psychiatric disorder among people with epilepsy. A variety of risk factors for depression among people with epilepsy have been identified; however, few studies have examined these risk factors over time. The primary purpose of this study was to explore the relationship between demographic characteristics, seizure-related factors, and psychosocial factors and depressive symptoms over 6 months. Three hundred and nineteen adults with epilepsy completed three surveys at 3-month intervals. Multiple linear regression was used with the baseline variables to predict depressive symptoms at baseline, 3 months, and 6 months. Employment status, social support, and stigma emerged as predictors of depressive symptoms at all three time points. Other factors that predicted depression symptoms in one or two time points were self-management, financial strain, and activity restriction due to seizures. The results indicate that multiple factors influence depressive symptoms among people with epilepsy.
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Abstract
BACKGROUND Few validated pediatric tools exist to directly gather data about children's perceptions of their own healthcare; parent surveys are typically used as proxies. A psychometrically sound, child-focused survey captures children's unique perceptions for quality improvement. OBJECTIVES This study developed and evaluated reliability of a survey, assessed score differences by children's age, and compared the responses of children and parents. METHOD The Children's Perceptions of Healthcare Survey was developed for inpatient and outpatient quality improvement. Following expert review, the tool was administered to 237 parent-child dyads at the time of discharge from an inpatient pediatric unit (n = 121) and after outpatient clinic visits (n = 116). Responses were analyzed and compared. RESULTS Internal consistency reliability for the tool was high (child/adolescents: alpha = .84; parents: alpha = .86), with no significant differences by child age or child gender. Parent and child scores were significantly correlated (r = 0.29, P < .001). About half of parents' scores were higher than their children's scores. DISCUSSION This tool worked well to collect data from a wide age range of children across healthcare settings. Children's perceptions were unique; involving children in care assessment is worthwhile and captures insights missed when only parents are surveyed. The Children's Perceptions of Healthcare Survey is a valid, psychometrically sound tool to capture children's unique perspectives regarding their healthcare and may be useful for system quality improvement.
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Affiliation(s)
- Linda Lindeke
- School of Nursing, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
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Austin JK, Shore CP, Dunn DW, Johnson CS, Buelow JM, Perkins SM. Development of the parent response to child illness (PRCI) scale. Epilepsy Behav 2008; 13:662-9. [PMID: 18706521 PMCID: PMC2662721 DOI: 10.1016/j.yebeh.2008.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 07/29/2008] [Accepted: 07/29/2008] [Indexed: 11/18/2022]
Abstract
The aims of this study were to develop an instrument to measure parents' responses and perceptions related to the onset of either seizures or asthma in a child (aged 4-14) and to assess the initial reliability and validity of the instrument. The 35-item scale developed comprised five subscales: Child Support, Family Life/Leisure, Condition Management, Child Autonomy, and Child Discipline. Subjects were parents of 224 children with new-onset seizures and 104 parents of children with new-onset asthma. Internal consistency reliabilities were stronger for Child Support, Family Life/Leisure, and Condition Management than for Child Autonomy and Child Discipline for both samples. Test-retest reliability ranged from good to fair for both samples. The associations between parent positive mood and all of the subscales for both samples in the predicted directions provided key empirical support for validity. The scale has potential for use in research and in the clinical setting. In addition, the scale has potential to be used with other conditions.
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Affiliation(s)
- Joan K Austin
- Indiana University School of Nursing, Indianapolis, IN 46202-5107, USA.
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Mu PF. Transition experience of parents caring of children with epilepsy: A phenomenological study. Int J Nurs Stud 2008; 45:543-51. [PMID: 17157850 DOI: 10.1016/j.ijnurstu.2006.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 10/25/2006] [Accepted: 10/27/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Families who have a child with epilepsy show a significant impact on both the dynamics of the child's development and family systems in a social context. Knowledge of a family's lived experience in dealing with the early stages of their child's illness will provide a deeper understanding of their life and coping process. Most studies have focused on the child's developmental issues, parental attitudes, coping strategies and the child's adjustment. In order to assist families to cope with the early stage of having a child with epilepsy, nurses need to understand the nature of a family's lived experience. OBJECTIVE The purpose of this study was to investigate the essence of the family health-illness transition experience from the parental perspective when a child is afflicted with epilepsy. DESIGN Colaizzi's phenomenological approach was used. In-depth interviews were conducted with ten couples with regard to the first one and a half years after the diagnosis of epilepsy. SETTINGS AND PARTICIPANTS Ten couples from two medical centers in Taiwan participated in the study. The age range of the children at diagnosis was 0.2-4.3 years. METHODS Open attitude and imaginative variation techniques were used to investigate the meanings of the experience. This study used Colaizzi's method with both destructured and restructured analysis. Lincoln and Guba's trustworthiness criteria were employed to evaluate methodological rigor. RESULTS Three concepts emerged: parents' psychological reactions, parental coping patterns and family resources. The parents' psychological reaction was that of being emotionally traumatized and physically exhausted. Parental coping patterns were vigilant parenting and aimed at reframing roles, facing the social challenge and assisting the child's social re-integration. The nature of family resources was family resiliency. The findings provide a scientific knowledge base for nurses when assisting parents and children during the health to illness transitional phase following a diagnosis of epilepsy.
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Affiliation(s)
- Pei-Fan Mu
- School of Nursing, Institute of Clinical Nursing, National Yang-Ming University, No. 155, Sec. 2, Lih-Nong St., Taipei (112), Taipei, Taiwan ROC.
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Shore CP, Perkins SM, Austin JK. The Seizures and Epilepsy Education (SEE) program for families of children with epilepsy: a preliminary study. Epilepsy Behav 2008; 12:157-64. [PMID: 18086460 DOI: 10.1016/j.yebeh.2007.10.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 09/26/2007] [Accepted: 10/02/2007] [Indexed: 11/25/2022]
Abstract
We investigated the usefulness of the Seizures and Epilepsy Education (SEE) program in improving quality of life, management of the seizure condition, and health care utilization in families having a child with epilepsy. Members of 15 families attended the program, with at least one parent from each family represented. Children attended if they were at least 12 years of age. Participants completed research instruments prior to attending the SEE program, and also 1 and 6 months after attendance. Both parents and children reported improvement in quality of life relating to child mental health after attending the SEE program. Parents reported reduced emotional impact of the child's condition, fewer worries, and greater knowledge related to epilepsy. Results suggest that attending the SEE program may be beneficial to families having a child with epilepsy; however, further study is needed with a more robust research design.
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Affiliation(s)
- Cheryl P Shore
- Indiana University School of Nursing, NU312 D, 1111 Middle Drive, Indianapolis, IN 46202, USA.
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Fernandes PT, Salgado PCB, Noronha ALA, de Boer HM, Prilipko L, Sander JW, Li LM. Epilepsy stigma perception in an urban area of a limited-resource country. Epilepsy Behav 2007; 11:25-32. [PMID: 17613276 DOI: 10.1016/j.yebeh.2007.02.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Revised: 02/23/2007] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To estimate the perception of stigma attached to epilepsy in an urban society of a limited-resource country, Brazil. METHODS We applied a validated Stigma Scale of Epilepsy (SSE) cross-sectionally to 1850 people from all regions within the metropolitan area of Campinas, following a sampling selection methodology (95% confidence interval and error of 2.3). RESULTS The overall score for epilepsy stigma perception was 42 (range, 3-98; SD, 14). The SSE score for women was higher (43) than that for men (40). With respect to religion, Spiritism had the lowest SSE score (35) compared with Catholic, Evangelical, other, and no religion. Level of education was inversely related to SSE scores; illiterate people had higher SSE scores (45) than people with higher education (37). CONCLUSION This is one of the first systematic assessments of epilepsy stigma perception in an urban area of a limited-resource country. It was found that the magnitude of stigma is different within segments of the local society, highlighting that sociocultural factors such as gender, religion, and level of education may be important predictors of stigma.
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Affiliation(s)
- Paula T Fernandes
- Department of Neurology, State University of Campinas, Campinas, Brazil
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Fernandes PT, Salgado PCB, Noronha ALA, Sander JW, Li LM. Stigma scale of epilepsy: validation process. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65 Suppl 1:35-42. [PMID: 17581666 DOI: 10.1590/s0004-282x2007001000006] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE: To validate a Stigma Scale of Epilepsy (SSE). METHODS: The SSE was completed by 40 adult with epilepsy attending an Outpatient Epilepsy Clinic at the University Hospital of UNICAMP, and by 40 people from the community. People were interviewed on an individual basis; a psychologist read the questions to the subjects who wrote the answers in a sheet. The procedure was the same for all the subjects and completion took around ten minutes. RESULTS: The SSE has 24 items. The internal consistency of the SSE showed alpha Cronbach’s coefficient 0.88 for the patients with epilepsy and 0.81 for the community. The overall mean scores of the Stigma Scale of Epilepsy formula were: 46 (SD=18.22) for patients and 49 (SD=13.25) for the community where a score of 0 would suggest no stigma, and 100 maximum stigma. DISCUSSION: The SSE has satisfactory content validity and high internal consistency. It allows the quantification of the perception of stigma by patients and people from community; this can then be used for interventional studies, such as mass media campaign in minimizing the negative facets of stigma.
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Affiliation(s)
- Paula T Fernandes
- Department of Neurology, Faculty of Medicine, UNICAMP, Campinas, SP, Brazil
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Abstract
PURPOSE To examine psychosocial care needs of children with recent-onset asthma. DESIGN/METHODS Data were collected over 2 years from 63 children ages 8-14 years. RESULTS Children's need for attention to specific aspects of their asthma care remained high over the 2 years, as did their perceived needs for information and support and their concerns and fears. PRACTICE IMPLICATIONS Children have many needs, and healthcare professionals may not be providing care that addresses these needs. The Child Report of Psychosocial Care can be used as a quick tool to assess and guide interventions related to specific areas of need.
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Affiliation(s)
- Angela M McNelis
- School of Nursing, University of Indiana, Indianapolis, IN, USA.
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46
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Austin JK, Dunn DW, Perkins SM, Shen J. Youth With Epilepsy: Development of a Model of Children's Attitudes Toward Their Condition. CHILDRENS HEALTH CARE 2006; 35:123-140. [PMID: 17075611 PMCID: PMC1627850 DOI: 10.1207/s15326888chc3502_2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A model of children's attitudes toward their epilepsy was tested in 173 children (9-14 years) with epilepsy and their parents. Predictor variables tested were child characteristics, family mastery, child worry, child self-efficacy for seizure management, child psychosocial care needs, and seizure variables. Data were analyzed using structural equation modeling, leading to a revised model in which less child worry, greater family mastery, and greater child seizure self-efficacy were directly related to more child positive attitudes. Discussion focuses on potential targets for psychosocial interventions aimed at improving attitudes toward epilepsy.
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47
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DiIorio C, Shafer PO, Letz R, Henry TR, Schomer DL, Yeager K. Behavioral, social, and affective factors associated with self-efficacy for self-management among people with epilepsy. Epilepsy Behav 2006; 9:158-63. [PMID: 16798100 DOI: 10.1016/j.yebeh.2006.05.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 05/02/2006] [Accepted: 05/03/2006] [Indexed: 10/24/2022]
Abstract
The purpose of the study described in this article was to evaluate the extent to which selected behavioral, social, and affective factors contribute to self-reported epilepsy self-efficacy. Participants completed three assessments 3 months apart, with only those completing both the first and second assessments included in this analysis. Self-efficacy scores at the second assessment were regressed on the behavioral, social, and affective characteristics ascertained at the first assessment. The analysis revealed that self-management, depressive symptoms, and seizure severity explain the most variance in self-efficacy; patient satisfaction and stigma are less important predictors; and social support and regimen-specific support are not significant predictors. The results provide direction for identifying people with low levels of self-efficacy and highlighting areas that might help enhance self-efficacy in persons with epilepsy.
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Affiliation(s)
- Colleen DiIorio
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Mu PF, Kuo HC, Chang KP. Boundary ambiguity, coping patterns and depression in mothers caring for children with epilepsy in Taiwan. Int J Nurs Stud 2005; 42:273-82. [PMID: 15708014 DOI: 10.1016/j.ijnurstu.2004.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2004] [Revised: 06/26/2004] [Accepted: 07/01/2004] [Indexed: 11/19/2022]
Abstract
A descriptive correlational study was designed to examine the relationships between boundary ambiguity, coping strategies and depression in mothers caring for children with epilepsy. A total of 316 mothers were recruited from three medical centers in Taiwan. A pilot study established the reliability and validity of the Chinese language version of the Coping Health Inventory for Parents (CHIP). Results showed that boundary ambiguity was negatively associated with the total score by CHIP for family coping patterns I and II. In addition, family coping patterns I, II, and III were negatively associated with depression in the mothers. These results provide insight into family stress management strategies that are unique to these mothers and are associated with the relationships between boundary ambiguity, family coping patterns and outcome. The results also suggest methods to improve family centered nursing intervention, which may help mothers to establish effective interactions with their epileptic children as well as develop for them effective coping patterns to manage family stress.
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Affiliation(s)
- Pei-Fan Mu
- Institute of Clinical Nursing, National Yang-Ming University, P.O. Box 13-247, Taipei, Taiwan, ROC.
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Abstract
AIM This paper reports a study examining the stress that fathers experience when caring for a child with epilepsy. BACKGROUND A seizure, which is frightening and potentially damaging, creates uncertainty about its possible effects and threatens the integrity of family systems. In the Chinese social context, epilepsy is stereotyped 'sudden craziness' of people and affected family feel shamed by the diagnosis. When a child has epilepsy, the stereotype of epilepsy affects the family experience in terms of stress and their coping process. Few studies have focused on how a father with an ill child adapts to family stress. METHODS This study was based on the resiliency model of family stress, adjustment, and adaptation, and was designed to examine the relationships among fathers' uncertainty, coping strategies, and depression. From three teaching hospitals in Taiwan, 210 fathers were recruited. A pilot study was conducted to establish the reliability and face validity of the Chinese language version of the Coping Health Inventory for Parents. FINDINGS Results showed that paternal uncertainty was negatively associated with the total Coping Health Inventory for Parents score for family coping patterns for factors I, II, and III. Uncertainty and coping strategies for factors II and III were indicators of paternal depression and accounted for 10.3% of the total variance. CONCLUSIONS The results give insight into the unique family stress that fathers experience as a result of the interaction between the social context of a child with epilepsy and the family's coping patterns. They also suggest ways to improve family-centred nursing interventions to help parents establish effective caring patterns to manage the family stress.
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Affiliation(s)
- Pei-Fan Mu
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan.
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50
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DiIorio C, Shafer PO, Letz R, Henry TR, Schomer DL, Yeager K. Project EASE: a study to test a psychosocial model of epilepsy medication managment. Epilepsy Behav 2004; 5:926-36. [PMID: 15624235 DOI: 10.1016/j.yebeh.2004.08.011] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to test a psychosocial model of medication self-management among people with epilepsy. This model was based primarily on social cognitive theory and included personal (self-efficacy, outcome expectations, goals, stigma, and depressive symptoms), social (social support), and provider (patient satisfaction and desire for control) variables. Participants for the study were enrolled at research sites in Atlanta, Georgia, and Boston, Massachusetts and completed computer-based assessments that included measures of the study variables listed above. The mean age of the 317 participants was 43.3 years; about 50% were female, and 81%white. Self-efficacy and patient satisfaction explained the most variance in medication management. Social support was related to self-efficacy; stigma to self-efficacy and depressive symptoms; and self-efficacy to outcome expectations and depressive symptoms. Findings reinforce that medication-taking behavior is affected by a complex set of interactions among psychosocial variables.
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Affiliation(s)
- Collen DiIorio
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1520 Clifton Rd, Atlanta, GA 30322, USA.
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