[Illness Experience of Married Korean Women with Epilepsy]

Systematic review of frequency of felt and enacted stigma in epilepsy and determining factors and attitudes toward persons living with epilepsy-Report from the International League Against Epilepsy Task Force on Stigma in Epilepsy

OBJECTIVE

To review the evidence of felt and enacted stigma and attitudes toward persons living with epilepsy, and their determining factors.

METHODS

Thirteen databases were searched (1985-2019). Abstracts were reviewed in duplicate and data were independently extracted using a standardized form. Studies were characterized using descriptive analysis by whether they addressed "felt" or "enacted" stigma and "attitudes" toward persons living with epilepsy.

RESULTS

Of 4234 abstracts, 132 met eligibility criteria and addressed either felt or enacted stigma and 210 attitudes toward epilepsy. Stigma frequency ranged broadly between regions. Factors associated with enacted stigma included low level of knowledge about epilepsy, lower educational level, lower socioeconomic status, rural areas living, and religious grouping. Negative stereotypes were often internalized by persons with epilepsy, who saw themselves as having an "undesirable difference" and so anticipated being treated differently. Felt stigma was associated with increased risk of psychological difficulties and impaired quality of life. Felt stigma was linked to higher seizure frequency, recency of seizures, younger age at epilepsy onset or longer duration, lower educational level, poorer knowledge about epilepsy, and younger age. An important finding was the potential contribution of epilepsy terminology to the production of stigma. Negative attitudes toward those with epilepsy were described in 100% of included studies, and originated in any population group (students, teachers, healthcare professionals, general public, and those living with epilepsy). Better attitudes were generally noted in those of younger age or higher educational status.

SIGNIFICANCE

Whatever the specific beliefs about epilepsy, implications for felt and enacted stigma show considerable commonality worldwide. Although some studies show improvement in attitudes toward those living with epilepsy over time, much work remains to be done to improve attitudes and understand the true occurrence of discrimination against persons with epilepsy.

[Structural Equation Modeling on Health-Related Quality of Life in Adults with Epilepsy]

PURPOSE

This study aimed to identify variables influencing the health-related quality of life (HRQoL) of adults with epilepsy in order to establish a structural model and design an intervention strategy to improve patients' HRQoL.

METHODS

The selected subjects were 212 patients with epilepsy aged between 18 and 70 years who were currently receiving treatment from hospital, general hospital, and clinic. They were surveyed using a structured questionnaire.

RESULTS

The goodness of fit measures of the final hypothetical model were as follows: χ²/df=2.51, GFI=.91, AGFI=.90, CFI=.96, SRMR=.04, NFI=.93, and RMSEA=.08. The major variables influencing the HRQoL of adults with epilepsy were epilepsy self-efficacy, depression, social support, and side effects of anti-epileptic drugs (AEDs), which were significant in the mentioned order, whereas the duration of AEDs use and perceived stigma did not show any effects. Six variables accounted for 75.6% of HRQoL. Variables having a direct and total effect on the HRQoL of adults with epilepsy were the side effects of AEDs, social support, epilepsy self-efficacy, and depression, and those with an indirect effect were the side effects of AEDs and social support.

CONCLUSION

It is necessary to accurately identify the side effects of AEDs in adults with epilepsy and accurately observe the physical changes caused by depression. In addition, it is imperative to establish an active and effective nursing intervention program to strengthen the self-efficacy of the patients and to improve their quality of life through social support provided by family members and medical professionals.