The Impact of Affective State on Quality of Life in Focal Epilepsy in Turkey

Co-morbid mental health conditions in people with epilepsy and association with quality of life in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Comorbid mental health conditions are common in people with epilepsy and have a significant negative impact on important epilepsy outcomes, although the evidence is mostly from high-income countries. This systematic review aimed to synthesise evidence on the association between comorbid mental health conditions and quality of life and functioning among people with epilepsy living in low- and middle income countries (LMICs).

METHODS

We searched PubMed, EMBASE, CINAHL, Global Index medicus (GID) and PsycINFO databases from their dates of inception to January 2022. Only quantiative observational studies were included. Meta-analysis was conducted for studies that reported the same kind of quality of life and functioning outcome. Cohen's d was calculated from the mean difference in quality-of-life score between people with epilepsy who did and did not have a comorbid depression or anxiety condition. The protocol was registered with PROSPERO: CRD42020161487.

RESULTS

The search strategy identified a total of 2,101 articles, from which 33 full text articles were included. Depression was the most common comorbid mental health condition (33 studies), followed by anxiety (16 studies). Meta-analysis was conducted on 19 studies reporting quality of life measured with the same instrument. A large standardized mean effect size (ES) in quality of life score was found (pooled ES = -1.16, 95% confidence interval (CI) - 1.70, - 0.63) between those participants with comorbid depression compared to non-depressed participants. There was significant heterogeneity between studies (I2 = 97.6%, p < 0.001). The median ES (IQR) was - 1.20 (- 1.40, (- 0.64)). An intermediate standard effect size for anxiety on quality of life was also observed (pooled ES = -0.64, 95% CI - 1.14, - 0.13). There was only one study reporting on functioning in relation to comorbid mental health conditions.

CONCLUSION

Comorbid depression in people with epilepsy in LMICs is associated with poor quality of life although this evidence is based on highly heterogeneous studies. These findings support calls to integrate mental health care into services for people with epilepsy in LMICs. Future studies should use prospective designs in which the change in quality of life in relation to mental health or public health interventions across time can be measured.

Turkish validity and reliability of the Personal Impact of Epilepsy Scale

AIM

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

MATERIALS AND METHOD

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

RESULTS

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

CONCLUSION

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