Self-Esteem, Social Phobia and Depression Status in Patients with Epilepsy

Social Anxiety, Social Support, and Quality of Life in Patients With Epilepsy at a Tertiary Care Hospital in Saudi Arabia

Objectives The objectives of this study were to measure the prevalence of social anxiety disorder and its association with quality of life (QoL) in patients with epilepsy (PWE) in King Khalid University Hospital, Riyadh City, Saudi Arabia. Methodology A self-administrated, online, questionnaire-based, cross-sectional study was conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia on PWE 18 years of age and above from February 2021 to January 2022. Social anxiety and the five domains of QoL were measured using the validated Arabic versions of the Liebowitz social anxiety scale and European quality-of-life 5-dimensions 3-levels (EQ-5D-3L), respectively. Information was collected on sociodemographic characteristics, social support, and adverse life events. Results This study included 246 patients, of which approximately 25% and 15% had mild/moderate and severe/very severe levels of social anxiety, respectively. Severe social anxiety was significantly associated with poor QoL domains, namely, restricted mobility (2.65 [1.00, 6.99]), inability to perform usual activities (3.88 [1.61, 9.36]), pain or discomfort (3.21 [1.38, 7.48]), and anxiety and depression (5.77 [2.45, 13.61]). Similarly, the lack of social support was also significantly associated with poor QoL, such as restricted mobility (2.42 [1.12, 5.22]), restricted self-care (3.64 [1.18, 11.17]), inability to perform usual activities (2.86 [1.42, 5.75]), pain/discomfort (2.53 [1.38, 4.66]), and anxiety and depression (1.93 [1.04, 3.57]). Females showed higher odds for restricted mobility (2.79 [1.29, 6.03]) and low education with limited self-care (7.38 [1.49, 36.71]). Conclusion Patients with epilepsy reported high levels of social anxiety that have a negative effect on their QoL. Healthcare providers should be able to provide counseling to the patient and their family members. In addition, social support is important to improve their mobility and socialization with friends and neighbors.

Turkish validity and reliability study of disease-related fear scale in patients with epilepsy

OBJECTIVE

This study was conducted to examine the validity and reliability of the Turkish disease-related fear scale (D-RFS) for adult patients with epilepsy.

METHODS

This methodological study was conducted with 154 patients with epilepsy who were referred to the neurology clinic and outpatient clinic of Firat University Hospital between December 2021 and March 2022. Content and construct validity were evaluated after the scale was translated into Turkish. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted for construct validity. Item analyses and internal consistency analyses were conducted for reliability. Convergent validity was also evaluated.

RESULTS

As a result of the evaluations and analyses, the content validity index of the scale was found to be 0.97. Exploratory factor analysis showed that the value of total variance explained by two factors was 74.77%. Factor loading of all items was found to be between 0.60 and 0.93. Cronbach's alpha values of the factors were found to be 0.97, while the total Cronbach's alpha value was found to be 0.95. As a result of the EFA and CFA, the 27-item, 2-factor disease-related fear scale was confirmed without changes to the original form of the scale. Good fit index values were obtained as a result of CFA.

CONCLUSION

The Turkish version of the disease-related fear scale for adult patients with epilepsy is a valid and reliable measurement tool to evaluate the disease-related fear of adult patients with epilepsy and to use in clinical practice.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Social phobia and its relationship with perceived epilepsy-associated stigma in patients with epilepsy

Patients with epilepsy (PWE) might feel stigmatized due to the likelihood of having uncontrollable seizures and the possibility of their sudden occurrence in the community, which may lead to increased rates of social phobia in these patients. People with social phobia interpret others' attitudes toward them negatively and hence feel stigmatized. This vicious circle may be applied to PWE, reduces the quality of life and might cause them more challenging psychosocial problems than seizure management. We aimed to investigate the relationship between social phobia and stigmatization in PWE. Forty PWE and 40 age- and sex-matched healthy control subjects (HC) were included in the study. Liebowitz social anxiety scale (LSAS), Beck anxiety inventory (BAI), and Beck depression inventory (BDI)-II were administered to all participants. In addition to these, the stigma scale of epilepsy (SSE) was applied to the PWE, and the subcategory scores of this scale were calculated. The mean ages of the patient group and HC were determined to be 32.68 ± 10.67 and 33.80 ± 7.81, respectively (p>0.05). A significant difference was determined in the BDI-II, LSAS, and BAI scores of the patient group compared to HC (p<0.05). A significant correlation was found between scores of LSAS and SSE and this relationship continued regardless of depression levels (p<0.05). Our results demonstrate that social phobia is positively correlated with stigmatization in PWE. In PWE, psychiatric disorders are generally under-recognized and mistreated. Plus, it has a substantial impact on patients' quality of life. To achieve the social reintegration of these patients, comorbid psychiatric conditions of the disease and the factors associated with these conditions should be identified and treated.

Social anxiety is associated with poor quality of life in adults with epilepsy in Northeast China: A cross-sectional study

OBJECTIVE

This study aimed to investigate the factors influencing the level of social anxiety in patients with epilepsy (PWE) in Northeast China. We also identified the effect of social anxiety on the quality of life in these patients.

METHODS

A consecutive cohort of 148 adult PWE from The First Hospital of Jilin University were recruited. In this sample, 116 patients had focal epilepsy, 20 had generalized epilepsy, and 12 had unclassified epilepsy. Depressive symptoms, social anxiety, and quality of life were evaluated using the Chinese version of the Patient Health Questionnaire 9 (PHQ-9), 20-item Social Phobia Scale (SPS), 20-item Social Interaction Anxiety Scale (SIAS), and Quality-of-Life Inventory in Epilepsy-31 (QOLIE-31), respectively. Multivariate linear regression analyses were employed to identify independent factors influencing SPS scores and SIAS scores.

RESULTS

Correlation analysis suggested that sex, age at onset, seizure frequency over the last year, AED treatment model, >50% nocturnal seizures, PHQ-9 score, and QOLIE-31 score had a significant correlation with the SPS score. The age at onset, seizure frequency over the last year, AED treatment model, PHQ-9 score, and QOLIE-31 score correlated with the SIAS score. Multiple linear regression analysis showed that the total QOLIE-31 score (β = - 0.481; p = 0.001) was inversely associated with the SPS score in PWE. Additionally, earlier age of onset (β = -0.156; p = 0.022) and low total QOLIE-31 score (β = -0.457; p = 0.001) were risk factors for high SIAS scores.

CONCLUSION

We found that social anxiety was independently associated with poor quality of life. Earlier age of onset was also a risk factor for social anxiety. Future studies with large sample sizes are required to confirm our findings.

Effect of seizure viewing on psychological outcome in persons with epilepsy

PURPOSE

Psychiatric disease is the most common co-morbidity seen in persons with epilepsy (PWE), often secondary to psychosocial disturbances due to poor adaptation to the disease. Optimizing epilepsy treatment by targeting both seizure control and addressing psychological issues go a long way in improving psychological outcome among PWE. This study aims to assess the psychological status among PWE using validated questionnaires and to assess the effect of viewing their own seizures on their psychological milieu post-viewing.

METHODS

A prospective interventional study was conducted enrolling 52 PWE. Their baseline psychological scores were assessed using Hospital Anxiety Depression Scale (HADS), Self Esteem Inventory (SEI), Locus of Control (LOC) and Quality of Life in Epilepsy (QOLIE-31). The scores were reassessed 3 months post seizure viewing and compared with the baseline scores.

RESULTS

Among the 52 patients analyzed, anxiety was present in 20 (38.4%) and depression in 8 (15.3%). The mean HADS-A (anxiety) scores for study population was 9.56 ± 4.12. Gender, income status, risk factors antedating index seizure, type of seizure, temporal semiology, seizure frequency, MRI or EEG characteristics did not have any significant association with baseline psychological scores. There was statistically significant reduction in HADS-A scores from 9.56 ± 4.12 to 8.35 ± 3.85 in the study population after seizure viewing (p = 0.049). We identified patient characteristics that benefit seizure viewing with respect to each of the psychological batteries mentioned earlier.

CONCLUSION

This study emphasizes that viewing one's own seizures improves the psychological milieu of PWE and improves their quality of life by helping them cope up with their illness more judiciously.

Factors associated with social anxiety in South Korean adults with epilepsy

PURPOSE

The aim of this study was to examine social anxiety in South Korean adults with epilepsy and to identify associated factors.

METHOD

This was a cross-sectional, multicenter study in South Korea. Social anxiety was assessed using short forms of the Social Phobia Scale (SPS-6) and Social Interaction Anxiety Scale (SIAS-6). The SPS-6 scores ≥9 and SIAS-6 scores ≥12 were considered indicative of social phobia and social interaction anxiety, respectively. The Patient Health Questionnaire-9 (PHQ-9); Stigma Scale-Revised (SS-R); Disclosure Management Scale; Family Adaptation, Partnership, Growth, Affection, Resolve (F-APGAR) scale; and a questionnaire assessing knowledge about epilepsy were also used.

RESULTS

Of a total of 219 patients with epilepsy, 21% and 11% had SPS-6 scores ≥9 and SIAS-6 scores ≥12, respectively. In logistic regression analysis, SPS-6 scores ≥9 were independently associated with SS-R scores of 4-9 (odds ratio [OR]: 8.626, 95% confidence interval [CI]: 2.515-29.587, p = .001), SS-R scores 1-3 (OR: 5.496, 95% CI: 1.757-17.197, p = .003), and PHQ-9 scores ≥10 (OR: 4.092, 95% CI: 1.823-9.185, p = .001). In contrast, SIAS-6 scores ≥12 were related only to PHQ-9 scores ≥10 (OR: 8.740, 95% CI: 3.237-23.599, p < .001). Belonging to a dysfunctional family and lack of knowledge about epilepsy tended to be associated with social phobia (p = .071) and social interaction anxiety (p = .090), respectively. Epilepsy-related variables were not related to social anxiety.

CONCLUSION

Social anxiety is not rare in patients with epilepsy. In this study, social phobia was associated with perceived stigma and depressive symptoms, whereas social interaction anxiety was related only to depressive symptoms in patients with epilepsy.

Disability patterns over the first year after a diagnosis of epilepsy

OBJECTIVE

To determine the patterns and predictors of disability over the first 12 months after a diagnosis of epilepsy.

PATIENTS AND METHODS

The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people with newly diagnosed epilepsy in Sydney, Australia. Disability was assessed using the World Health Organization's, Disability Assessment Schedule (WHODAS) 2.0 12-item version, at baseline (i.e. within 28 days of diagnosis) and 12 months post-diagnosis. Demographic, socioeconomic, clinical and epilepsy-related data, obtained through structured interviews, were entered into multivariable linear regression and shift analysis to determine predictors of greater disability.

RESULTS

Of 259 adults (≥18 years), 190 (73%) had complete WHODAS at baseline (mean ± SD scores 4 ± 6) and follow-up (4 ± 8). After adjustment for age, sex and co-morbidity, greater overall disability at 12 months was associated with lower education (P = 0.05), economic hardship (P = 0.004), multiple antiepileptic medications (P = 0.02) and greater disability (P < 0.001) at the time of diagnosis; these variables explained 38.3% of the variance. Among the 12 WHODAS items, "being emotionally affected by health problems" was the most frequent disability problem identified at both time points (all P < 0.0001). The proportion of participants without problems in that domain improved over 12 months (from 24% to 50%, P < 0.0001), whereas the other 11 items remained relatively stable. Independent baseline predictors of a worse emotional outcome at 12 months were severe/extreme emotional distress (odds ratio [OR] 4.52, 95% confidence intervals [CI] 1.67-12.24), economic hardship (OR 2.30, 95% CI 1.24-4.25) and perceived stigma (OR 2.02, 95% CI 1.03-3.93).

CONCLUSION

Most people report problems with emotional health after a diagnosis of epilepsy but many recover over the next 12 months. Services addressing the social and psychological impact of diagnosis may be needed to improve outcome.

Stigma accounts for depression in patients with epilepsy

OBJECTIVE

Epilepsy is a chronic disease with an increased risk of stigmatization due to psychosocial consequences of the seizures. Intuitively, one may well conclude that stigmatization would lead to depression in patients with epilepsy as well as in other patient groups with increased risk of stigmatization. Indeed, there are a few studies in support of this intuition. In this study, we aimed to investigate the relationship between level of stigmatization and the severity of the depressive symptoms in our patients with epilepsy.

METHODS

This is a substudy of our main study, which aimed to develop a scale for the quantification of the stigma level in patients with epilepsy. The study included a total of 302 patients with epilepsy, who had at least a literacy level education and one-week-seizure-freedom. Beck Depression Inventory (BDI) was used to quantify depressive symptoms. The correlation between BDI scores and the Stigma Scale for Epilepsy-Self Report (SSE-SR) scores was evaluated. A regression analysis was done in order to parse out significant sociodemographic and clinical factors contributing to depressive symptoms. Statistical analyses were done using the Statistics Package for the Social Sciences software 24.0 package program.

RESULTS

We saw that 46.9% (n=139) of this population rated themselves as having at least mildly depressive symptoms with BDI (BDI>9). There was a moderate positive correlation between stigma scores and BDI scores (p=0.000, r=0.504), and 96.3% of highly stigmatized patients had at least mildly depressive scores, 73.9% of the nonstigmatized group had none or minimal depressive scores. Stigma scores (β=.51), gender, educational level, seizure frequency, and income level were the variables significantly affecting the BDI scores. Stigma score accounted for 26.2% of the variance in the BDI score.

CONCLUSION

This study shows that stigmatization of the patients with epilepsy leads to depression in those patients. Therefore, protection of the patients with epilepsy against stigmatization may also help to protect them from a concomitant disabling condition. On the other hand, detection for depressive symptoms in already stigmatized patients with epilepsy may unearth a treatable condition.