Risk factors for psychological distress in community-treated epilepsy

Using machine learning approach to predict depression and anxiety among patients with epilepsy in China: A cross-sectional study

BACKGROUND

Anxiety and depression are the most prevalent comorbidities among epilepsy patients. The screen and diagnosis of anxiety and depression are quite important for the management of patients with epilepsy. In that case, the method for accurately predicting anxiety and depression needs to be further explored.

METHODS

A total of 480 patients with epilepsy (PWE) were enrolled in our study. Anxiety and Depressive symptoms were evaluated. Six machine learning models were used to predict anxiety and depression in patients with epilepsy. Receiver operating curve (ROC), decision curve analysis (DCA) and moDel Agnostic Language for Exploration and eXplanation (DALEX) package were used to evaluate the accuracy of machine learning models.

RESULTS

For anxiety, the area under the ROC curve was not significantly different between models. DCA revealed that random forest and multilayer perceptron has the largest net benefit within different probability threshold. DALEX revealed that random forest and multilayer perceptron were models with best performance and stigma had the highest feature importance. For depression, the results were much the same.

CONCLUSIONS

Methods created in this study may offer much help identifying PWE with high risk of anxiety and depression. The decision support system may be valuable for the everyday management of PWE. Further study is needed to test the outcome of applying this system to clinical settings.

The impact of social factors, especially psychological worries on anxiety and depression in patients with epilepsy

BACKGROUND

Social factors are believed to affect mental health in patients with epilepsy (PWE). However, there is still a lack of sufficient manifest proof, given the difficulty of exposing PWE to relatively consistent natural social environments with a low or high level of social interaction to study their significant role.

METHODS

This single-center, longitudinal study was conducted via online questionnaires during the coronavirus disease 2019. PWE were recruited from downtown Wuhan and surrounding areas. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 were used to assess psychological status.

RESULTS

We analyzed 588 questionnaires completed by 294 PWE who participated in the dual survey. Under lockdown and reopening, the prevalence of anxiety was 13.6%/22.5%, and the prevalence of depression was 19.4%/34.0%. Raising children and seizure-related characteristics, including uncontrolled seizures, seizure exacerbation, seizure frequency ≥ 2/m, and changes in drug regimen, were risk factors in the first and second surveys. A high education level (OR = 1.946, 95% CI = 1.191-3.182), low life satisfaction (OR = 1.940, 95% CI = 1.007-3.737), worry about unanticipated seizures (OR = 2.147, 95% CI = 1.049-4.309), and worry about purchasing medication outside (OR = 2.063, 95% CI = 1.060-4.016) were risk factors for higher scores after reopening. Worry about unanticipated seizures (OR = 3.012, 95% CI = 1.302-6.965) and in-person medical consultation (OR = 2.319, 95% CI = 1.262-4.261) were related to newly diagnosed patients with psychological disorder after reopening.

CONCLUSIONS

We identified an association between social variables and epileptic psychiatric comorbidities.

Severe psychological distress among patients with epilepsy during the COVID-19 outbreak in southwest China

Objective

To compare the severity of psychological distress between patients with epilepsy and healthy controls during the COVID‐19 outbreak in southwest China, as well as identify potential risk factors of severe psychological distress among patients with epilepsy.

Methods

This cross‐sectional case‐control study examined a consecutive sample of patients older than 15 years treated at the epilepsy center of West China Hospital between February 1 and February 29, 2020. As controls, sex‐ and age‐matched healthy visitors of inpatients (unrelated to the patients) were also enrolled during the same period. Data on demographics and attention paid to COVID‐19 were collected by online questionnaire, data on epilepsy features were collected from electronic medical records, and psychological distress was evaluated using the 6‐item Kessler Psychological Distress Scale (K‐6). Potential risk factors of severe psychological distress were identified using multivariate logistic regression.

Results

The 252 patients and 252 controls in this study were similar along all demographic variables except family income. Patients with epilepsy showed significantly higher K‐6 scores than healthy controls and spent significantly more time following the COVID‐19 outbreak (both P < .001). Univariate analyses associated both diagnosis of drug‐resistant epilepsy and time spent paying attention to COVID‐19 with severe psychological distress (defined as K‐6 score >12; both P ≤ .001). Multivariate logistic regression identified two independent predictors of severe psychological distress: time spent paying attention to COVID‐19 (odds ratio [OR] = 1.172, 95% confidence interval [CI] = 1.073‐1.280) and diagnosis of drug‐resistant epilepsy (OR = 0.283, 95% CI = 0.128‐0.623).

Significance

During public health outbreaks, clinicians and caregivers should focus not only on seizure control but also on mental health of patients with epilepsy, especially those with drug‐resistant epilepsy. K‐6 scores > 12 indicate severe psychological distress. This may mean, for example, encouraging patients to engage in other activities instead of excessively following media coverage of the outbreak.

Psychological distress symptoms and illness perception in patients with epilepsy in Northwest Greece

OBJECTIVE

The purpose of the present study was to compare psychological distress between patients with epilepsy and healthy controls and to evaluate potentially related factors to psychological distress in patients with epilepsy. Furthermore, we assessed how psychological distress and other potential factors mediate illness perception in patients with epilepsy in an urban area of Northwest Greece.

MATERIALS AND METHODS

A case-control study was conducted in adult patients with epilepsy followed up at the University Hospital of Ioannina and in healthy controls. The Symptom Checklist-90 Revised (SCL-90R) for symptoms of psychological distress and the overall psychological distress Global Severity Index (GSI) evaluation, the brief illness perception questionnaire (B-IPQ), and the Adverse Event Profile (AEP) questionnaire for the antiepileptic drugs (AEDs) were used.

RESULTS

Seventy patients with epilepsy and 70 controls were recruited in the study. Somatic, depression, and anxiety symptoms and the GSI were higher in patients than in controls. In patients with epilepsy, the AEP score was significantly associated with psychological distress. Illness perception was associated with the number and the total number of administered AEDs; the AEP score; somatic, obsessive, depressive, and anxiety symptoms; and the GSI. After regression analysis, epilepsy characteristics, AEDs, and psychological distress accounted for 11.7%, 28.7%, and 5.5% of variance in BIP-Q score, respectively.

CONCLUSION

Screening for psychological distress in patients with epilepsy is of high importance in clinical practice as somatic, depression, and anxiety symptoms and overall psychological distress are more severe in patients with epilepsy than in healthy controls. The symptoms of psychological distress are strongly associated with the adverse effects of AEDs. The epilepsy characteristics, the AEDs, and the psychological distress could determine a large part of illness perception in epilepsy, with the adverse effects of AEDs being the strongest predictor.

Metacognitive beliefs and illness perceptions are associated with emotional distress in people with epilepsy

PURPOSE

Emotional distress is common in people with epilepsy (PWE) for which efficacious interventions are required. Developing evidence-based treatments should be based on testable models of the psychological mechanisms maintaining psychopathology. The Self-Regulatory Executive Function (S-REF) model proposes that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. Although preliminary support exists for the role of metacognitive beliefs in emotional distress in PWE, their role has yet to be tested when controlling for the contribution made by illness perceptions.

METHODS

Four hundred and fifty-seven PWE completed an online survey, which assessed anxiety, depression, metacognitive beliefs, illness perceptions, general demographic factors, and epilepsy characteristics.

RESULTS

Hierarchical regression analyses demonstrated that metacognitive beliefs and illness perceptions were both associated with anxiety and depression when controlling for the influence of demographic variables and epilepsy characteristics. However, metacognitive beliefs accounted for more variance in anxiety and depression than illness perceptions.

CONCLUSION

Metacognitive beliefs appear to make a greater contribution to anxiety and depression in PWE than illness perceptions. Prospective studies are now needed to establish the causal role of metacognitive beliefs in both the development and persistence of emotional distress.

A systematic review of neuropsychiatric comorbidities in patients with both epilepsy and intellectual disability

Epilepsy is a neurological condition that is particularly common in people with intellectual disability (ID). The care for people with both epilepsy and ID is often complicated by the presence of neuropsychiatric disorders, defined as psychiatric symptoms, psychiatric disorders, and behavioral problems. The aim of this study was to investigate associations between epilepsy or epilepsy-related factors and neuropsychiatric comorbidities in patients with ID and between ID and neuropsychiatric comorbidities in patients with epilepsy. We performed a systematic review of the literature, published between January 1995 and January 2015 and retrieved from PubMed/Medline, PsycINFO, and ERIC and assessed the risk of bias using the SIGN-50 methodology. Forty-two studies were identified, fifteen of which were assessed as having a low or acceptable risk-of-bias evaluation. Neuropsychiatric comorbidities were examined in relation to epilepsy in nine studies; in relation to epilepsy-related factors, such as seizure activity, seizure type, and medication in four studies; and in relation to the presence and degree of ID in five studies. We conclude that the presence of epilepsy only was not a clear determinant of neuropsychiatric comorbidity in patients with ID, although a tendency towards negative mood symptoms was identified. Epilepsy-related factors indicating a more severe form of epilepsy were associated with neuropsychiatric comorbidity as was the presence of ID as compared to those without ID in patients with epilepsy, although this should be validated in future research. A large proportion of the studies in this area is associated with a substantial risk of bias. There is a need for high quality studies using standardized methods to enable clear conclusions to be drawn that might assist in improving the quality of care for this population.

The predictors of psychiatric disorders among people living with epilepsy as seen in a Nigerian Tertiary Health Institution

Background:

Mental disorders may complicate epilepsy which can further impair the quality of life of people living with this chronic neurological condition. The aim of this study was to determine the types of psychiatric disorders in patients with epilepsy and to determine the sociodemographic and clinical factors that may predict these psychiatric illnesses.

Materials and Methods:

This is a descriptive cross-sectional study carried out over a period of 6 months at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. The Mini International Neuropsychiatric Interview was used to determine the psychological health of 74 consecutively recruited adult patients with epilepsy attending the psychiatric outpatients' clinic of the hospital. Psychiatric diagnoses were based on Diagnostic and Statistical Manual for Mental Disorders, 4^th Edition criteria, and logistic regression analysis was done to determine variables that predict psychiatric disorder.

Results:

Majority of the participants were male (67.6%) with their age ranging from 18 to 68 years and the mean age of 30.55 ± 10.91 years. Thirty-three (44.6%) of our study respondents had psychiatric diagnoses that included major depressive disorder (21.6%), schizophrenia (17.6%), generalized anxiety disorder (4.1%), and hypomania (1.4%). Being unemployed (odds ratio [OR] = 3.24. 95% confidence interval [CI] = 1.15–9.10, P = 0.026) and short-term seizure free period (OR = 0.19, 95% CI = 0.04–0.78, P = 0.022) were the variables found to be predictive of psychiatric diagnoses.

Conclusions:

The study revealed that a large percentage of people living with epilepsy develop mental disorders which can further increase the burden and worsen the quality of life of patients with this chronic debilitating condition.

Risk factors for depression in community-treated epilepsy: systematic review

OBJECTIVE

Depression is one of the most common psychiatric comorbidities in epilepsy; however, the factors contributing to this association remain unclear. There is a growing consensus that methodological limitations, particularly selection bias, affect many of the original studies. A systematic review focussed on community-based studies offers an alternative approach for the identification of the risk factors for depression.

METHODS

Searches were performed in MEDLINE (Ovid), 2000 to 31 December 2013, EMBASE, and Google Scholar to identify studies examining risk factors for depression in epilepsy. Community-based studies of adults with epilepsy that reported at least one risk factor for depression were included.

RESULTS

The search identified 17 studies that met selection criteria, representing a combined total of 12,212 people with epilepsy with a mean sample size of 718. The most consistent risk factors for depression were sociodemographic factors, despite the fact that most studies focus on epilepsy-related factors.

SIGNIFICANCE

Most studies lacked a systematic conceptual approach to investigating depression, and few risk factors were consistently well studied. Future community-based studies require a detailed systematic approach to improve the ability to detect risk factors for depression in epilepsy. Psychological factors were rarely studied in community-based samples with epilepsy, although the consistent association with depression in the few studies that did suggests this warrants further examination.

Serotonin transporter gene × environment and risk of depression in community-treated epilepsy

OBJECTIVES

This study aimed to test whether a specific serotonin transporter (5HTT) gene polymorphism interacting with life stress increased the risk of depression in patients with epilepsy.

METHODS

The Tasmanian Epilepsy Register Mood Study (TERMS) used a cross-sectional study design of a community sample of patients with epilepsy previously recruited into the Tasmanian Epilepsy Register. It employed a mailed self-complete questionnaire and saliva DNA collection. Depression was assessed using the Center for Epidemiologic Studies Depression Scale. Environmental measures were selected to cover recent stressful events, epilepsy-related stress, current social support, and early life stress.

RESULTS

Of 820 eligible participants, 553 (67%) participants completed the study. Experience of at least one stressful life event was very common, with a significant association between depression and the stressful life events (F=26.2, df=3, p<0.001). There was no association between serotonin transporter genotype and level of depressive symptoms reported (F=0.421, df=2, p=0.7). There was no evidence of any adverse life experiences interacting with serotonin transporter genotype to moderate the risk of depression.

SIGNIFICANCE

The failure to demonstrate a main effect of genotype on depression or a gene × environment interaction differs from several studies of patients with other chronic diseases. However, it is consistent with larger general population studies.