Determinants of felt stigma in epilepsy

Assessment of stigmatization and self-esteem in patients with epilepsy

AIM

This study was conducted to examine the relationship between stigmatization and self-esteem of patients with epilepsy.

METHODS

This cross-sectional study was conducted with 216 patients at a university hospital in Van, a province in eastern Turkey. The researcher prepared the data collection tools, including a personal information form, Jacoby Stigma Scale and the Rosenberg self-esteem scale, in line with the literature. The Jacoby stigma scale was applied to assess stigma. Data analysis was performed using t-test, one-way analysis of variance (ANOVA), and Tukey, LSD coefficient.

RESULTS

The mean total stigmatization score of patients with epilepsy was 21.11 ± 10.00, while the mean total self-esteem score was 20.26 ± 5.16. The study found a significant negative correlation between stigmatization and self-esteem scores (r = -0.411; p < 0.05).

CONCLUSION

The research study revealed that patient with epilepsy have a high perception of stigma and low selfesteem levels.

Psychometric evaluation of the Serbian version of the Stigma Scale of Epilepsy (SSE)

OBJECTIVE

To evaluate the psychometric properties of the Serbian-language version of the Stigma Scale of Epilepsy (SSE).

METHODS

The sample consisted of 108 patients with epilepsy (PWE) (60.2 % were female, age range: 19-67 years) and 102 students (86.3 % were female, age range: 18-47 years). The study encompassed two phases: (1) translation of the SSE into Serbian using the back-translation technique, and (2) evaluation of reliability and construct validity of the Serbian-language version of SSE. In addition to the SSE, the PWE filled out a Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). The socio-demographic and clinical variables were noted for each patient by the semistructured interview. Besides completing the SSE, the students were asked if they knew anyone with epilepsy. The reliability of the questionnaire was tested by assessing the internal consistency of the scale (Cronbach's α), while construct validity was assessed by factor analysis, method of known-groups validation, and correlation analysis.

RESULTS

SSE demonstrates a satisfactory level of reliability in both samples, with Cronbach's α of 0.86 in the PWE sample and 0.90 in the student sample. Using exploratory factor analysis, four factors were identified in both samples, corresponding relatively well with the scale domains originally produced, with a few exceptions described. Adverse effects (AEs) of antiseizure medications (ASMs) and driving ability significantly influenced SSE scores, but there were no significant effects of other socio-demographic and clinical variables on epilepsy-related stigma in the PWE sample. In addition, depression severity significantly influenced SSE scores (based on NDDI-E cut-off score), with the SSE showing a positive association with PHQ-9 (r = 0.42, p < .001) and GAD-7 (r = 0.35, p < .001) as well. Regarding the student sample, the effects of personal knowledge of someone with epilepsy on SSE scores were found to be significant. Besides, students (M = 46.28, SD = 16.43) reported higher epilepsy-related stigma than patients (M = 40.66, SD = 17.01), t(208) = 2.43, p < .05, d = 0.34.

CONCLUSION

The Serbian version of the SSE has good psychometric properties and represents a useful tool for assessing epilepsy-related stigma in both patients and the general population.

An investigation of stigma and self-management in individuals diagnosed with epilepsy

AIM

The complex nature of epilepsy disease confronts individuals with difficulties such as stigma. Stigma has a negative impact, particularly on individuals' coping with the disease. It is important for individuals diagnosed with epilepsy to adopt many self-management behaviors so that they can control these situations. This study aims to measure the stigma and self-management levels of individuals diagnosed with epilepsy and determine the relationship between stigma and self-management.

METHODS

This descriptive and associational study was conducted in the Neurology Outpatient Clinic of a Training and Research Hospital and 295 patients were included in the sample based on various inclusion criteria such as having a diagnosis of epilepsy for at least six months and not having any psychiatric disorder that would prevent reading and comprehension. Data were collected through the Descriptive Information Form, the Stigma Scale of Epilepsy, and the Epilepsy Self-Management Scale. Data analysis was performed using IBM SPSS Statistics Standard Concurrent User V 26 statistical package program.

FINDINGS

The Stigma Scale of Epilepsy total mean score was found 60.62 ± 15.40 in individuals diagnosed with epilepsy. The mean scores for the sub-scales were found 7.08 ± 2.20 for the false beliefs sub-scale, 18.86 ± 4.97 for the discrimination sub-scale, 21.64 ± 7.07 for the social isolation sub-scale, 8.46 ± 3.18 for the inadequacy sub-scale, and 5.45 ± 1.41 for the stigma resistance sub-scale. The ESMS total mean score of individuals diagnosed with epilepsy was found to be 140.54 ± 15.33. The mean scores for the ESMS sub-scales were 44.76 ± 4.29 for the medicine management sub-scale, 20.29 ± 5.98 for the information management sub-scale, 30.49 ± 4.80 for the safety management sub-scale, 23.95 ± 4.34 for the seizure management sub-scale, and 21.02 ± 4.65 for lifestyle management sub-scale. A significant and negative relationship was found between the Epilepsy Self-Management Scale (ESMS) and the Stigma Scale of Epilepsy.

CONCLUSION

This study found that individuals experienced a moderate level of stigma and had high levels of self-management. Stigma was found to decrease with the increase in the self-management level. In this regard, it is recommended to conduct intervention studies to increase self-management levels and reduce stigma for individuals diagnosed with epilepsy.

Determinants of felt-stigma in adolescents with epilepsy: Is it the same story?

PURPOSE

The present study aimed to investigate previously researched variables in adult people with epilepsy (PWE), which include felt stigma, perceived overprotection, concealment of epilepsy, and epilepsy-related concerns for adolescents with epilepsy (AWE). Another goal was to determine the reported levels of these variables and explore the relationships among them, as well as their associations with demographic and clinical factors. Additionally, we also investigated whether clinical and demographic variables create significant changes in these variables. Lastly, we aimed to determine the variables that predict felt-stigma in AWE.

METHODS

On hundred and nineteen AWE aged between 10 and 18 were included in the study by using convenience sampling. Participants received the scales and demographic information form either in face to face meeting or via a Zoom session.

RESULTS

Nearly half of the participants stated high level of felt stigma, perceived overprotection and concealment of epilepsy, while more than half reported concerns about their future/occupational prospects. Also, felt stigma had significant relations with concealment of epilepsy and concerns related to epilepsy. Early adolescents were under more risk for perceived overprotection, while late adolescents had higher concerns related to future/occupation. Females reported more felt stigma. Finally, felt stigma was predicted by concealment, concerns related to future/occupation, and concerns related to social life.

CONCLUSION

The variables that explain the felt-stigma in AWE appear to be quite similar to those in adult PWE.

The effects of concealment of epilepsy on medication adherence in people with epilepsy: A cross-sectional study

AIM

Adherence to antiseizure medication is of great importance in achieving seizure control and maintaining well-being for people with epilepsy. Therefore, it is important to assess medication adherence and factors affecting medication adherence in this patient group. This study aims to examine the effects of concealment of epilepsy on medication adherence in people with epilepsy.

METHOD

This cross-sectional study was conducted with 220 people with epilepsy. Data were collected using a patient information form, the Morisky Medication Adherence Scale-8 (MMAS-8), and the Concealment of Epilepsy Scale (CES) and analyzed using descriptive statistics and multiple linear regression analysis.

RESULTS

The mean age of the participants was 49.84 ± 9.43 years, and 53.6% of them were male. Their mean MMAS-8 score was 4.25 ± 1.99%, and 72.3% had low medication adherence. Additionally, their mean CES score was 49.84 ± 9.43. The CES scores of the participants negatively predicted their MMAS-8 scores (p < 0.05), and medication adherence was positively predicted by female gender, the duration of diagnosis, the single administration of drugs per day, and employment status, whereas it was negatively predicted by the annual number of seizures (F=19.256, p < 0.001).

CONCLUSION

In this study, people with epilepsy were found to have low medication adherence and a high tendency to conceal epilepsy. Furthermore, the tendency to conceal epilepsy had a negative effect on medication adherence.

IMPLICATIONS

Psychosocial interventions aimed at reducing the tendency to conceal epilepsy can contribute to medication adherence in people with the condition.

Comparison of knowledge and awareness of epilepsy between medical students of two universities in Poland

BACKGROUND

Epilepsy is one of the most common neurological disorders. As a chronic disease, associated with long-term treatment with antiseizure medication, it can have a negative impact on patients' quality of life. Moreover, patients are faced with a significant psychosocial burden associated with the stigma surrounding epilepsy. Medical professionals should be well educated and free of prejudices in order to provide adequate care for patients with epilepsy. The aim of the study was to evaluate the knowledge and awareness of epilepsy among medical students of years 1-6 in Poland and examine if certain personality traits influence students' view of epilepsy.

METHODS

The study was conducted using snowball sampling of 166 Polish medical students from Medical University of Gdansk and Medical University of Warsaw. Participants completed a survey which consisted of their subjective assessment of knowledge of epileptology, actual knowledge of epileptology, and their view of stereotypes about epilepsy. In addition, students completed the IPIP-BFM-20 personality questionnaire.

RESULTS

Polish medical students have sufficient basic knowledge about epilepsy (mean scores of students from both universities is 14 out of 25 points). There is still room for improvement, especially in the field of epidemiology, semiology, factors provoking seizures, antiseizure medications, and most importantly about first aid during seizure (e.g., 7% of respondents believed it is necessary to put something between teeth of a patient during seizure). Age and the year of study were well correlated with knowledge score (p = 0.008) and level of awareness of the stereotypes. We found that most personality traits do not have a strong impact on the level of knowledge about epilepsy.

CONCLUSIONS

Most students have a satisfying level of knowledge about epilepsy. Academic teachers should put more emphasis on first aid during seizures and awareness of psychosocial challenges associated with the disease. It is crucial for future physicians to not only possess sufficient theoretical knowledge, but also establish an empathetic doctor-patient relationship in order to provide better care for patients with epilepsy and other chronic diseases.

Online seizure first aid certification program is an effective means of improving student knowledge and self efficacy surrounding epilepsy

INTRODUCTION

Epilepsy is a neurological disorder, characterized by recurring seizures, affecting more than 3.4 million adults and children throughout the United States. Still, there are sizable gaps in awareness and knowledge of this disorder, and persistent misunderstandings and stigmas surrounding epilepsy and seizure first aid (SFA) pose a risk to those living with this condition. The Epilepsy Foundation, with support from the Centers for Disease Control and Prevention (CDC), has developed programs to address the issue of insufficient public education and awareness surrounding epilepsy. One of these programs is a free, accessible online Seizure Recognition and First Aid Certification program, established in 2021. We aimed to evaluate the effectiveness of the Epilepsy Foundation's online Seizure Recognition and First Aid Certification program in improving student knowledge of epilepsy and appropriate bystander-intervention methods to assist a person experiencing a seizure.

METHODS

The Epilepsy Foundation's online Seizure Recognition and First Aid Certification course evaluates student performance via a 16-question knowledge assessment and six question self-efficacy assessment provided both before and after completion of the course. Pre- and post-course scores of students who enrolled between December of 2021 and September of 2022 were collected. Average score improvement was evaluated via the difference in pre-course and post-course first-attempt scores. Statistical significance was evaluated using paired sample, two-tailed t-tests of pre-course and post-course scores.

RESULTS

Average pre-course knowledge score was 74.33% (n = 10,371, σ² = 3.04%), post-course score was 88.04% (n = 10,371, σ² = 0.83%), and score difference was 13.71% (p < 0.001). Average pre-course self-efficacy score was 63.44% (n = 8,046, σ² = 4.71%), post-course score was 87.08% (n = 8,046, σ² = 1.68%), and score difference was 23.64% (p < 0.001).

CONCLUSION

We found a significant increase in knowledge and self-efficacy assessment scores after students completed the online Seizure Recognition and First Aid Certification course, suggesting that the program is an effective method of improving the understanding of epilepsy and bystander interventions to assist a person who is experiencing a seizure. In the future, awareness should continue to be promoted through SFA training programs and improving accessibility to such programs so that the risks associated with experiencing a seizure without receiving assistance are reduced for people living with epilepsy.

A qualitative study on the experience of stigma for Chinese parents of children with autism spectrum disorder

Experiencing stigma related to having a child with autism spectrum disorder (ASD) can be difficult and is detrimental to parent well-being. Since the research on stigmatized experiences among parents of children with ASD in non-Western communities is limited, this qualitative study examined the experiences, reactions and impacts of stigma on parents of children with ASD in Hong Kong. In-depth interviews were conducted with 54 Chinese parents/caregivers of children with ASD aged between 35 and 73 years old. Data were analyzed using an inductive approach. The participants reported stigma which stemmed from negative labelling of their children by schools and healthcare professionals, bullying by peers, stereotypes of ASD and stigma linked to autistic children's behavior in the community. The reactions of participants towards stigmatization were classified into internalizing reactions including apologizing, ignoring and concealing ASD and externalizing reactions such as fighting back. The participants also reported impacts of stigma on both personal and emotional levels. The results point to the urgent need for the government to allocate resources and make concerted efforts to reduce stigma by educating the community to foster more positive attitudes towards individuals with ASD and offer support and counselling services to parents.

Stigma and its association with health-related quality of life in adults with epilepsy

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.

Felt Stigma and Its Underlying Contributors in Epilepsy Patients

Objective

To explore the correlated clinical and psychological factors of stigmatization and investigate the relationship between stigma and white matter abnormalities in epilepsy patients.

Methods

Stigmatization was obtained by a three-item stigma scale in 256 epilepsy patients with genetic or unknown etiology. Personality and quality of life (QOL) were assessed by Eysenck Personality Questionnaire (EPQ) and QOL-31 questionnaire respectively. One hundred and fourteen of them were performed Hamilton Depression Scale-17 (HAMD) and scanned with diffusion tensor imaging in 3T MRI. Fractional anisotropy (FA) values of frontotemporal contact fibers were calculated.

Results

There were about 39.8% patients felt stigma, with the highest score (Score 3) in 8.2% (21/256). Stigma scores were significantly negatively correlated with education (P < 0.01), age of onset (P < 0.05), extraversion score of EPQ (P < 0.01), total and all the subscale QOL scores (P < 0.001), and positively correlated with duration (P < 0.01), HAMD score (P < 0.001), neuroticism score of EPQ (P < 0.001). We found negative correlation between stigma scores and FA values of right superior longitudinal fasciculus and left cingulum (P < 0.05). Logistic regression results showed that FA value of left cingulum (P = 0.011; OR = 0.000), social function (P = 0.000; OR = 0.935) of QOL, and neuroticism score of EPQ (P = 0.033; OR = 1.123) independently correlated to felt stigma.

Conclusion

Felt stigma in epilepsy patients was found to be correlated with neuroticism, depression, and deficient social function of QOL, which might be predisposed by the impairment of the left cingulum. Our results provide preliminary evidence for the underlying neural circuits in stigmatization.

Understanding the Role of Stigma and Misconceptions in the Experience of Epilepsy in India: Findings From a Mixed-Methods Study

It is surprising that although 12 million people in India suffer from epilepsy this remains a thoroughly under-researched area in the sociology of health and practice. We address this intellectual and policy neglect by reviewing the social, psychological and legal challenges governing the lives of people living with epilepsy (PWE) by paying particular attention to negotiations in arranged marriages and employment. Drawing on the analytical frameworks of the sociological study of stigma, critical race theory and paying attention to the cultural models of health and suffering, this study utilized a combination of (online) survey data (N = 100) and in-depth qualitative interviews (N = 10) with PWE and their families. The online survey was administered to map the level of awareness about epilepsy and its clinical management among the general population, whereas the in-depth interviews were conducted to understand the experience, self-perception and everyday struggles of those diagnosed with the condition. Findings from the survey on non-PWE suggest a general lack of awareness and fearful misconceptions around epilepsy related seizures. In-depth interviews with PWEs revealed concealment (of the illness) as a dominant coping strategy to attenuate the social alienation and rejection associated with epilepsy. Further, PWE participants reported persistent discrimination, harassment and prejudiced understanding of diminished cognitive capacities at workplaces as a result of cultural myths and popular representations of epilepsy-related seizures. The study also demonstrated the significance of institutional support groups in assisting PWE to cope with symbolic violence and forge solidarities. We conclude with reflections on the ethical dilemmas faced by medical practitioners while dealing with social-medical interventions of epilepsy treatment. Overall, results from this study undergird the significance to revisit the social-moral as well as legal frameworks that persistently restrict opportunities for PWE in India. In an attempt to reimagine inclusive futures regardless of disease, disability and affliction, we attempt to move beyond the biomedical gaze and instead privilege stories of individual personhood, struggles and aspirations.

Validation of the Chinese Version of the Stigma Scale of Epilepsy

Purpose

This study was carried out to test the validity and reliability of the Chinese version of the Stigma Scale of Epilepsy (SSE), with aim to better understand the public stigmatizing attitudes of epilepsy in China and help elucidate stigma determinants for interventions.

Methods

The SSE was translated into Simplified Chinese Mandarin. In this study, most of the participants were enrolled via convenience sampling by randomly distributing questionnaires on the streets and parts of the participants were recruited by an online platform named Wenjuanxing. We assessed the psychometric properties of the SSE in 310 Chinese native-speaker. Cronbach's alpha was tested for reliability. Index of Content Validity (CVI) was calculated. Exploratory and confirmatory analysis were used to explore the factor structure and verify the validity of SSE.

Results

The Cronbach's alpha is 0.936 for the overall scale, and the CVI value is greater than 0.78. The exploratory factor analysis (EFA) extracted SSE six factors: the fear of seizure attacks (factor 1), sympathy for patients with epilepsy (PWEs) (factor 2); difficulties faced by PWEs (factor 3); speculation on PWEs' feeling (factor 4); discrimination against PWEs (factor 5); and knowledge about epilepsy (factor 6). The item 13 was proven to be problematic and has been eliminated. The confirmatory factor analysis (CFA) ensured the great construct validity (χ²/SD = 1.725, goodness of fit index (GFI) = 0.916, and root mean square error of approximation (RMSEA) = 0.048), convergent validity (the factor loads of each item corresponding to each latent variable >0.6, average variance extracted (AVE) > 0.5, and composite reliability (CR) > 0.7), and discrimination validity (all of the absolute value of correlation coefficient are <0.5,and less than the square root of AVE) of the SSE.

Conclusions

The Chinese version of the SSE scale was a valid and reliable tool to measure epilepsy-associated stigma in the Chinese society.

Validity and reliability of the Chinese version of the epilepsy stigma scale

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.

The Effects of Perceived Stigma on the Concealment of Disease and Satisfaction with Life in Patients with Epilepsy: An Example in Eastern Turkey

BACKGROUND

Stigma and exclusion are common features of epilepsy in both developed and developing countries, and they cause a significant burden associated with the condition. At the same time, although it varies from country to country depending on cultural differences and economic conditions, having epilepsy causes significant social consequences.

OBJECTIVE

This study was conducted to examine the effects of perceived stigma on the concealment of disease and satisfaction with life in patients with epilepsy living in the east of Turkey.

METHODS

This cross-sectional and descriptive study was carried out with 150 patients who met the study criteria and who agreed to participate in the study between March and July 2021 in a university hospital in Elazığ, east of Turkey. The data were collected using a personal information form, an Epilepsy Stigma Scale (ESS), a Concealment of Epilepsy Scale (CES), and a Satisfaction with Life Scale (SWLS).

RESULTS

The total mean ESS score of the patients was 40.7 ± 9.04, the total CES mean score was 57.19 ± 12.57, and the total SWLS mean score was 6.68 ± 2.86. When the regression coefficients were examined, it was found that the ESS variable had a positive and significant effect on the CES, while the ESS and the CES had a negative and significant effect on satisfaction with life (p < 0.001).

CONCLUSION

It was found that the patients had high levels of perceived stigma and concealment of epilepsy and low satisfaction with life levels. It was also found that the patients concealed their disease for fear of stigma, which negatively affected their satisfaction with life.

Development and validation of the Epilepsy Self-Stigma Scale

Objective

Self‐stigma is the internalization of negative public attitudes and is often experienced by patients with epilepsy (PWE). Greater self‐stigma is associated with lower self‐esteem and hinders therapeutic behavior. The study aims were to develop the Epilepsy Self‐Stigma Scale (ESSS) to assess self‐stigma in PWE and to examine the scale's reliability and validity.

Methods

We created a test scale based on items from an existing stigma scale and the results of a previous qualitative analysis we conducted. We recruited 200 outpatients from departments specializing in epilepsy (psychiatry, neurology, and pediatric neurology) at four facilities in Tokyo and Saitama prefecture, Japan, between September and December 2020. Participants also completed the Rosenberg Self‐Esteem Scale (RSES) and Beck Depression Inventory (BDI‐II).

Results

Questionnaires were returned from 102 participants (response rate: 51%). After excluding two participants with incomplete questionnaires, data for 100 participants were analyzed (53 women, 47 men; mean age [standard deviation]: 39.86 [17.45] years). Exploratory factor analysis extracted eight items loading on three factors: internalization of stigma, societal incomprehension, and confidentiality. Cronbach's α for all items and each factor demonstrated acceptable internal consistency (α = 0.76‐0.87). Test‐retest reliability was confirmed using data from 21 participants who completed the scale twice (r = 0.72 to 0.90). ESSS total scores and subscale scores correlated with RSES and BDI‐II scores (r = −0.30 to 0.55). The ESSS demonstrated substantial constructive validity. However, total scores did not significantly correlate with objective physician assessment of self‐stigma.

Significance

The results showed that the eight‐item ESSS has high reliability and validity. This scale could facilitate the examination of factors associated with self‐stigma in PWE, which could inform the development of effective interventions for reducing stigma.

The relationship between social anxiety and felt stigma in patients with epilepsy: A network analysis

PURPOSE

Felt stigma and social anxiety are both common in patients with epilepsy (PWE) and they share an important relationship. Here in the present study, we investigated how social anxiety and different concepts of felt stigma relate to each other in PWE in order to provide some suggestions for the prevention and intervention of social anxiety and felt stigma in PWE.

METHODS

A total of 189 patients with epilepsy were enrolled in our study. Social anxiety was evaluated with the Liebowitz social anxiety scale. Felt stigma was evaluated with the Kilifi stigma scale for epilepsy. The data were subjected to network analysis.

RESULTS

The findings indicated that eight edges with the strongest regularized partial correlations existed in the network, such as the edge between S3 "Embarrassed" and S4 "Disappointed", and the edge between S14 "Discriminate" and S15 "Outcast". In addition, S10 "Inferior" and S11 "Avoid" had the highest strength and predictability. The flow network of social anxiety indicated that most concepts of felt stigma were directly connected with social anxiety. The strongest edge existed between S8 "Uncomfortable" and social anxiety, while S6 "Society" and S5 "Rewarding life" were also closely connected with social anxiety.

CONCLUSION

The current study highlighted the critical central concept S10 "Inferior" and critical concepts associated with social anxiety, including S8 "Uncomfortable", S6 "Society" and S5 "Rewarding life". The findings revealed in this study may offer some help in the clinical prevention and intervention of felt stigma and social anxiety in PWE. However, all of the conclusions above need further confirmatory studies to validate them.

Improving public stigma, sociocultural beliefs, and social identity for people with epilepsy in the Aseer region of Saudi Arabia

•

An update of the data reported previously in 2016 in Aseer region.

•

The level of education and awareness regarding epilepsy in Aseer region has improved recently.

•

The belief in spiritual and traditional therapies has decreased, considering them as additional options.

Differences in the sociocultural practice and biases against people with epilepsy (PWE) largely contribute to the development of stigmatization. In this study, we evaluated factors that impact stigma for PWE involved in evolution and maintenance to report changes in the public awareness and cultural practices. We performed a cross-sectional study in which data were collected from a self-administered electronic survey composed of 33 items targeting the population in the Aseer region. Feedback response was obtained from 937 respondents. Of these, 921 participants (98.3%) had heard or read about the disorder previously. Approximately 84.8% believed that epilepsy was one of the brain disorders. 95.8% disagreed that epilepsy was due to a contagious disease. However, 40.1% of the responders were convinced that it was the result of a spiritual reason. Still, more than 9% believed treating PWE should be approached spiritually. About 75% felt that epilepsy could be the results of a test delievered by God. In addition to the clinical impact from seizures in PWE, it carries a social label and public stigma that influences one's social prognosis. Raising awareness through campaigns would improve the knowledge and practices of the population and hence provide a healthier environment for PWE, alleviating feelings of stigma, and improving their quality of life.

Patient empowerment as capabilities: The perspective of patients with epilepsy at a medical-social center in France

The aim of the study was to develop a new conceptual framework of empowerment based upon the perspective of patients with refractory epilepsy at the medical-social center of La Teppe (France). A qualitative research methodology was used, which consisted of focused ethnography and in-depth interviews. The 19 patients interviewed came from three hospital services and were in the age range of 20-60. Ten interviews were also conducted with healthcare providers, which included neurologists, psychiatrists, nurses, and social educators. Results were analyzed via an intuitive process of thematic analysis. The researcher also constructed narrative cases of the patient interview to better understand patient responses in context. The results show that patients understood empowerment as the ability to develop and take advantage of opportunities in their overall lives. This included searching to be healthy by reducing their seizures, developing their practical reason in order to be able to make more autonomous life choices, and living with and toward others in positive social relationships. The patient's perspective on empowerment encompasses but also goes beyond their medical care. We therefore propose a novel conceptual framework for empowerment as the patient's capabilities to develop and make their life choices, with help as needed from their support network. In order to help patients toward empowerment, clinical care can include discussions and dedicate resources that help patients work toward their overall life projects. Several methodologies, including the use of a personalized project and therapeutic patient education, are elaborated to give ideas for empowerment programming in epilepsy care.

Community integration, self-esteem, and perceived stigma in a Nigerian sample with epilepsy

OBJECTIVE

The objective of the study was to investigate the levels, interrelationships, and associated factors of community integration (CI), perceived stigma (PS), and self-esteem in people living with epilepsy (PWE) in Anambra and Enugu States of south-east Nigeria.

METHODS

This was a cross-sectional survey involving 70 consenting adults living with epilepsy consecutively recruited from three purposively sampled specialized clinics in Anambra State. The Reintegration to Normal Living Index, the Epilepsy Stigma Scale, and the Rosenberg Self-Esteem Scale were used to estimate CI, PS, and self-esteem, respectively among the participants. Data were analyzed at 0.05 level of significance.

RESULTS

The mean age of the participants (28.6% females) was 34.91 ± 16.21 years. The participants had moderate PS score (43.54 ± 14.20), poor self-esteem score (17.63 ± 6.12), and mild-to-moderately restricted CI score (67.83 ± 24.72). Participants' PS, CI, and self-esteem significantly correlated with one another (p < 0.05) with PS and self-esteem being significant predictors of CI. Participants' PS had a significant correlation with their age at onset of epilepsy, while their self-esteem and CI significantly correlated with their seizure episodes (p < 0.05). Participants' PS and CI were significantly different across different categories of their occupational and educational statuses. Perceived stigma also varied across participants' marital status with divorced participants having the worst score (p < 0.05).

CONCLUSION

People living with epilepsy had moderate PS, poor self-esteem, and mild-to-moderate CI, which correlated significantly with one another. Results suggest the possibility of using CI as an outcome for assessing the effectiveness of stigma and self-esteem interventions during epilepsy rehabilitation.

Validity and reliability of the Turkish version of Public Attitudes Toward Epilepsy scale

OBJECTIVE

This study was conducted to test the validity and reliability of the Turkish version of the Public Attitudes Toward Epilepsy (PATE) scale, which aims to understand public perceptions of seizures and epilepsy.

METHODS

The scale was translated following the standard procedures. For psychometric validation, the Turkish version of the PATE scale was administered to 201 native Turkish speakers above the age of 18 who had no history of seizures or epilepsy. It was found that the respondents were able to fill out the scale quickly and without difficulty in understanding the translated items on the scale.

RESULTS

Cronbach's alpha coefficient was found to be 0.843 for the overall scale and above 0.7 for each individual item. Cronbach's alpha was 0.78 for the general domain and 0.792 for the personal domain. Exploratory and confirmatory factor analyses were carried out and showed that the scale had a structure similar to that of the original scale, with the 14 items grouped under two dimensions, similar to the original scale.

CONCLUSION

The Turkish version of the PATE scale was a valid and reliable tool to measure the attitudes toward epilepsy in Turkish society.

The self-stigma of patients with epilepsy in Japan: A qualitative approach

The mental health of patients with epilepsy represents a substantial public health concern in Japan. For instance, the Japanese term for epilepsy, "tenkan", has the negative meaning of "mad" and "a violent temperament that is apt to be infatuated". Although epilepsy is now understood as a disease caused by abnormal neuronal activity in the brain, discrimination and stigma against people with epilepsy remain deeply rooted in Japanese culture. Understandably, this stigma can have a serious impact on the psychology and behavior of individuals with epilepsy. To our knowledge, no studies have clarified the formation process or examined the treatment of self-stigma in patients with epilepsy in Japan. Characterizing coping strategies and examining methods for reducing self-stigma will increase our understanding of the experiences of patients and facilitate effective psychiatric rehabilitation. Accordingly, the purpose of our study was to investigate the quality and degree of cognition regarding self-stigma and to examine coping strategies in patients with epilepsy living in the community. The participants were psychiatric outpatients aged 20-65 years who had been diagnosed with epilepsy and visited our psychiatric outpatient clinic between October 1 and December 31, 2016. We conducted semi-structured interviews with 20 patients who consented to participate. For data analysis, we used the content analysis method proposed. Our study revealed details of self-stigma in patients with epilepsy. Patients and their families are often aware of the presence of this self-stigma, and many do not know how to address it. In this study, we qualitatively examined self-stigma in patients with epilepsy on the basis of patient narratives. Per our findings, we would like to examine intervention methods for reducing self-stigma in patients with epilepsy.

Standing up to stigma in epilepsy

This article explores the nature of stigma and discusses how stigma negatively affects both adults and children with epilepsy.

Overprotection and determinants of overprotection in adults with epilepsy

PURPOSE

To examine the perceived overprotection of adult people with epilepsy (PWE) by using a specifically developed novel scale. The study also investigated whether perceived overprotection is associated with particular demographic or clinical variables.

METHODS

This cross-sectional study is based on responses from 200 adult PWE. The participants completed a clinical-demographic questionnaire, the perceived overprotection scale, felt-stigma scale, concealment of epilepsy scale and epilepsy concern scale.

RESULTS

One-way ANOVA results show that perceived overprotection was significantly greater among participants with lower income and levels of education. The highest number of affirmative responses in the perceived overprotection scale were related to going out alone and being given fewer family responsibilities due to epilepsy. Hierarchical regression results show that concerns related to social life and to future and occupation were significant predictors of high perceived overprotection.

CONCLUSION

Psycho-social factors, specifically concerns, seem to be more important than epilepsy-related variables in explaining perceived overprotection in adult PWE.

Mood variations and personality traits in patients with epilepsy over the course of their menstrual cycle

INTRODUCTION

The incidence of mood disorders and psychopathology is more frequent in patients with epilepsy (PWE) than in the general population. Also, it has been reported that PWE suffer more seizures during certain phases of their menstrual cycle (MC). Still, limited information exists regarding the relationship between the physical and emotional changes during the MC in PWE. Therefore, in this study, we aimed to evaluate the mood and personality traits of PWE during their MC and to compare them with controls.

METHODS

A cohort of 22 PWE and nine controls was gathered. All the participants underwent psychiatric, electroencephalographic, and gynecological evaluations.

RESULTS

Overall, PWE scored higher in depression compared with controls (p < 0.05), PWE also obtained higher scores for the personality traits of neuroticism and self-isolation (p < 0.05). During the evaluation of the symptoms of premenstrual syndrome (PMS), PWE were more symptomatic during the early follicular (EF) phase in comparison with the rest of the phases of their MC, whereas the control group showed the known premenstrual pattern of symptoms during the late luteal (LL) phase. The frequency of seizures (40.6%) and electroencephalographic abnormalities (34.8%) was also higher during the EF phase of the MC when compared with the other phases of the MC (p < 0.05).

CONCLUSIONS

The results of this study suggest that unlike the PMS present in women without epilepsy, PWE appear to show a "menstrual syndrome" that consists of similar mood changes and physical symptoms. This arrangement of symptoms seems to have an impact on the increase in seizure activity.

Social impairment and stigma in genetic generalized epilepsies

INTRODUCTION

Patients with epilepsy have poor social outcome. Multifactorial factors are usually involved, but among them, stigma features may have an important role. Genetic generalized epilepsies (GGEs) were previously considered "benign" syndromes. The aim of our study was to assess social impairment and stigma in GGE and to evaluate differences between the following GGE subsyndromes: juvenile myoclonic epilepsy (JME), juvenile absence epilepsy (JAE), and generalized tonic-clonic seizures alone (GTCSA). Additionally, we compared these outcomes with outcomes from a cohort of patients with epilepsy with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS), a severe and difficult-to-treat syndrome. Results were compared with social data from the general population.

METHODS

Adult patients with epilepsy with a previously classified GGE or MTLE-HS were consecutively invited to fill in a sociodemographic and stigma questionnaire in outpatient clinic. Clinical data and psychiatric comorbidities were retrieved from clinical notes.

RESULTS

Questionnaires from 333 patients were obtained: 226/67% from patients with GGE (JME: 106/31.8%, GTCSA: 74/22.2%, and JAE: 46/13.8%) and 107/32.1% from patients with MTLE-HS. We found that patients with GGE have a good academic achievement but they have increased difficulties in finding a partner, higher rates of divorce, and a reduced number of children per woman and per man when compared with general population. We also observed that patients with GGE have higher rates of unemployment (22.6%) and lower monthly income than general population. Severe problems in housing were only seen in GGEs. Of these, 3 patients (1.3%) were in homeless condition. Over half (52%) of patients with MTLE-HS and over a quarter (28%) of patients with GGE experienced felt stigma. Psychiatric comorbidity was highly prevalent among GGE (34.1%), especially in patients with refractory epilepsy. Mood and anxiety disorders were the most prevalent conditions. No other significant differences were found between GGE subsyndromes.

DISCUSSION

We found an impairment in every social domain assessed (except in level of education) when compared with general population. Most of the social outcome parameters were unexpectedly close or similar to MTLE-HS or even worse as it was the prevalence of homelessness among GGE. Social impairment is underdiagnosed and might be considered in clinical practice even in syndromes for some time considered benign such as GGE.

Risk and protective factors related to stigma among people with epilepsy: An integrative review

INTRODUCTION

Stigma is a critical issue among people with epilepsy (PWE). There is a need to undertake an integrative review of the factors associated with stigma, as it is experienced subjectively, and cannot be fully understood through quantitative research alone. The aims of this study were to explore the factors influencing epilepsy-associated stigma and to extend our understanding of stigma using an integrative review approach.

METHODS

Three databases (i.e., CINAHL, PubMed, and PsycINFO) were searched for articles published from January 2010 through December 2018 on stigma among PWE. Selected articles were assessed for quality using the mixed-method appraisal tool. The matrix method was used for data extraction and analysis. Overall, the process of the review was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

RESULTS

Overall, 26 studies were included in this review: four qualitative studies, twenty-one quantitative studies, and one mixed-method study. Several factors associated with stigma were found, divided into four categories across two main aspects: individual (i.e., disease and social characteristics) and community (i.e., overall impression/beliefs regarding epilepsy and social networks) based on the Framework Integrating Normative Influences on Stigma.

CONCLUSIONS

The impression of and beliefs about epilepsy among the general population as well as among PWE were the primary factors affecting stigma. Thus, there is a need for the provision of accurate information about epilepsy to both these groups. Additional studies on epilepsy-associated stigma employing various methodological approaches are required.

Disclosure strategies in adults with epilepsy when telling, "I have epilepsy": The How2tell study

OBJECTIVE

To generate evidence-based knowledge about the strategies that adult people with epilepsy (PWEs) use in the process of telling others about their epilepsy.

METHODS

In-depth, one-to-one interviews explored PWEs' first-hand experiences of self-disclosure (or not), and grounded theory methods of inductive-deductive analysis were used to identify strategies used in disclosing. Interviews were audio-recorded, transcribed, coded, and independently recoded by two researchers using a coding framework specifically developed in this study. To account for maximum variation, PWEs (aged 18+ years) with different life experiences and situations relating to (1) gender, (2) age, (3) employment status, (4) personal relationships, (5) family relationship, (6) support group involvement, and (7) seizure frequency were included. Given the many variables and psychosocial issues associated with epilepsy, demographic details and validated measures including Quality of Life in Epilepsy-10-P, Coping Inventory of Stressful Situations-Adult, and Patient Health Questionnaire-9 were used to describe the characteristics of participants and to contextualize the results.

RESULTS

Forty-nine adults with epilepsy participated. Data analysis revealed six interrelated categories (with subcategories) of the strategies that PWEs reported using in the process of disclosure: (1) concerns about disclosing; (2) weighing up who and when to tell; (3) opportunities for telling; (4) moment of disclosure-how to construct the message; (5) tailoring the message to audience needs-altering the message when telling family members, partner, friends, children, or employer and workplace colleagues; and (6) managing reactions by making it ordinary.

SIGNIFICANCE

People with epilepsy use a range of different strategies during the process of disclosing their epilepsy. These strategies were used to inform the development of the How2tell multimedia self-management resource for PWEs on self-disclosure in everyday social and life situations. How2tell is designed to benefit PWEs by empowering them with practical information about the process of telling another person, "I have epilepsy."

Epilepsy-associated stigma from the perspective of people with epilepsy and the community in Italy

OBJECTIVE

The objective of this study was to assess the stigma related to epilepsy from the perspective of people with epilepsy (PWE) and from the Italian community (Rome and central Italy); moreover, the impact of the perceived stigma on the mood and quality of life of patients was also evaluated.

MATERIALS AND METHODS

We consecutively enrolled 100 PWE and 202 nonepileptic subjects (NES). Both PWE and NES completed an Italian version of the Stigma Scale of Epilepsy (SSE), a 24-items questionnaire that has been demonstrated to allow the quantification of the stigma perception by patients and people from the community. Moreover, the PWE fulfilled a 3-item Jacoby's Stigma Scale, the Quality of Life in Epilepsy-31 (QOLIE-31 [Q3])), and Beck Depression Inventory II (BDI-II) questionnaires for the evaluation of the quality of life and depressive symptoms. The results of the SSE were correlated with clinical and demographic details of PWE and NES, as well as the Q31 and BDI-II scores in PWE.

RESULTS

The SSE scores were significantly higher in NES with respect to PWE (respectively 47.1 vs 39.5, p < .001). Forty-two percent of PWE reported feeling stigmatized, with 5% reporting feeling highly stigmatized. In PWE, the perceived stigma was not correlated with seizure frequency but was significantly associated with worse quality of life, more severe depressive symptoms, and higher number of AEDs. The multiple regression analysis showed that the quality-of-life overall score and Q31 subscale exploring "social function" are the most significant predictors of stigma.

CONCLUSIONS

By using an Italian translation of the SSE questionnaire, even if we cannot consider our sample representative of the whole Italian community our study evidenced higher rates of stigma related to epilepsy in NES than in PWE. The PWE still experience feelings of stigmatization strongly correlated with higher depressive symptoms and worse quality of life that has proven to be the most significant predictor of stigma. Finally, seizure frequency does not affect the perceived stigma, which is instead significantly influenced by antiepileptic therapy.

Stigma, emotional aspects, and psychological symptoms in individuals with epilepsy

The relationship between stigma and psychological aspects in adults with epilepsy is poorly studied. The Stigma Scale of Epilepsy (SSE) was related to the Factorial Neuroticism Scale (FNS), Symptoms Assessment Scale-40 (SAS-40), and clinical aspects of 71 individuals with epilepsy, at a significance level of p < 0.05. Clinical and sociodemographic aspects are associated with the presence of psychological symptoms and emotional maladjustment. The occurrence of psychological symptoms in the SAS-40 was associated with uncontrolled seizures, longer illness duration, and perception of greater stigma. There was a relationship between perceived stigma, age, and epilepsy duration. In the linear regression for determining the factors that potentially affected perception of stigma, the symptom dimensions 'somatization' in the SAS-40 (p < 0.001) and the 'psychosocial maladjustment' in the FNS (p = 0.012) were included, and the clinical aspects were excluded. Psychological symptoms were associated with uncontrolled seizures and perceived stigma. Perception of stigma was associated with somatization and psychosocial maladjustment.

Arts-based knowledge translation in aerial silk to promote epilepsy awareness

INTRODUCTION

Arts-based knowledge translation (ABKT) strategies represent an innovative approach to disseminate results of qualitative studies, especially to tackle social issues, such as stigma and prejudice, due to knowledge gaps. Epilepsy affects 1% of the world population and brings a strong psychosocial impact to the patient, family members, and caregivers. People with epilepsy have difficulties to establish social relationships due to stigma.

METHODS

In this study, we narrate the construction of an aerial and contemporary dance based on the results of a qualitative study with patients with epilepsy, their families, and health professionals, called "'Dialogue with Emotions' to overcome barriers and to improve quality of life in epilepsy". Under the ABKT classification, this study is defined as a strategy of subjective key messages, which are presented as active performances (contemporary dance and aerial acrobacies).

RESULTS

In this sense, the choreography called "Perspective" presented elements that relate to suffering, pain, fear, social isolation, followed by mutual support, resilience, adaptation, and happiness. Through its scenic poetry and acrobatics combined with special lighting effect and soundtrack, this choreography represents the potential to overcome suffering and experience happiness if people embrace a different perspective over epilepsy.

CONCLUSION

This presentation conveyed perceptions on epilepsy in a way to create an experience for its audience. It represented an opportunity to stimulate reflection, discussion, and knowledge construction between members of the academy, as well as patients and caregivers. Thus, this artistic presentation was able to promote discussions about epilepsy, disseminating research results, promoting empathy and compassion.

Correlates of stigma in adults with epilepsy: A systematic review of quantitative studies

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.

Development of the perceived stigma scale and the concealment of epilepsy scale for the Turkish population

The aim of this study was to develop two culture-specific scales to measure the level of felt stigma, and level of concealment of Turkish adult people with epilepsy (PWE). For this purpose, a 10-item felt-stigma scale and a 17-item disclosure of epilepsy scale were developed and then applied to 200 adult PWE. After item and factor analyses of the stigma scale, the 10 items with a one-factor solution explained 45.6% of the variance with a 0.86 internal consistency value. Higher scores represent higher felt stigma. The concealment of epilepsy scale has 17 items loaded on one factor, which explained 45.1% of the variance. Cronbach's alpha coefficient was found to be 0.92. The higher the score, the higher the concealment of illness by the participant. For convergent validity, the relationship between stigma and disclosure scales was examined, and a positive significant relation (r=0.64, p<0.000) was found.

Epidemiological profile of epilepsy in low income populations

Epilepsy is a global disease with an unequal distribution. About 80% of the affected individuals reside in low and middle income countries. The incidence and prevalence of epilepsy in low income populations is higher than in the rest of the world, this is partly explained by some risk factors such as head trauma, perinatal injury and CNS infections, which are more common in poor regions, especially in rural areas. Epilepsy is considered a treatable condition with high rates of therapeutic response. About three fourths of patients achieve control of the disease with the use of antiepileptic drugs, however, despite this benign prognosis, over 75% of patients from low income populations do not receive treatment at all. The cultural beliefs, the inequity in the distribution of public health services, the inadequate supply of antiepileptic drugs, the low number of neurologists involved in the attention of epilepsy, and the social stigma, are the main reasons that increase the treatment gap and the burden of disease in low income populations with epilepsy. We conducted a narrative review regarding the epidemiology of epilepsy in low income populations by searching PubMed, EMBASE, Google Scholar and thoroughly examining relevant bibliographies. This review aims to summarize the main epidemiological aspects of epilepsy in LMIC, emphasizing on incidence, prevalence, socio-demographic profile, TG, social stigma and QoL.

Correlates of perceived stigma for people living with epilepsy: A meta-analysis

OBJECTIVE

Epilepsy, one of the most common, serious chronic neurological diseases, is accompanied by different levels of perceived stigma that affects people in almost all age groups. This stigma can negatively impact the physical and mental health of people living with epilepsy (PLWE). Good knowledge of perceived stigma for PLWE is important. In this study, we conducted a meta-analysis to identify the correlates of perceived stigma for PLWE.

METHODS

Studies on factors associated with perceived stigma for PLWE, including sociodemographic, psychosocial, and disease-related variables, were searched in PubMed, PsychINFO, EMBASE, and Web of Science.

RESULTS

Nineteen variables (k>1) were included in the meta-analysis. For sociodemographic characteristics, findings revealed that the significant weighted mean correlation (R) for "residence" and "poor financial status" were 0.177 and 0.286, respectively. For disease-related characteristics, all variables of significance, including "seizure severity," "seizure frequency," "number of medicines," and "adverse event" (R ranging from 0.190 to 0.362), were positively correlated with perceived stigma. For psychosocial characteristics, "depression" and "anxiety" with R values of 0.414 and 0.369 were significantly associated with perceived stigma. In addition, "social support," "quality of life (QOLIE-31,89)," "knowledge," and "attitude," with R values ranging from -0.444 to -0.200 indicating negative correlation with perceived stigma.

CONCLUSION

The current meta-analysis evaluated the correlates of perceived stigma for PLWE. Results can serve as a basis for policymakers and healthcare professionals for formulating health promotion and prevention strategies.