Psychosocial adjustment of people with epilepsy in Hong Kong

Anxiety, depression, and psychosocial adjustment in people with epilepsy

Objective

Effect of psychological disorders on social functioning in people with epilepsy (PWE) is not extensively reported. We evaluate psychosocial functioning in PWE attending an outpatient clinic and aim to understand the differences in psychosocial functioning between anxiety, depression, and coexisting anxiety and depression in PWE.

Materials and Methods

A prospective evaluation of psychosocial functioning of 324 consecutive adult PWE attending outpatient epilepsy clinic was done using self-reported Washington Psychosocial Seizure Inventory. The study population was divided in four groups - without psychological disorders, anxiety, depression, and both anxiety and depression.

Results

The mean age of study population was 25.90 ± 6.22 years. Anxiety was noted in 73 (22.5%), depression in 60 (18.5%), and both anxiety and depression were seen in 70 (21.6%) and the rest had normal psychosocial function. There were no significant differences across all the four sub-groups for sociodemographics. Psychosocial functioning did not differ significantly between PWE with normal psychosocial function and PWE with anxiety alone. However, psychosocial functioning scores were worse in PWE with depression and PWE with both anxiety and depression when compared to PWE with normal psychosocial function.

Conclusion

In the present study of PWE attending an outpatient epilepsy clinic, one-fifth of PWE had both anxiety and depression. Psychosocial functioning in PWE with anxiety was similar to otherwise healthy/normal PWE, whereas PWE with depression showed poor psychosocial functioning. Role of psychological interventions on psychosocial aspects of epilepsy should be studied extensively in future.

Predictors of Psychosocial Adaptation and Mental Well-Being Among People With Chronic Illnesses and Disabilities in Hong Kong

Psychosocial adaptation to chronic illness and disability (CID) involves a complex interplay of the client’s background factors with resilience and coping. To date, there have been few studies on psychosocial adaptation to CID in the Chinese context. To examine the predictors of psychosocial adaptation, we surveyed people with CID from community-rehabilitation settings and self-help groups ( N = 224). The research questionnaire collected information on demographics, health-related factors, social support, resilience, coping strategies, psychosocial adaptation, and mental well-being. Resilience, coping strategies, health-related factors, and sex were found to be important predictors of psychosocial adaptation. Using structural equation modeling (SEM), we tested a conceptual model on how social support and health-related factors predict adjustment variables (resilience and coping strategies), which further affect psychosocial adaptation and mental well-being. All the variables are closely linked and the path coefficients are all significant. An overall fair model fit (comparative fit index [CFI] = 0.89; root mean square error of approximation [RMSEA] = 0.089) was obtained. The results provide support for the conceptual model we proposed based on health-related coping and the phase model of psychosocial adaptation. The key predictors of psychosocial adaptation and mental well-being in Chinese people with CID in Hong Kong are similar to those identified in non-Chinese studies.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Impact of an Epilepsy Educational Programme on Coping Mechanism, Attitude, Knowledge and Awareness: A Rural Sabah Experience

Epilepsy is a disabling disease which has not been adequately emphasised as a public health concern. Patients are often left in the dark about their disease, affecting their ability to cope and live a normal life. This study aimed to explore and evaluate the effects of a structured epilepsy education programme (EEP) on awareness, knowledge and attitude (AKA) and coping mechanism of patients. Recruited participants were required to complete the modified Malay AKA epilepsy questionnaire and Malay brief coping orientation to problem experienced (Brief COPE)-27. Upon completion, they received a structured EEP conducted by trained personnel using validated materials. Participants were then followed up for a period of 6 months and reassessed at 1, 3 and 6 months to measure any changes in their AKA and coping mechanisms. Twenty-two participants were successfully recruited. Total AKA score of participants showed a significant increase (mean score difference = 16.3, p = 0.021, 95% CI: 3.0, 28.1) at 6 months post-EEP. This improvement was mostly contributed by the increase in both knowledge and attitude scores. Religion was the most preferred coping mechanism (82.5%), followed by instrumental support, emotional support, active coping and acceptance at 75.0%, respectively. Only three domains showed significant differences after the educational programme: planning: 62.5% versus 77.5%, p = 0.026; denial: 57.5% versus 37.5%, p = 0.004; venting: 62.5% versus 52.5%, p = 0.004. The EEP was effective in improving attitude and knowledge while bringing about changes in coping skills of patients over a period of time. Educational programmes should be part of epilepsy standard of care, especially as they are inexpensive and brief yet impactful

Impact of choice of coping strategies and family functioning on psychosocial function of young people with epilepsy

Both medical and psychological factors have an important impact upon the psychosocial functioning of young people with epilepsy. The purpose of this study was to identify factors that distinguish young people with epilepsy and high psychosocial functioning from those with lower levels. The participants were 114 young people (40 males, 74 females) with active epilepsy and a mean age of 17.92years (SD=3.90) who completed either a paper (60.5%) or a web-based survey (39.5%) comprising demographic, medical, and psychosocial measures. Psychosocial measures included family functioning, adolescent coping, anxiety, depression, and quality of life. A latent class analysis produced two psychosocial functioning groups based on participants' scores for anxiety, depression, and quality of life. Young people were more likely to be members of the group with poor psychosocial functioning if they had a seizure in the last month (Wald=5.63, p<.05), came from families with lower levels of communication and problem solving (Wald=5.28, p<.05), and made greater use of non-productive (emotion-focused) coping strategies such as wishful thinking, withdrawal, and worry (Wald=12.00, p<.01). The findings suggest that, in addition to standard medical treatment, clinicians may promote better outcomes by strengthening family functioning and encouraging less use of nonproductive coping strategies.

Quality of life in adult patients with epilepsy and their family members

PURPOSE

Epilepsy is not only a neurological disorder but may also have negative psychosocial consequences on people with epilepsy (PWE) and their relatives. Epilepsy has a major impact on quality of life (QoL) in PWE and family members. However, less is known about the impact of family support and family functioning on quality of life for PWE and family members and their interaction. Therefore, the study aimed to investigate factors that influence QoL in hospitalized adult patients with epilepsy and their relatives.

METHOD

An explorative cross-sectional study has been conducted in a tertiary clinic in Switzerland. Hospitalized adult patients with epilepsy and their relatives were enrolled in the study. Subjective QoL as well as family support and family functioning were measured with patients and family members. Patients and their relatives assessed the patients' support need and their satisfaction with the care provided. In addition, patients were administered a disease-related HRQoL measure (QoLIED-36, Version 2). Backward stepwise multivariate linear regression analysis was used to explain variances in patients and relatives' subjective QoL.

RESULTS

One hundred and four dyads of patient and family member participated. Subjective QoL in patients and family members differed significantly, as did satisfaction with care delivery. In both groups family support contributed significantly to QoL. In the models 40% of the variance in QoL in patients and relatives could be explained. While the quality of life of the family members was affected by the patients' knowledge about the disease and the reason for their current hospitalization, patient QoL scores had no influence on the QoL of family members. The patients' QoL, however, depended significantly on the QoL of the family members.

CONCLUSION

Interventions should address both PWE and family members and focus on the self-care improvement of PWE and the well-being and coping of family members. A patient-centred approach needs to include both the PWE and the relatives and address family support in order to alleviate stress in the patients and relatives alike.

The stigma of people with epilepsy is demonstrated at the internalized, interpersonal and institutional levels in a specific sociocultural context: findings from an ethnographic study in rural China

Epilepsy is a common chronic neurological disease. One of its characteristics is that it can bring severe stigma for patients. At the same time as controlling the epileptic seizures, taking appropriate measures to reduce the stigma of epilepsy is an important aspect of any comprehensive intervention strategy. We examined the views of 106 participants of different target groups, including patients with epilepsy (PWE), their family members, neighbors, teachers, employers, community administrators, doctors and nurses, using one-to-one in-depth interviews and group discussions. The discussions covered the following aspects related to epilepsy: the participants' understanding of epilepsy, the patients' own perception of epilepsy, attitudes of the surrounding people, the social and cultural environment, social support available to them, and government regulations and policies. We found that the stigma of epilepsy is a very negative self-feeling from the patients' perspective. Many complex and diverse factors determine its formation and severity. The stigma of epilepsy, in a particular social and cultural context, can be demonstrated at the internalized, interpersonal and institutional levels. Hence, we suggest that effective measures to alleviate stigma should be based on ways of eliminating factors that cause institutional stigma. Additionally, depending on the specific circumstances of PWE, a personalized approach to eliminate factors that cause internalized and interpersonal stigma needs to be adopted. Only by addressing impacting factors at each of these three levels can the stigma of PWE in China be alleviated or even eliminated.

Personality traits and social behaviors predict the psychological adjustment of Chinese people with epilepsy

Very little is known about the psychosocial correlates of psychological morbidity among Chinese people with epilepsy (PWE). No studies have investigated the association between social relationships and psychological morbidity, while most studies examined only the negative impact of maladaptive personalities on psychological adjustment in PWE. This study examined the association of psychological morbidity with a broad array of personality traits and social skills in a sample of 54 Chinese PWE. Respondents completed the Temperament and Character Inventory (TCI), the Social Performance Survey Schedule (SPSS), and the Hospital Anxiety and Depression Scale (HADS) via semi-structured interview. Regression analyses revealed that, independent of demographic and medical variables and perceived impact, Harm Avoidance was positively associated with anxiety and depression whereas Self-Directedness was negatively associated with anxiety and depression; that Cooperativeness was inversely associated with anxiety. Social skills were inversely associated with depression whereas negative social skills were inversely associated with anxiety. Clinical implications of adaptive personality traits and social skills functioning are discussed.

Striving for balance: coping with epilepsy in Iranian patients

Patients with epilepsy are subject to a wide range of distinctive psychosocial consequences, which can be more harmful than the seizures themselves and other medical difficulties accompanying them. This qualitative study was aimed at identifying coping strategies employed by 21 Iranian adults with epilepsy. The study participants were chosen by purposeful sampling from hospitals, neurologists' clinics, rural health care facilities, and epilepsy associations. Data were collected through semistructured interviews. A qualitative content analysis method was used to analyze the gathered data. The analysis resulted in the emergence of six themes and seven subthemes: confronting the disease using religious sentiment, seeking support, fighting the disease, defending oneself against the disease, concealing the disease, and expressing emotions. The findings showed that the participants used an emotion-focused approach more often than a problem-focused approach as a coping strategy. The results will improve health care professionals' knowledge of how Iranian patients cope with epilepsy and help them to design nursing care models to promote successful coping strategies for patients.

Behavioral risk factors among Arizonans with epilepsy: Behavioral Risk Factor Surveillance System 2005/2006

Modifiable risk factors to help improve health outcomes for people with epilepsy in Arizona were identified using the 2005-2006 Arizona Behavioral Risk Factor Surveillance System (BRFSS). Of 9524 adults who participated in this survey, 125 reported ever being diagnosed with epilepsy (lifetime prevalence=1.3%, 95% CI=1.1-1.6%). Individuals with active epilepsy (those who had seizures in the prior 3 months and/or were taking anticonvulsants) had an overall lower quality of life. This likely resulted from a large number of medical comorbidities and poor mental and physical health days. Regression models suggested that for individuals with active epilepsy, physical activity was associated with fewer activity-limited days, whereas for individuals with inactive epilepsy, medical comorbidity was positively associated with activity-limited days. Further research is needed to increase the reliability of the findings.

Health-related quality of life of patients with epilepsy in Turkey

The aim of this study was to measure the health related quality of life (HRQOL) of epilepsy patients and to compare it with that of a healthy control group. The evaluation included the effects of the type of seizure, duration of seizure and medical treatment on the quality of life of the patients. The group studied consisted of 221 participants (121 epilepsy patients and 100 healthy control individuals) who completed a sociodemographic data form and who were administered the World Health Organization Quality of Life (WHOQOL-100) scale. The epilepsy patients had statistically lower physical health, psychological well-being, level of independence and global HRQOL than participants in the control group (p<0.05). The analysis of variance showed that the partial epilepsy subgroup had significantly lower averages for all the quality-of-life subfields except for the social relationship dimension. On regression analysis, being married, having a generalized type of seizure and being treated with fewer medications were all related to higher scores on the HRQOL. Epilepsy is a disease that has neurological, psychiatric and psychosocial dimensions that should be evaluated using a multidisciplinary approach.

Health-related quality of life of children with epilepsy in Hong Kong: how does it compare with that of youth with epilepsy in Canada?

OBJECTIVE

The primary aim of our study was to compare the health-related quality of life (HRQL) of children with epilepsy in Hong Kong with that of children with epilepsy in Canada, and to explore possible factors affecting these findings. A second interest was to determine agreement between proxy reports and self-ratings among children with epilepsy in Hong Kong, compare these with findings in Canada, and identify factors that influence the concordance.

METHODS

Child self-report and parent-proxy questionnaires on an epilepsy-specific HRQL measure, appropriately translated and validated in Chinese, were administered to 266 Hong Kong children and their parents. An unpaired t test was used to compare the scores with published results from 381 Canadian children and their parents, who used the original English version of the measure. Demographic characteristics of the two groups were compared using t tests, chi2 tests, and Fisher's exact tests. Agreement between parents' and children's scores was evaluated with intraclass correlation coefficients (ICCs) and standardized response means (SRMs). The total HRQL score differences between parents and children in Hong Kong were compared with those in Canada using an unpaired t test. Factors that might affect the parent-child score difference were studied using Pearson correlation analysis, chi2 test, and analysis of variance. Factors studied included: sex, current age, age at diagnosis, duration of epilepsy, number of antiepileptic drugs used, type of seizure, seizure severity, cognition of the child, the type of school attended, presence of neurological problems, presence of behavioral problems, recent health care usage, education and employment status of both parents, housing status of the family, and relationship of the proxy respondent to the child.

RESULTS

(1) In contrast to the Canadian sample, Hong Kong children with epilepsy were older (P<0.01), had a longer duration of epilepsy (P<0.01) and less severe seizures (P<0.01), and were more likely to attend normal schools (P<0.01). Children in Hong Kong reported more interpersonal/social difficulties (P<0.01), more worries (P<0.01), and more secrecy about their epilepsy (P<0.01). Parents in Hong Kong believed that their children perceived more worries (P<0.01) and were more secretive about their epilepsy (P<0.01). (2) Moderate to good agreement between parent-proxy response scores and child self-report scores was demonstrated (ICC=0.50-0.69, SRM=0.19-0.33). The total HRQL score differences between parent and child in Hong Kong were not different from those in Canada. None of the factors studied were related to the parent-child score difference.

CONCLUSIONS

Youth with epilepsy in Hong Kong and their parents reported poorer quality of life than children with epilepsy in Canada. Further studies are necessary to identify the determinants of HRQL in children with epilepsy in different cultures. Acceptable agreement between the two ratings suggests that proxy reports can be used when child self-reports cannot be obtained.

The brain 5HTergic response to an acute sound stress in rats with generalized (absence and audiogenic) epilepsy

The brain serotoninergic (5HTergic) system of epileptic subjects can influence their vulnerability to stress. We studied the putative dependency of 5HT neurotransmission parameters on emotional stress, and the presence, types and severity of seizures using rats with genetic generalized (absence and/or audiogenic) epilepsy, of WAG/Rij and Wistar strains. The animals were stressed by exposure to a short aversive noise or left without sound stimulation. Tissue concentrations of 5HT, tryptophan (TRT) and 5-hydroxyindolacetic acid (5HIAA) were assessed by HPLC. The stressor activated the 5HTergic system within thalamus (5HIAA elevated), frontal cortex (5HT, TRT elevated), hypothalamus (increased TRT) in all rats. However, the normal (non-epileptic) rats displayed the highest response in the frontal cortex and the lowest one in the thalamus, as compared to the epileptic rats. Absence-epileptic rats exhibited higher thalamic 5HIAA increase than their controls. Significant correlations existed between propensity of absence epilepsy and 5HTergic parameters measured in the cortex and hypothalamus of absence-epileptic rats. No major difference was found between groups with and without audiogenic epilepsy. The results imply that the stress response depends on the presence of epileptic pathology and the seizure type and severity. The brain 5HT may be involved in the control of the paroxysms and behaviour in absence-epileptic subjects.

Health related quality of life in adult patients with epilepsy compared with a general reference population in Taiwan

To compare the health-related quality of life (HRQL) for patients with epilepsy and health subjects, we collected the clinical and demographic data and information on health states by using the Taiwan version of World Health Organization quality of life (WHOQOL)-BREF questionnaire in 296 patients (aged 19-73 years) with confirmed active epilepsy visiting the clinic of National Taiwan University Hospital, and 296 age-, gender-, municipal- and education-matched Taiwanese healthy subjects sampled from a national health interview survey. Multiple regression analyses with stepwise selection strategy were conducted to study risk factors for impairment of HRQL. Patients with epilepsy have poorer HRQL than the healthy population in physical, psychological and social domains but not in environment domain (p<0.005). Patients with less than 4 attacks during the previous 1 month had a better score in the availability and quality of health and social care in environment domain than healthy subjects (p<0.05). After controlling other determinants, seizure frequency, and comobid with other diseases are the important factors in predicting HRQL for epilepsy patients. Patients with employment and married had a significantly better HRQL. Effective control of seizure frequency and thoughtful promotion of positive attitudes in community are essential to improve the HRQL of epilepsy patients.

Predicting the quality of life in Hong Kong Chinese adults with epilepsy

Epilepsy is both a medical diagnosis and a social label. The traditional care of patients with epilepsy tends to focus on seizure control and drug treatment. There is a growing concern in the West about the importance of the influence of psychosocial factors on the quality of life. The main purpose of the present study is to explore and delineate the relationships between biomedical and psychosocial predictors and the health-related quality-of-life outcomes of Chinese patients in Hong Kong. Independent measures consisted of two types of predictors: biomedical and psychosocial variables. The biomedical variables included seizure frequency and the number of years since diagnosis. The psychosocial variables included locus of control, social support, and mood. The Quality of Life in Epilepsy Scale was used as the outcome measure. Correlation and hierarchical regression techniques were used. Results showed that psychosocial variables did make a significantly independent contribution to the prediction of the quality of life of patients with epilepsy. Furthermore, results suggested that mood could act as a mediator between seizure characteristics and psychosocial factors, on the one hand, and quality of life, on the other. The statistical significance of the health locus of control and the satisfaction with social support confirmed the importance of the influence of the subjective sense of mastery of condition on quality of life. The clinical implication was discussed in the context of developing psychological interventions in increasing the self-efficacy and resourcefulness of the patients.