Depression and Altered Quality of Life in Women with Epilepsy of Childbearing Age

Abstract

Summary:Purpose: To calculate the prevalence of depression in a referral population of women of childbearing age, to define the factors associated with depression, and to assess health-related quality of life (HRQOL) in the same population.Methods: The 642 consecutive women with epilepsy aged 18-55 years were enrolled by 40 neurologists over an 8-month period and asked to give details on selected demographic and clinical features regarding the disease, any associated clinical condition, and any drug treatment. Depression was diagnosed by using the Hamilton depression scale and HRQOL was measured through the SF-36 form. Demographic, clinical, and therapeutic risk factors for depression were searched for within the study population.Results: Depression (any severity) was present at interview in 242 women, giving a prevalence rate of 37.7% [95% confidence interval (CI), 33.9-41.6]. Mild depression was reported by 18.5% of women, moderate depression by 8.6%, major depression by 10.3%, and severe depression by 0.3%. Factors found to be independently associated with depression (any severity) included treatment of associated conditions [relative risk (RR), 1.5; 95% CI, 1.2-1.8), concurrent disability (RR, 1.3; 95% CI, 1.0-1.6), seizures in the preceding 6 months (RR, 1.4; 95% CI, 1.1-1.7), and being unemployed or a housewife (RR, 1.3; 95% CI, 1.0-1.5). Factors associated with moderate to severe depression included treatment for associated conditions (RR, 2.0; 95% CI, 1.4-2.7), seizures in the preceding 6 months (RR, 1.7; 95% CI, 1.2-2.5), and being unemployed or a housewife (RR, 1.6; 95% CI, 1.1-2.2). Compared with normal women of similar age, patients with epilepsy tended to present lower scores for each HRQOL domain (mostly Role Physical, General Health, Social Functioning, and Role Emotional). However, when the analysis was limited to nondepressed women with epilepsy, any difference disappeared.Conclusions: Women with epilepsy of childbearing age are at high risk of depression. Factors associated with depression include lack of occupation, the presence of an underlying disabling condition (with treatment), and the severity of epilepsy. Compared with the general population, depressed women have greater impairment of HRQOL with epilepsy, which reflects the physical, social, and emotional implications of the disease. Key Words: Depression-Epilepsy-HRQOL.The association between epilepsy and depression is well known. The prevalence of interictal depression in patients with epilepsy has been shown to range between 9 and 55%, depending on the sample population and the methods of assessment (1). By contrast, the prevalence of depression in the general population is thought to be 1-3% in men and 2-9% in women (2). A history of depression is significantly more frequent in patients with epilepsy than in nonepilepsy controls (3), and major depression is a risk factor for seizures (4). Several factors have been implicated in the development of depression in patients with epilepsy, including genetic susceptibility, etiology, seizu...

Cellular mechanisms underlying acquired epilepsy: The calcium hypothesis of the induction and maintainance of epilepsy

“…In daily life, both refractory epileptic patients, as well as epileptic patients dealing with constant management issues of treatment, can suffer from limitations in mental and physical functions, difficulties in employment status of both the individual and the family caregivers and altered interpersonal relationships at work, home, and school (Cramer et al, 1999;Buelow, 2001). Thus, the stigma associated with epilepsy, as well as functional disabilities of the disease, can greatly diminish the quality of life of persons with epilepsy (Beghi et al, 2004;Benavente-Aguilar et al, 2004;McEwan et al, 2004). …”

Women with epilepsy: clinically relevant issues

“…The overall prevalence rate of psychiatric conditions in epilepsy ranges between 20-30% and 50-60%, according to different estimates (Jones et al, 2010;Karouni et al, 2010). Depression has a particularly high prevalence rate in patients with epilepsy, and WWE are at increased risk of developing depression (Beghi et al, 2004). Moreover, symptoms of depression have been reported by WWE before and after pregnancy (Reiter et al, 2013).…”

Quality of Life and Psychiatric Aspects in Epilepsy

“…Factors associated with depression include lack of occupation, the presence of an underlying disabling condition (with treatment), and the severity of epilepsy. Compared with the general population depressed women have greater impairment of HRQOL with epilepsy, which reflects the physical, social and emotional implications of the disease (Beghi et al, 2004). Several comorbid psychiatric problems accompany the clinical picture in epilepsy.…”