The Relative Impact of Anxiety, Depression, and Clinical Seizure Features on Health‐related Quality of Life in Epilepsy

Abstract

Summary:Purpose: To determine the independent effects of depression and anxiety on health-related quality of life (HRQOL) in epilepsy as well as the relative explanatory power of psychiatric comorbidity compared with demographic and clinical epilepsy variables (e.g., seizure frequency, severity, and chronicity).Methods: Subjects (n = 87) with temporal lobe epilepsy completed self-report measures of depression, anxiety, HRQOL, and seizure severity. Information was derived regarding subjects' seizure frequency, duration, and treatment. HRQOL status (QOLIE-89) was examined in relation to self-reported symptoms of anxiety and depression, clinical seizure features, and demographic characteristics.Results: Depression and anxiety were independently associated with reduced HRQOL. Psychiatric comorbidity explained more variance in HRQOL than did combined groups of clinical seizure or demographic variables. Although weaker in explanatory power than psychiatric comorbidity, several epilepsy factors were nonetheless significantly related to HRQOL, including seizure frequency, severity, and chronicity.Conclusions: Interictal anxiety and depression exert independent adverse effects on HRQOL. In addition, frequent, severe, and chronic seizures reduce HRQOL, but appear less powerful predictors of HRQOL than interictal psychiatric symptoms. Recognition and treatment of comorbid depression and anxiety is an important consideration in improving quality of life in epilepsy.

Epilepsy and quality of life: socio-demographic and clinical aspects, and psychiatric co-morbidity

“…Similarly to some studies 10 , no significant difference was found in the QoL due to the other socio-demographic aspects studied, although other papers 5,[7][8][9]15 reported that an elevated age and low scholastic level were related to a worse QoL.…”

“…Some studies describe an association between poly-therapy and a worse QoL 10,26,27 , particularly in the dimension of seizure worry, which represents a concern with the occurrence of ES, apprehension about possible traumatisms and the social effects of the unpredictability of the ES. However, other studies did not observe this association 8,16 . On the other hand, some authors question the ability to evaluate the impact of AED on the QoL, since this aspect has a very small impact on calculation of the scores in the QOLIE-31 26 .…”

“…Some studies described very low QoL values for female epileptic patients and for females in the general population 9,26 . These lower values could be attributed to different cultures and social support, or could be related to problems with pregnancy and epilepsy 6,8 . However, new studies are required to nullify such questions.…”

“…According to the literature 8,28 , depression was found in an important proportion of the cases, with slight depressive symptoms predominating. It is known that in epileptic patients, depending on the type of population and the diagnostic instruments used, psychiatric disturbances are prevalent and depression is the most frequent co-morbidity 8,17 .…”

Kindling epileptogenesis in immature rats leads to persistent depressive behavior

“…In that study, more than twice as many children with epilepsy (20% compared to 9% of control) reported suicidal ideation. Interictal psychiatric symptoms adversely influence the health-related quality of life to a greater extent than the frequency, severity and chronicity of seizures [7]. Consideration of the psychiatric comorbidities in treatment decisions involving drug selection has been discussed for both adult [8] and pediatric [9] patients with epilepsy.…”