Factors associated with health-related quality of life, anxiety and depression among young adults with epilepsy and mild cognitive impairments in short-term residential care

INTRODUCTION: This study examined associations of health-related quality of life (HRQOL), anxiety, and depression with medical and psychosocial variables. Participants were young adults with epilepsy and additional mild cognitive impairments in short-term residential care of the Bethel Institute, Germany. METHODS: Thirty-six individuals were interviewed using the Quality of Life in Epilepsy Inventory 31 (QOLIE-31), the Hospital Anxiety and Depression Scale (HADS) and the neuroticism scale of the Neo-Five-Factor Inventory (NEO-FFI). Medical as well as socio-demographic data were assembled from client files. RESULTS: Regression analyses revealed neuroticism as the strongest predictor of HRQOL, anxiety and depression. The only variables that additionally explained a substantial proportion of variance counting for 6-10% in the three criteria were age at epilepsy onset and sex: epilepsy onset after the age of 10 years was associated with lower HRQOL and higher anxiety, men suffered from more depression than women. DISCUSSION: Neuroticism as a personality disposition seems to be most influential on HRQOL and anxiety in people with epilepsy and mild cognitive impairment. The impact of sex and age at epilepsy onset on HRQOL, anxiety and depression of this epilepsy subpopulation should be further clarified.     

Effects of psychosocial functioning,depression, seizure frequency,and employment on quality of life in patients with epilepsy

This study aimed to investigate the quality of life (QOL) in patients with epilepsy and its correlation with psychosocial impact, depression, seizure-related items, and living circumstances. One hundred two patients who visited the epilepsy clinic at Nagoya City University Hospital participated in this study. We used the Quality of Life in Epilepsy Inventory-31-P (QOLIE-31-P) as a measure of QOL, the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) as the screening instrument for rapid detection of major depression, and the Side Effects and Life Satisfaction Inventory (SEALS) to evaluate psychosocial functioning, seizure-related items, and living circumstances. Significant correlations of the QOLIE-31-P overall score with these questionnaires and seizure-related or demographic variables were identified and analyzed by stepwise linear regression. The QOLIE-31-P overall score correlated significantly with the NDDI-E, SEALS overall score, number of anticonvulsants, frequency of focal seizure with impairment of consciousness or awareness (focal seizure), sheltered work, and employment. The stepwise linear regression showed that the QOLIE-31-P overall score was explained by the effects of psychosocial functioning, depression, frequency of focal seizure, and employment, in that order, with these factors explaining 74% of the variance. Thus, using both the SEALS and NDDI-E may be useful to detect some aspects of QOL in clinical settings.     

Risk factors for fatigue in patients with epilepsy

Fatigue is highly prevalent in patients with epilepsy and has a major impact on quality of life, but little data is available on its effects and management in epilepsy. To identify the incidence and risk factors of fatigue in patients with epilepsy, 105 epilepsy patients (45 women and 60 men) were enrolled in our study. Demographic and clinical data were collected and psychological variables including fatigue, sleep quality, excess daytime sleepiness, anxiety, and depression were measured by Fatigue Severity Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale, respectively. Of 105 patients, 29.5% exhibited fatigue (FSS score ⩾4). We found no correlation between the occurrence of fatigue and any of our demographic or clinical variables. Fatigue is correlated with low sleep quality, anxiety, and depression, but not with excess daytime sleepiness. Thus, we concluded that fatigue is highly prevalent in patients with epilepsy, and that low sleep quality, anxiety, and depression are significantly correlated with fatigue in epileptics, while excess daytime sleepiness not.     

Sleep disturbances, socioeconomic status, and seizure control as main predictors of quality of life in epilepsy

Improving quality of life is the most important goal for patients with epilepsy. To recognize the factors associated with quality of life in patients with epilepsy in Mexico, we performed a cross-sectional survey using the Quality of Life in Epilepsy 31 (QOLIE-31) inventory to assess the quality of life of 401 adult patients with epilepsy at the National Institute of Neurology and Neurosurgery of Mexico. Clinical and demographical data were collected. Multiple regression was used to determine which factors affected quality of life in our patients. The variables that most strongly predicted a lower QOLIE-31 total score after multiple regression were sleep disorders (P<0.001), socioeconomic status (P<0.001), female gender (P=0.002), and high seizure frequency (P=0.001). In our study, neither depression nor time of evolution of epilepsy had significant influence on QOLIE-31 scores.     

Quality of life and associated factors among adults with epilepsy in Nigeria

OBJECTIVE: Epilepsy is a common condition worldwide and has been observed to affect quality of life (QOL). Though, much has been written on this subject among western populations, little research has been done in developing countries of Africa including Nigeria. The study aims to identify factors associated with quality of life among adult epilepsy patients in this environment. METHOD: Respondents were evaluated using the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), the 30-item General Health Questionnaire (GHQ-30), the modified Mini Mental State Examination (mMMSE),and the Hospital Anxiety and Depression Scale (HADS). Diagnosis of epilepsy was based on clinical and electroencephalographic findings. RESULTS: The mean age of the 51 respondents was 27.7 years (SD = 9.7). Thirteen (25.5%) had an average of 2 seizure episodes in the month preceding the interview, while 37 (72.5%) have had the condition for more than 5 years. Factors that were significantly associated with overall quality of life included being female (p < 0.05), seizure frequency (p < 0.01), using more than 1 anti-epileptic drugs (AEDs) (p < 0.01), GHQ-30 score (p < 0.01), high anxiety score (p < 0.001), and high depression score (p < 0.01). Multiple regression analysis showed that depressive symptoms were the single most important factor explaining low QOL. Other factors were GHQ-30 score, seizure frequency, and being a woman. CONCLUSION: Controlling seizures and paying attention to the psychological needs of adult epileptics will have a positive effect on the QOL among Nigerian epileptics.     

Determinants of quality of life in people with epilepsy in Serbia

PurposeThis study aimed at finding determinants of quality of life in people with epilepsy (PWE) living in Belgrade, Serbia.MethodIn this study, we recruited consecutive adults with epilepsy attending our outpatient department. Adult patients (age range: 18–65 years) of normal intelligence and without any progressive neurological disease or psychiatric disorder were included in the study. They completed the following questionnaires: QOLIE-31 Inventory (Serbian version), Beck's Depression Inventory-II, Beck's Anxiety Inventory, Symptom Check List-90, and Neurotoxicity Scale-II. Hierarchical multiple regression analysis was performed to assess the predictive effects of some factors on QOLIE-31 Inventory.ResultsThe mean QOLIE-31 score of 203 patients who completed the questionnaires was 70.64 ± 17.74. Sociodemographic factors (age, sex, education, and employment) did not significantly predict QOLIE-31 score. Significant determinants of quality of life were clinical characteristics – seizure severity and etiology of epilepsy – accounting for 30.9% of the variance, depressive and anxiety symptoms accounting for 42.8% of the variance, and cognitive effects of antiepileptic drugs, accounting for 1.5% above other variables.ConclusionsThe results suggest that seizure severity and etiology of epilepsy, depressive and anxiety symptoms, and cognitive adverse medication effects are main determinants of quality of life in this population of PWE.     

Determinants of quality of life in people with epilepsy and their gender differences

Improving the patient's quality of life (QOL) is the most important goal of epilepsy management. We performed this study to determine the factors associated with QOL in people with epilepsy and to assess whether there are gender differences in these determinants. Patients were interviewed using the Quality of Life in Epilepsy Inventory-31(QOLIE-31), the Adverse Event Profile (AEP), the Self-Rating Anxiety Scale (SAS), and the Hamilton Depression Rating Scale (HAMD). Two hundred forty-seven patients (152 men, 95 women) were included in the analysis. Among all patients, regressive analyses showed that AEP score was the strongest predictor of the QOLIE-31 overall score, accounting for 10.4% of the variance. The next strongest predictors were the number of currently used antiepileptic drugs (AEDs) (3.6%), the HAMD score (2.5%), and the SAS score (1.2%). Importantly, there were gender differences in these predictors of QOL. The strongest predictors of the QOLIE-31 overall score in women were the AEP score and the number of AEDs. In contrast, the strongest predictors in men were the SAS score, the AEP score and the frequency of seizures. These results indicate that perceived adverse effects of treatments and number of AEDs exerted greater effects on QOL in women, whereas anxiety and seizure-related variables had a stronger impact on QOL among men. Accordingly, it may be necessary to individualize interventions to improve the QOL of people with epilepsy.     

Alexithymia and Posttraumatic Stress Disorder Following Epileptic Seizure

This study investigated (1) the incidence of posttraumatic stress disorder following epileptic seizure (post-epileptic seizure PTSD) and psychiatric co-morbidity and (2) the extent to which alexithymia traits related to the severity of the preceding outcomes. Seventy-one people with epilepsy participated in the study and completed the Posttraumatic Stress Diagnostic Scale, Hospital Anxiety and Depression Scale (HADS), and Toronto Alexithymia Scale. The control group comprised 71 people without epilepsy who completed the HADS. Fifty-one percent met the diagnostic criteria for full-PTSD; 30 % for partial-PTSD and 19 % for no-PTSD. The epilepsy group reported significantly more anxiety and depression than the control with demographic variables controlled for. Difficulty identifying feelings predicted post-epileptic seizure PTSD, anxiety and depression. It was positively correlated with post-epileptic seizure PTSD and depression, while it was negatively correlated with anxiety. People can develop PTSD and psychiatric co-morbid symptoms following epileptic seizures. The severity of these symptoms was related to difficulty in identifying internal feelings and emotions.     

Influence of clinical,demographic, and socioeconomic variables on quality of life in patients with epilepsy: findings from Georgian study

OBJECTIVE: To identify the clinical, demographic, and socioeconomic factors that are associated with a poor quality of life in patients with epilepsy in Georgia. METHODS: Clinical, demographic, and socioeconomic status data were collected from 115 adult epileptic outpatients being treated in the epilepsy programme at the Sarajishvili Institute of Neurology and Neurosurgery (SINN) in Tbilisi, Georgia. Health Related Quality of Life (HRQL) was measured by the Quality of Life in Epilepsy Inventory (QOLIE-31). Multiple regression analysis was used to determine which variables were associated with QOLIE-31 total and subcomponent scores. RESULTS: Mean age of the patient population was 37.9 (SD 15.8) years; 43.5% were females; 51.8% did not have a partner; 39.1% had some university education; 82.6% were unemployed. Of 115 epileptic patients 83.3% had partial, and 16.7% had generalised seizures. Overall, 32.2% of patients were seizure free, and 28.7% experienced more than 10 seizures over the past year. The variables that most strongly predicted a lower QOLIE-31 total score were a low education level, high seizure frequency, and long duration of epilepsy. The QOLIE-31 all subcomponent scores correlated strongly with seizure frequency. Advanced age was a significant predictor for a low overall quality of life, energy/fatigue, and cognitive scores. Female sex was the factor that significantly predicted a low seizure worry score. Education level strongly correlated with overall quality of life, and cognitive and social functioning scores. CONCLUSIONS: Clinical factors such as high seizure frequency and long duration of epilepsy had a significant influence on HRQL. Advanced age, female sex, and a low education level were the demographic factors that correlated strongly with low quality of life scores.     

Factors affecting quality of life in adults with epilepsy in Taiwan: A cross-sectional,correlational study

PurposeThe purpose of this study was to assess eight factors considered important for quality of life in persons with epilepsy in order to determine which of these components affect quality of life in adults with epilepsy in Taiwan.MethodsA cross-sectional, correlational study using structured questionnaires assessed 260 patients with epilepsy purposively sampled from a medical center in Northern Taiwan. Health-related quality of life (HRQoL) was evaluated with the Quality of Life in Epilepsy—31 (QOLIE-31) questionnaire. Data also included personal and health-related characteristics, knowledge of epilepsy, efficacy in the self-management of epilepsy, and social support.ResultsScores for the QOLIE-31 were correlated with the following factors: (1) demographic characteristics of age, gender, and income; (2) sleep quality; (3) symptoms of anxiety and depression; (4) epilepsy-specific variables: seizure frequency; types, number, and frequency of antiepileptic drugs (AEDs); and adverse events of AEDs; and (5) social support. Stepwise regression analysis showed that seven factors were predictive for quality of life: anxiety, depression, adverse events of AEDs, social support, seizure frequency of at least once in three months, household income of NT$ 40,001–100,000, and male gender. These factors accounted for 58.2% of the variance of quality of life.SignificanceOur study assessed multiple factors in an examination of relationships and predictive factors for quality of life in adults with epilepsy in Taiwan. Knowledge of these contributing factors can assist health-care providers when evaluating patients with epilepsy to help target interventions for improving quality of life.     

A community study of the presence of anxiety disorder in people with epilepsy

Anxiety represents a major problem for people with epilepsy, and it is important to understand why it arises and how to reduce its potential debilitating and adverse effects. The aim of this study was to determine the prevalence of anxiety in a community-identified sample of people with epilepsy and to identify which demographic and clinical factors are most closely associated with anxiety and which factors predict the presence of anxiety among people with epilepsy. Adults with epilepsy in the community (n=515) were identified through primary care records and sent validated questionnaires, which included the Hospital Anxiety and Depression Scale (HADS). The mailout also included items on demographic and clinical variables. The prevalence of anxiety (HADS score >11) in this sample was 20.5% (95% CI: 16.9-24.1%) and was associated with a current history of depression, perceived side effects of antiepileptic medication, lower educational attainment, chronic ill health, female gender, and unemployment. It was not associated with the duration of epilepsy. The findings from this study suggest that anxiety disorders in a community population with epilepsy are most strongly predicted by factors independent of epilepsy-related variables, with the exception of patient-reported side effects. It is important to be aware of these factors when evaluating an individual with epilepsy.     

A Brief Questionnaire to Screen for Quality of Life in Epilepsy The QOLIE-10

Summary: Purpose : To evaluate a brief questionnaire to screen aspects of health-related quality of life for persons with epilepsy.
Methods : A study of 304 adults with epilepsy was undertaken at 25 seizure clinics in the United States. It was used for derivation of a brief screening tool from a longer instrument (QOLIE-89).
Results : The 10–item questionnaire (QOLIE-10) covers general and epilepsy-specific domains, grouped into three factors: Epilepsy Effects (memory, physical effects, and mental effects of medication), Mental Health (energy, depression, overall quality of life), and Role Functioning (seizure worry, work, driving, social limits). Scale scores were significantly different among seizure groups (p = 0.003).
Conclusions : The QOLIE-10 can be completed by a patient in several minutes and reviewed rapidly by the physician. This screening tool could provide potentially useful information for initial assessment or follow-up of problem areas that are not commonly evaluated during routine clinical visits with patients with epilepsy.     

Differentiating anxiety and depression symptoms in patients with partial epilepsy

Anxiety and depression are separate psychiatric conditions that are often interrelated. This study examines whether they exist independently in this population of patients with partial epilepsy and if they affect all quality-of-life domains. Adult epilepsy patients taking two or more antiepileptic drugs completed a health status survey including demographic items, the Hospital Anxiety and Depression Scale, and the Quality of Life in Epilepsy-10 (QOLIE-10). The questionnaire was completed by 201 epilepsy patients. Symptom prevalences of anxiety (52% none, 25% mild, 16% moderate, 7% severe) and depression (62% none, 20% mild, 14% moderate, 4% severe) were high. All health-related quality-of-life (HRQOL) domains worsened significantly with increasing levels of anxiety and depression: Total QOLIE-10 scores decreased from 72+/-18 in patients with no anxiety to 54+/-13 in those with mild, 48+/-18 in those with moderate, and 40+/-23 in those with severe anxiety (P<0.0001). Total QOLIE-10 scores decreased from 70+/-16 in patients with no depression to 50+/-16 in those with mild, 45+/-16 in those with moderate, and 24+/-21 in those with severe depression (P<0.0001). No significant difference in anxiety scores was observed controlling for seizure frequency or epilepsy duration. Regression analyses showed that anxiety and depression account for different proportions of variance as predictors of HRQOL (R2=0.337 (anxiety) and 0.511 (depression)). The data suggest that patients may benefit from increased attention to the role of anxiety separately from depression.     

成年癫痫患者抑郁、焦虑状况及生活质量调查

目的调查成年癫痫患者抑郁、焦虑的患病率及可能的危险因素;评价抑郁及焦虑对癫痫患者生活质量的影响。方法采用Beck抑郁问卷(BDI)、贝克焦虑量表(BAI)及癫痫患者生活质量量表-31(QO-LIE-31中文版),对200例成年癫痫患者的抑郁、焦虑情况及生活质量进行评估。结果在200例癫痫患者中43.5%伴发抑郁,28.5%伴发焦虑,23%伴发抑郁及焦虑。发作频繁、无有薪职业是癫痫患者伴发抑郁的重要危险因素,无有薪职业是癫痫患者伴发焦虑的危险因素。抑郁组及抑郁伴焦虑组的QOLIE-31总分及各项评分均低于非抑郁非焦虑组(P=0.000);焦虑组的QOLIE-31总分(P=0.004)及发作的担忧(P=0.019)、认知功能(P=0.009)方面的得分均低于非抑郁非焦虑组。结论抑郁和焦虑是癫痫患者常见的精神共病,严重影响了癫痫患者的生活质量。积极控制发作、为癫痫患者提供更多的就业机会是改善癫痫患者生活质量的重要因素。     

Positive correlation between anxiety severity and plasma levels of dehydroepiandrosterone sulfate in medication-free patients experiencing a major episode of depression

Although numerous studies have identified a correlation between dehydroepiandrosterone sulfate (DHEAS) levels and anxiety or depression, those findings remain controversial. The purpose of the present study was to determine whether a correlation exists between depression severity and anxiety severity and serum DHEAS concentrations in medication-free patients experiencing a major depressive episode. Twenty-eight medication-free major depressive outpatients (Hamilton Rating Scale for Depression 17 [HAM-D 17] score >or=17) were enrolled consecutively. Plasma DHEAS levels of all subjects were measured. Blood from subjects was drawn at 0900-1100 h Depression severity was assessed with the HAM-D 17 and the Hospital Anxiety and Depression Scale (HADS) depression subscale. Anxiety was assessed using the HADS anxiety subscale. Serum concentrations of DHEAS were measured immediately following the HAM-D 17 and HADS assessments. A significant, positive correlation was identified between HADS anxiety subscale total score and morning serum DHEAS concentration (P = 0.013) after controlling for age, gender and body mass index (BMI). No statistically significant correlations were found between depression ratings and morning serum DHEAS concentrations. This preliminary study provides pilot data indicating that morning serum DHEAS concentrations were positively correlated with HADS anxiety subscale score (anxiety severity) after controlling for age, gender and BMI in medication-free outpatients experiencing a major depressive episode. It is not known if morning serum DHEAS levels would show similar or dissimilar changes in non-depressed subjects. The present result needs subsequent replication.     

不育妇女的功能障碍、精神病症状和生活质量：一项来自土耳其横断面研究

背景：不孕不育是一种重大的生活危机,它可以导致精神病症状的发展并且对夫妻的生活质量产生负面影响,但其影响程度可能取决于文化背景。
　　目标：我们比较了土耳其城市中生育妇女和不孕妇女的精神病症状程度、功能障碍水平和生活质量。方法：该横断面研究纳入了100名在里泽教育和研究医院的妇产科门诊治疗不孕不育的已婚女性和100名已婚已育的妇女作为对照组。对所有参与者均采用社会人口信息筛查表、医院焦虑抑郁量表(Hospital Anxiety and Depression Scale, HADS)、简单功能障碍问卷(Brief Disability Quesitonnaire, BDQ)和健康状况问卷(Short Form Health Survey , SF-36)进行评估。
　　结果：不育女性的平均焦虑分量表得分和抑郁分量表得分稍高于对照组,但差异无统计学意义。不孕组妇女中有显著临床焦虑症状的比例（即焦虑分量表得分>11）显著高于育龄妇女(31%v.17%, X2=5.37, p=0.020),但有显著临床抑郁症状的比例（即抑郁分量表评分HADS>8）在两组间没有显著性差异(43%v.33%, X2=2.12, p=0.145)。不育女性自我报告前一个月的功能障碍显著比对照组严重,并且不育女性在SF-36的8个分量表中4个（一般健康、活力、社会功能和心理健康）显著差于对照组。与目前工作的不育女性相比,目前没有工作的女性不育患者报告的抑郁和焦虑程度较轻,且一般健康状况、活力和心理健康状况较好。
　　结论：未发现土耳其城市地区中寻求治疗的不孕不育已婚女性并比已婚已育妇女有更严重的抑郁症状,但他们确实报告有较大的躯体和心理障碍并且生活质量较差。不孕不育的负面影响对在职不孕女性妇女比无业的不孕妇女更严重。西方国家这通常报告不孕患者抑郁和焦虑的患病率更高,我们需要更大规模的随访研究以评估这些结果与西方国家报告的结果不同的原因。     

Validity and reliability of the Hospital Anxiety and Depression Scale in a hypertrophic cardiomyopathy clinic: the HADS in a cardiomyopathy population

OBJECTIVE: The purpose of this study is the validation of the Hospital Anxiety and Depression Scale (HADS) in patients suffering from hypertrophic cardiomyopathy in an inner city teaching hospital. The secondary objective was to establish whether the use of the total HADS score to detect "caseness" is justified. METHODS: One hundred fifteen patients in a cardiac outpatient clinic completed the HADS, which was compared against the gold standard Structured Clinical Interview for DSM-III-R nonpatient version (SCID-np). Receiver operating characteristic (ROC) curves were created for the anxiety and depression subscales, as well as the total score, then sensitivity, specificity, likelihood ratios and positive and negative predictive values were calculated. Retest correlation was assessed at 2 weeks in 31 patients. RESULTS: The depression subscale was highly sensitive (100%) when the cutoff score 8 was used; however, the corresponding specificity was poor (79%). Raising the cutoff to 10 improved specificity but compromised sensitivity. The anxiety subscale was performed similarly though with less accuracy. The total HADS score produced a poor ROC curve and performed best when the cutoff was 14. CONCLUSIONS: The HADS performs well as a screening instrument for anxiety and depression in this population at the designed cutoff score 8. However, its use as a research instrument and the practice of using the total score to detect caseness are not supported by this study.     

Quality of life of patients with epilepsy living in Kingston, Jamaica

Quality of life in epilepsy has not been documented in the English-speaking Caribbean. The aim of this study was to explore the quality of life of persons with epilepsy (PWE) living in Jamaica and determine the impact of socioeconomic factors by examining two socially distinct groups in semiprivate (Epilepsy Centre of Jamaica) and public (Kingston Public Hospital) outpatient clinics. One hundred nine consecutive patients were interviewed. Quality of life was assessed using the Quality of Life in Epilepsy-31 inventory (QOLIE-31). Both groups were matched for gender, epilepsy syndrome, epilepsy duration, and number of antiepileptic drugs. Predictors of quality of life included number of antiepileptic drugs (P=0.039), epilepsy duration (P<0.05), and functional status (P<0.001). Neither seizure frequency nor socioeconomic status predicted QOLIE-31 scores. Mean QOLIE-31 total score (61.57 vs 49.2, P<0.001) and QOLIE-31 subscale scores (with the exception of the Seizure Worry score [53.8 vs 48.2, P=0.08]) were significantly higher than the corresponding t scores. The QOLIE-31 can reliably be used in Jamaica. Our findings suggest Jamaicans living with epilepsy perceive themselves as having a better than expected quality of life.     

Coping, affective distress, and psychosocial adjustment among people with traumatic upper limb amputations

OBJECTIVE: This study investigated the prevalence of symptoms of depression and anxiety in a sample of predominantly elderly males with acquired upper limb amputations (n=138) and examined the contribution of coping strategies to the prediction of psychosocial adjustment. METHOD: One hundred and thirty-eight men with injury-related upper limb amputations completed self-report questionnaires assessing coping strategies, symptoms of anxiety and depression, and psychosocial adaptation to prosthesis use. RESULTS: Prevalence of significant depressive symptoms was 28.3% [Hospital Anxiety and Depression Scale, Depression subscale (HADS-D) score > or =8]. Prevalence of significant anxiety symptoms was 35.5% [HADS Anxiety subscale (HADS-A) score > or =8]. Coping styles emerged as important predictors of psychosocial adaptation. In particular, avoidance was strongly associated with psychological distress and poor adjustment. CONCLUSIONS: These findings suggest the potential benefits of interventions to reduce reliance on avoidant coping and stimulate more problem-focused approaches to coping with difficulties and challenges in order to facilitate adaptation and prevent problems in psychosocial functioning postamputation.