Risk factors for depression in community-treated epilepsy: Systematic review

doi:10.1016/j.yebeh.2014.11.023

Epilepsy & Behavior

Volume 43, February 2015, Pages 1-7

https://doi.org/10.1016/j.yebeh.2014.11.023 Get rights and content

Highlights

•
A systematic review of community-based studies offers an alternative approach for identifying of risk factors for depression.
•
The search identified 17 studies, representing a combined total of 12,212 people with epilepsy.
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The most consistent risk factors for depression were socio-demographic, but most studies focus on epilepsy-related factors.
•
Most studies lacked a systematic conceptual approach to investigating depression.

Abstract

Objective

Depression is one of the most common psychiatric comorbidities in epilepsy; however, the factors contributing to this association remain unclear. There is a growing consensus that methodological limitations, particularly selection bias, affect many of the original studies. A systematic review focussed on community-based studies offers an alternative approach for the identification of the risk factors for depression.

Methods

Searches were performed in MEDLINE (Ovid), 2000 to 31 December 2013, EMBASE, and Google Scholar to identify studies examining risk factors for depression in epilepsy. Community-based studies of adults with epilepsy that reported at least one risk factor for depression were included.

Results

The search identified 17 studies that met selection criteria, representing a combined total of 12,212 people with epilepsy with a mean sample size of 718. The most consistent risk factors for depression were sociodemographic factors, despite the fact that most studies focus on epilepsy-related factors.

Significance

Most studies lacked a systematic conceptual approach to investigating depression, and few risk factors were consistently well studied. Future community-based studies require a detailed systematic approach to improve the ability to detect risk factors for depression in epilepsy. Psychological factors were rarely studied in community-based samples with epilepsy, although the consistent association with depression in the few studies that did suggests this warrants further examination.

Introduction

Depression is one of the most common psychiatric comorbidities in epilepsy and arguably the most extensively researched [1]. Despite these facts, the factors that contribute to the increased rate of depression remain unclear [2], [3]. Comorbid depression has a range of adverse consequences, including decreased quality of life, diminished medication adherence, poorer treatment outcomes, increased health service use, increased cognitive complaints, and increased risk of other chronic diseases and suicide [4]. A better understanding of the risk factors for depression in epilepsy may inform efforts to reduce this important health disparity.

The rate of depression appears to rise as one moves from primary care to secondary care and tertiary care [5], [6]. This suggests that ascertainment bias may limit the generalizability of findings from secondary–tertiary samples to community-treated people with epilepsy. The use of systematic reviews in epilepsy research has confirmed the higher prevalence of depression in people with epilepsy and has demonstrated a consistent association between depression and impaired quality of life [7], [8], but this approach has not been utilized to identify risk factors for depression. The aim of this study was to review recent studies that examined depression in a community sample of adults with epilepsy to identify factors associated with depression.

Section snippets

Methods

A systematic review to identify factors associated with depression in adult patients with community-treated epilepsy was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Study selection

The search strategies identified 222 publications. Many were rejected as they did not include people with epilepsy, and 83 were selected for a full-text review. Fifty-seven studies did not meet the inclusion criteria (see Fig. 1), with failure to measure depression or any risk factors followed by potential selection bias due to reliance on hospital-derived samples being the most common reasons for exclusion. Some studies did not explicitly analyze risk factors for depression, but, where

Discussion

This systematic review found that the most consistent risk factors associated with depression were sociodemographic factors, despite the fact that most studies focus on epilepsy-related factors. Very few studies assessed a range of sociodemographic, disease-related, psychological, treatment-related, and genetic risk factors. Furthermore, none of these studies appeared designed to specifically address depression in epilepsy, and none adopted a systematic approach arising from best available

Ethical publication statement

We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Disclosure of conflicts of interest

Assoc. Prof. D'Souza has received travel, investigator-initiated, and speaker honoraria from UCB Pharma; educational grants from Novartis Pharmaceuticals, Pfizer Pharmaceuticals, and Sanofi-Synthelabo; educational, travel, and fellowship grants from GSK Neurology Australia; and honoraria from SciGen Pharmaceuticals. Dr. Cameron Lacey has received a research grant from Pfizer Pharmaceuticals. The remaining author has no conflicts of interest.

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Cited by (35)

Resilience and psychosocial factors in adult with epilepsy: A longitudinal study
2024, Epilepsy and Behavior
Resilience is conceptually characterized as a dynamic process encompassing positive adaptation in the context of significant adversity. Our goal was to assess the resilience in people with epilepsy (PWE) and how it impacts longitudinally on psychosocial factors, with a particular focus on the manifestation of stigmatization-related feelings.
We consecutively enrolled 78 adults PWE (42.5 ± 16.2 years old); among them 36 (46.1 %) were seizure-free. All subjects completed at baseline (T0) the Resilience Scale (RS-14) and questionnaires for the assessment of depressive symptoms, anxiety and quality of life: respectively, Beck Depression Inventory-II (BD-II), Generalized Anxiety Disorder-7 (GAD-7) and QOLIE-31 (Q31). All patients were followed up prospectively and re-evaluated after 6–22 months (T1; mean: 14 ± 8 months; median 14 months); at follow up they also completed the Stigma Scale of Epilepsy (SSE) for the assessment of the stigma associated with epilepsy. We correlated resilience values with all psychosocial scores at T0 and T1. Factors associated with resilient and vulnerable outcomes were identified. Finally, a multiple stepwise regression analysis was applied to identify predictors for resilience and stigma perception.
The results showed for the RS-14 score a significant direct correlation with the Q31 (p < 0.001) and an inverse correlation with the depressive and anxiety symptoms at both times (T0 and T1), as evaluated with BDI-II (p < 0.001) and GAD-7 (p < 0.001). Finally, we found a significant inverse correlation between RS-14 at T0 and the levels of stigmatization assessed with SSE at T1 (p =.015). Using a multiple stepwise regression analysis separately for resilience and stigma perception, depressive symptoms turned out as the best predictors for both variables. Finally, considering longitudinal evaluation we did not observe significant changes in depressive and anxious symptoms, despite a significant reduction in the total number of seizures at follow up.
Our study showed that depressive symptoms, anxiety and quality of life were significantly associated with resilience in PwE. Finally, as a novel finding resilience was proved to affect the perception of stigma related to epilepsy more than seizures.
Experience sampling methodology study of anxiety and depression in adolescents with epilepsy: The role of metacognitive beliefs and perseverative thinking
2024, Epilepsy and Behavior
Emotional distress is common in young people with epilepsy (YPwE). According to the Self-Regulatory Executive Function (S-REF) model, maladaptive metacognitive beliefs and perseverative thinking are fundamental in the development and maintenance of emotional distress. As emotional distress and perseverative thinking can highly fluctuate over short intervals in YPwE, it is important to account for this variability when testing the utility of psychological models. Experience sampling methodology (ESM) was therefore used to explore the momentary relationship between metacognitive beliefs, perseverative thinking, and emotional distress in YPwE. Eighteen participants diagnosed with epilepsy (aged 12–17 years) completed the 10-day ESM period. Participants were prompted to complete the ESM assessment five times daily. The ESM assessment assessed participant’s momentary levels of metacognitive beliefs, perseverative thinking (i.e., worry and rumination), and emotional distress (i.e., anxiety and depression). A series of multilevel regression analyses indicated that metacognitive beliefs were significantly positively associated with worry, rumination, anxiety and depression. After controlling for worry and rumination, respectively, metacognitive beliefs did not account for additional variance in anxiety or depression. Findings provide preliminary support for the utility of the S-REF model for emotional distress in YPwE. Metacognitive therapy, which is underpinned by the S-REF model, may be an appropriate intervention for emotional distress in YPwE. Future studies should assess the mediational relationship between metacognitive beliefs, perseverative thinking, and emotional distress using time-lagged models.
Psychosocial factors associated with anxiety and depression in adolescents with epilepsy: A systematic review
2023, Epilepsy and Behavior
Anxiety and depression are common in adolescents with epilepsy. Identifying psychosocial risk factors for anxiety and depression is essential for adolescents with epilepsy to receive appropriate support. This systematic review synthesised findings of studies examining the relationship between psychosocial factors and anxiety and/or depression in adolescents with epilepsy. Outcomes were anxiety, depression, and mixed anxiety & depression. Six electronic databases were searched for studies which: used cross-sectional or prospective designs; quantitatively evaluated the relationship between psychosocial factors and anxiety and/or depression; presented results for adolescents with epilepsy aged 9–18 years; and used validated measures of anxiety and/or depression. Psychosocial factors were categorised as intrapersonal, interpersonal, or parent-specific factors. Sixteen studies (23 articles) were included. All but one were cross-sectional. Regarding intrapersonal factors, alternative mental health difficulties were consistently positively associated with all three outcomes. Negative attitude towards epilepsy, lower seizure self-efficacy, lower self-esteem and stigma were consistently positively associated with depression. Interpersonal factors (i.e., lower family functioning assessed from an adolescent’s perspective) and parent-specific factors (i.e., parental stigma, stress, anxiety and psychopathology) were positively associated with at least one outcome. Adolescent epilepsy management should exceed assessment of biological/biomedical factors and incorporate assessment of psychosocial risk factors. Prospective studies examining the interplay between biological/biomedical factors and the psychosocial factors underpinning anxiety and depression in adolescents with epilepsy are needed.
Felt stigma may potentiate the relationship between perceived stress and depressive symptoms in persons with epilepsy
2022, Epilepsy and Behavior
Citation Excerpt :
Perceived stress assessed using the PSS-10 showed the highest degree of correlation with depressive symptoms, followed by felt stigma, being unemployed, recurrence of GTCS or FBTCS, and being married. The potential correlates or predictors of depression comorbid with epilepsy are thought to include sociodemographic factors, such as age, sex, educational level, employment situation, marital status, economic level, and social support; epilepsy-related factors, such as age at seizure onset, duration of epilepsy, seizure frequency, and seizure types and severity; ASM-related factors, such as polytherapy, ASM adherence, and use of a certain ASM; and psychological factors, such as anxiety, felt stigma, coping strategies, self-efficacy, and perceived stress [3,5,11,13,16,20–27]. A systematic review reported that psychological factors, such as coping strategies, self-efficacy, social support, and perceived stress, were more consistently correlated with depression than sociodemographic and epilepsy-related factors [20].
This study assessed the strengths of association among perceived stress, felt stigma, and depression in adults with epilepsy, and evaluated whether felt stigma altered the association between perceived stress and depression.
This multicenter, cross-sectional study included adults with epilepsy. Depression was assessed using the Beck Depression Inventory (BDI), and perceived stress was evaluated using the 10-item Perceived Stress Scale. Felt stigma was determined using the three-item Stigma Scale for Epilepsy, with individuals categorized as positive for felt stigma if they answered “yes” to at least one of these items. A hierarchical linear regression analysis and an analysis of covariance with interaction terms were performed.
The 316 adults with epilepsy included 171 men and 145 women; of these, 109 (34.5%) reported felt stigma. A hierarchical linear regression analysis showed that perceived stress was the most important correlate of depressive symptoms, followed by felt stigma, being unemployed, recurrence of generalized or focal to bilateral tonic-clonic seizures, and being married. The model explained 54.0% of the variance of BDI scores. Significant interactions between felt stigma and perceived stress on BDI scores was identified in both crude and adjusted models (p < 0.05 each). Specifically, in an adjusted model, BDI scores were more strongly associated with perceived stress in persons with (p < 0.001, partial eta² = 0.225) than without (p < 0.001, partial eta² = 0.205) felt stigma.
Perceived stress was the most significant correlate of depressive symptoms in adults with epilepsy, followed by felt stigma. The interaction between perceived stress and felt stigma on depressive symptoms was significant. These findings may help in developing cognitive behavioral therapy for stigma and stress management in persons with epilepsy.
Long-term mood, quality of life, and seizure freedom in intracranial EEG epilepsy surgery
2021, Epilepsy and Behavior
Citation Excerpt :
Further, there was no difference in other patient characteristics including number of AEDs, number of resections and driving status, in the patient cohort with high NDDI-E score (>15) suggestive of operational depression, compared to those with lower NDDI-E score (<15) (Table e-2). This underlines that the assessment and treatment of comorbid mood disorders in epilepsy should be addressed independent of seizure management status and quality of life, as there may be additional factors driving these important morbidities [39,40]. Nonetheless, given the cross-sectional nature of mood assessment with the NDDI-E score in this study, we were unable to assess mood outcomes preoperatively compared to postoperatively in each Engel Class.
To determine the long-term outcomes in patients undergoing intracranial EEG (iEEG) evaluation for epilepsy surgery in terms of seizure freedom, mood, and quality of life at St. Vincent’s Hospital, Melbourne.
Patients who underwent iEEG between 1999 and 2016 were identified. Patients were retrospectively assessed between 2014 and 2017 by specialist clinic record review and telephone survey with standardized validated questionnaires for: 1) seizure freedom using the Engel classification; 2) Mood using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E); 3) Quality-of-life outcomes using the QOLIE-10 questionnaire. Summary statistics and univariate analysis were performed to investigate variables for significance.
Seventy one patients underwent iEEG surgery: 49 Subdural, 14 Depths, 8 Combination with 62/68 (91.9%) of those still alive, available at last follow-up by telephone survey or medical record review (median of 8.2 years). The estimated epileptogenic zone was 62% temporal and 38% extra-temporal. At last follow-up, 69.4% (43/62) were Engel Class I and 30.6% (19/62) were Engel Class II-IV. Further, a depressive episode (NDDI-E > 15) was observed in 34% (16/47), while a ‘better quality of life’ (QOLIE-10 score < 25) was noted in 74% (31/42). Quality of life (p < 0.001) but not mood (p = 0.24) was associated with seizure freedom.
Long-term seizure freedom can be observed in patients undergoing complex epilepsy surgery with iEEG evaluation and is associated with good quality of life.
Correlates of depression and quality of life among patients with epilepsy in Nigeria
2020, Epilepsy Research
To determine the prevalence of Major Depressive Disorders (MDD) and its relationship to Quality of life.
A cross-sectional observational study.
Out-Patient Clinic of the Neuropsychiatric Hospital, Abeokuta, Nigeria.
Patients with diagnosis of Epilepsy with Electroencephalogram (EEG) confirmation.
Depression and Quality of life.
The prevalence of current MDD was 11.9 %, and patients having at least 1 seizure per week were 5 times more likely to develop MDD (OR = 5.104, p = 0.014). The mean (SD) QOLIE-31 scores was 77.98 (13.32), with presence of MDD (β = -11.101, p = 0.0001); having at least 1 seizure/week (β = -6.653, p = 0.037) being independent predictors.
Depression is a common comorbidity in patients with epilepsy and is associated with a lower quality of life.

View all citing articles on Scopus

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ReviewRisk factors for depression in community-treated epilepsy: Systematic review

Highlights

Abstract

Objective

Methods

Results

Significance

Introduction

Section snippets

Methods

Study selection

Discussion

Ethical publication statement

Disclosure of conflicts of interest

Epilepsy Behav

Epilepsy Behav

Seizure

Seizure

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Seizure

Epilepsy Behav

J Psychosom Res

Epilepsy Behav

Epilepsy Behav

Depression in epilepsy: a critical review from a clinical perspective

Nat Rev Neurol

Review
Risk factors for depression in community-treated epilepsy: Systematic review