Anxiety and depression in children with epilepsy and their mothers
Introduction
Epilepsy is a chronic disease that affects the behavioral and cognitive functioning of children [1]. The unpredictable nature and course of epilepsy may have a significant impact on both the physical and psychosocial functioning of the child and the family [2], [3], [4], [5].
Prevalence of depression is increased in adults with epilepsy, ranging from 34 to 78% [11], [12], [13], [14]. One study did not find an increased risk [15]. Children and adolescents with epilepsy also are at increased risk for depression, as documented in a number of previous studies [6], [7], [8], [9], [10]. In the general population, the rates of prevalence of depression in children and adolescents range from 2 to 9% [16], [17], [18]. The rate of depression in children and adolescents with chronic epilepsy as measured by self-reporting instruments varies between 23 and 26% [2], [3].
An understanding of childhood depression requires evaluation of the relationships between biological, social, and iatrogenic risk factors and negative life events. Most of the biological explanations for depression in the population with epilepsy have focused on seizure type and lateralization of epileptic foci. In the majority of studies, electroencephalographic findings and age of onset have not been associated with depression in children [7], [8], but seizure recurrence, high frequency, and longer duration of epilepsy have been found to be associated with depression [7], [9].
In the general population, the rates of prevalence of anxiety disorders are 9.1% in men and 18.1% in women [19]. The prevalence of both anxiety and depression increases with age. Prevalence rates for anxiety disorders in adults with epilepsy range from 14 to 78% [19], [20], [21]. However, few studies have examined anxiety in children with epilepsy and the prevalence remains unknown [7], [22], [23]. In adult patients with epilepsy, many risk factors predisposing to the development of anxiety, including neurological, pharmacological, and psychosocial factors, have been identified [24]. Among the neurological factors, severity of epilepsy has been associated with increased anxiety; however, other disease-related factors have not been shown to be predictive of anxiety in children with epilepsy [22]. Among the psychosocial factors, unpredictability of seizures, fear of death, parental reactions of distress and fear, restrictions on normal living and activities, stigmatization and social rejection, misinformation about the disorder, and resulting low self-esteem may predispose children and adolescents to anxiety and negative affective responses [25]. Antiepileptic drugs (AEDs) can also contribute to the development of anxiety or depression, either as a side effect or because of withdrawal [23].
The emotional impact of epilepsy on family members is a neglected topic, with the majority of studies confined to patients with epilepsy. Frequent seizures and accompanying injuries may lead to considerable emotional strain for family members, especially parents [26]. Furthermore, parental beliefs and attitudes concerning epilepsy may significantly impact adjustment for both the child and family. A negative social attitude toward disability has been reported to affect the adjustment of parents of children and adolescents with epilepsy, and parental adjustment has been reported to be inversely associated with the severity of the child’s epilepsy [27].
Ju et al. [28] reported that parents of children and adolescents with epilepsy have negative attitudes toward their children and have difficulties in their psychosocial adjustment probably because of social stigmata and misunderstanding of the illness. Pal and Chaudhury found that a significant proportion of parents adjusted poorly to their children with epilepsy in rural India. They hypothesized that in developing countries, parental adjustment is an important problem in epileptic children because of negative attitudes toward disability [29], [30]. Several studies now suggest that social support is an important influence on adjustment in parents of children with disabilities [31]. Trute and Hauch [32] showed that the parents who adapted well to the birth of a disabled child had good social support networks and came from strong, well-organized families.
The relationship between parental anxiety and quality of life of children with epilepsy is not clearly understood. Parental anxiety, which may result in restriction of activities, has been reported to be associated with decreased quality of life for both the child and family [27]. Previous findings suggest that parental anxiety may have an impact on parenting behaviors. Highly anxious parents may be more likely to perceive higher risks for their children and misinterpret information about their child’s condition. Transmission of parental anxiety to the child concerning health status is hypothesized to be a psychological risk for the child [33]. Whether behavioral changes associated with parental anxiety interfere with the process of parent–child separation and independence is unknown. Williams et al. [27] studied the anxiety and quality of life of parents of children with epilepsy. The mean level of parental anxiety was 38.58, which falls within the normal range. Their study suggests that families most vulnerable to reduced quality of life are those in which a child has poorly controlled epilepsy and increased parental anxiety [27].
The purpose of the present study was to examine the association between anxiety and depression in children and adolescents with epilepsy and anxiety and depression in their mothers, and to determine factors that may be predictive of their presence, in a hospital-based cross-sectional study of a Turkish clinical sample.
Section snippets
Patients and controls
The study included 35 children and adolescents with epilepsy (age range, 7–19) and their mothers who were seen in the Department of Neurology, Cerrahpasa School of Medicine, Istanbul, Turkey. Patients had been diagnosed with epilepsy for at least 1 year. Table 1 summarizes the demographic and clinical aspects of the patients included in the study.
The control group consisted of 35 healthy age-(age range, 8–17) and gender-matched children and adolescents recruited from two local high schools and
Results
Demographic and clinical features of the patient and control populations are summarized in Table 1. Two patients and their mothers were excluded from the analysis as they were not able to complete the CDI and STAIc. There was no difference between the ages of cases and controls (P > 0.05).
All variables that could potentially impact dependent outcome measures of the BDI, CDI, STAI, and STAIc were independently analyzed to identify factors that may need to be corrected for in the final analysis of
Discussion
In this study, we have prospectively investigated the relationship between epilepsy and depression and anxiety symptoms in children and adolescents with epilepsy and age- and gender-matched healthy controls, as well as mothers of these children, using self report scales.
Conclusion
We conclude that: (1) The prevalence of symptoms of depression is increased in patients with epilepsy, consistent with previous studies on children and adolescents with epilepsy. (2) The prevalence of symptoms of anxiety is increased in patients with epilepsy compared with previous general population studies; however, this study did not find significant differences between the group of children and adolescents with epilepsy and the control group. (3) The prevalence of symptoms of depression and
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