نقش محیط خانواده در افسردگی در بزرگسالان کره ای مبتلا به صرع

Purpose Depression is common in adults with epilepsy and an important factor that affects quality of life in these individuals. However, there are few studies on the interactions between epilepsy and family factors in adults and we here investigate this association. Methods This cross-sectional, multicenter study collected data on 391 adults with epilepsy and their caregivers recruited from 27 hospitals throughout Korea. The Beck Depression Inventory (BDI), Stigma Scale, and Caregiver Burden Inventory (CBI) were used to evaluate the study population. Multivariate analysis was conducted using hierarchical linear regression. The Sobel test and structural equation modeling were used to examine interrelationships among the potential factors. Results The mean patient BDI score was 16.3 (SD = 11.1). Depressive symptoms (BDI ≥ 10) were in 68.3% and 57.0% in patients and their caregivers, respectively. Hierarchical linear regression analysis only identified caregiver BDI (β = 0.219; p < 0.001) as an independent factor related to patient BDI. The mediational model suggested that caregiver BDI mediated the effects of other family factors on patient BDI: caregiver's educational level (p = 0.002), caregiver's CBI score (p < 0.001), caregiver's Stigma Scale score (p < 0.001), and family APGAR score (p < 0.001). In addition, structural equation modeling showed that the relation between caregiver and patient BDI was unidirectional. Conclusion Caregiver depression is the most important contributor to depression in adults with epilepsy. The other family factors such as caregiver's perception of burden and the level of family function are indirectly correlated with patient depression via the mediating effects of caregiver depression.

Depression is the most common psychiatric comorbidity with epilepsy. The point prevalence of depression is substantially higher among patients with epilepsy than the general population, ranging from 13 to 35% according to large population-based studies.1, 2 and 3 This prevalence can be as high as 50% among patients with medically refractory epilepsy.4 and 5 The pathogenic mechanisms of depression in patients with epilepsy result from the complex interactions between neurobiological (including genetic), iatrogenic, and psychosocial pathogenic factors.6 Furthermore, several studies suggest a bidirectional relationship between depressive disorders and epilepsy.7 Depression significantly impacts quality of life (QoL) in patients with epilepsy. In patients with uncontrolled seizures in particular, depression causes greater QoL reductions than the seizures themselves.8 Several factors, including demographic, seizure-related, treatment-related, and psychosocial factors, can contribute to depression in patients with epilepsy.9 The impact of epilepsy is not limited to patients who experience seizures, but also affects all members of the family to a certain degree. Most studies in this regard have focused on childhood epilepsy when assessing the relationship between the family environment and depression, and found that the family environment is predictive of the psychological well-being of children and adolescents with epilepsy.10 For example, parental perception of epilepsy stigma is associated with depression in children with epilepsy,10 and maternal depression negatively correlated with QoL in children with new-onset epilepsy.11 In contrast, there have been few studies of family members of adults with epilepsy. Poor social support (which mostly comes from the family) is a significant predictor of depression in adults with epilepsy.12 In a recent study, QoL in adults with epilepsy was reportedly significantly related to the QoL of family members,13 and negative family reactions may be detrimental to the QoL of adults with epilepsy.14 In addition, family life dissatisfaction is an established factor that affects the QoL and psychosocial well-being of adults with epilepsy.15 These findings suggest the need for further research into the family factors that affect adults with epilepsy. We have here investigated the relationship between family factors and depression in adults with epilepsy.

Caregiver depression is the most important contributor to depression in adults with epilepsy. The caregiver's educational level, caregiver's perception of burden and stigma, and family functioning level are indirectly correlated with patient depression via the mediational effects of caregiver depression. Our findings suggest that the family environment significantly impacts the depressive symptoms that present in adults with epilepsy, as is the case in childhood epilepsy, and that more appropriate family-centered care is also required when treating depression in adults with epilepsy. Further research is needed—especially prospective studies and interventional trials—to identify the important familial factors that impact patient depression and the results of particular treatments.