Authors :
Presenting Author: Rachel Friefeld Kesselmayer, PhD – University of Wisconsin School of Medicine and Public Health
Susan Smedema, PhD, CRC, LPC – University of Wisconsin-Madison
Dace Almane, MS – University of Wisconsin-Madison
Malachy Bishop, PhD, CRC – University of Wisconsin-Madison
Brian Phillips, PhD, CRC – Utah State University
Bruce Hermann, PhD – University of Wisconsin-Madison
Jana Jones, PhD – University of Wisconsin–Madison
Rationale:
To describe the influence of comorbidity on self-reported resilience and self-efficacy scores at 15-years post-childhood onset epilepsy diagnosis.
Methods: Youth with uncomplicated childhood onset epilepsy (age 8-18) (i.e., without intellectual disability or neurological impairment) were evaluated at baseline within 12 months of epilepsy diagnosis and 15 years later. At 15-year follow-up participants (now age 22-34), participated in a psychiatric interview using the Mini International Neuropsychiatric Interview (MINI). Medical comorbidity data were collected via online survey. The Brief Resilience Scale and New General Self-Efficacy (NGSE) Scale were among instrumentation administered via online survey at 15-year assessment. Bivariate analyses, including Mann-Whitney
U tests, examined the relationship between group and comorbidity status across self-reported resilience and self-efficacy scores.
Results:
A total of 74 individuals, 30 with epilepsy and 44 healthy controls participated in both baseline and 15-year follow-up evaluations. Focal or generalized epilepsy was diagnosed in 52% and 48% of participants, respectively. At 15-year follow-up, 78.6% of individuals presented with any psychiatric or medical diagnosis; 42.9% psychiatric only; 10% medical only; and 26.7% both. Among healthy controls, 62.8% had any psychiatric or medical diagnosis; 27.9% psychiatric only; 7.0% medical only; and 25% both. BRS and NGSE scores did not differ by group (epilepsy vs. control). Mann-Whitney U tests determined, across the total sample, individuals with any psychiatric or medical diagnosis reported lower resilience (p= < .001) and self-efficacy scores (p=.043). Mann-Whitney U tests indicated the presence of the following comorbidity groups to be related to reduced resilience scores in persons with epilepsy: any psychiatric diagnosis (p=.007), both psychiatric and medical diagnoses (p=.006), any mood disorder (p=.016), and any anxiety disorder (p=.001). Any psychiatric diagnosis (p=.048) and any mood disorder (p=.024) were negatively related to self-efficacy scores in persons with epilepsy. In the control group, resilience scores were associated with the following: any psychiatric diagnosis (p=.002), psychiatric only (p=.016), and any anxiety disorder (p=.002). In controls, reduced self-efficacy scores were associated with any psychiatric diagnosis (p=.023) and any anxiety disorder (p=.019).
Conclusions: High rates of comorbidity were identified in the epilepsy and control cohort at the 15-year follow up. In both the epilepsy group and healthy peers, resilience and self-efficacy were significantly reduced when comorbidity was present at 15-years, particularly psychiatric comorbidity. Psychiatric comorbidity should be identified early, monitored, and comprehensively treated. Further investigation is warranted to determine factors associated with increasing and pervasive rates of comorbidity in epilepsy. Regardless of epilepsy status, the findings implicate support for developing and implementing interventions targeting resilience and self-efficacy to reduce the adverse effects of psychiatric comorbidity.
Funding:
2R56NS044351