Abstracts

Rationale: Several studies on quality of life (QOL) in epilepsy verified that people with epilepsy had high levels of depression and anxiety, and emphasized on the importance of depression and anxiety in QOL of people with epilepsy. Stress, which has been reported to increase the occurrence of seizures and to affect on depression, is another potential factor to affect QOL. However there are only few reports concerning its relative contribution on QOL. In our study, we aimed to determine (1) the influence of stress upon epilepsy variables, (2) the contribution of stress factor upon patient's quality of life compared to depression, anxiety, and clinical variables of epilepsy.Methods: We included 129 adult patients with epilepsy who were interviewed at the outpatient clinic for epilepsy. All subjects completed a stress questionnaire, the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Quality Of Life In Epilepsy-31 (QOLIE-31). The stress questionnaire consisted of 36 items concerning personal, social and economical aspects. Responses are indicated on a 4-point scale with the end points being ‘not at all stressful’(1) and ‘very stressful’(4). An overall stress score is obtained by summming the ratings on the 36 items (range: 36~141 points). The demographic, social (education level, marriage, employment, socioeconomic status, religion) and clinical seizure information (seizure onset age, frequency, number of antiepileptic drugs) were obtained by medical records. Univariate linear regression was used for statistical analysis and all univariate variables significant at P =0.2 were entered into a hierarchical regression analysis.Results: Mean stress score was 57.2 (range: 37~121). Moderate and severe levels of depression (scores of ≥16) were reported in 37.9% of patients, and similar levels of anxiety were reported by 28.7%. There was a significant negative correlation between the stress and overall score of QOL (r =-0.604, P<0.001). Depression and anxiety were also negatively correlated with QOL (r =-0.714, P<0.001 and r =-0.491, P<0.001, respectively). Persons with higher scores on the stress questionnaire had higher depression and anxiety scores (r =0.51, P<0.001; r =0.18, P=0.04). In order of importance, stress appeared to contribute most significantly to the overall QOL than depression and anxiety: it contributed 32% to the patients' QOL; depression and anxiety contributed 17%; clinical variables contributed only 4%. No correlation was noted between the frequency of seizures and the results of the stress and psychiatric questionnaires. None of the epilepsy variables (age of onset, seizure frequency, duration of illness) affected the QOL.Conclusions: The large contribution of stress on quality of life suggest the need to identify the stressors found in persons with epilepsy in everyday clinical practice, specifically the stressors experienced by each person.