Abstracts

Rationale: Previous research suggests that 12-49% of mothers caring for children with epilepsy are at risk for clinical depression based on self-report measures of depressive symptoms. The objectives of this research were to: 1) prospectively examine the onset of depression in mothers of children newly diagnosed with epilepsy and 2) identify risk factors for mothers developing depression during the 24-month following epilepsy diagnosis in their children. Methods: Data were obtained from the Health Related Quality of Life in Children with Epilepsy Study (HERQULES), a national prospective study of children 4-12 years old with new-onset epilepsy followed for 24 months. Maternal (age, parity, marital status, education, employment, depressive symptoms), child (age, sex, family history, seizure type, epilepsy classification, duration, medication use, severity, health-related quality of life), and family (functioning, resources, demands, perception of family-centred care, income) variables were examined using mother and neurologist report at baseline, 6, 12, and 24 months. Maternal depression was defined as scoring at or above the threshold for clinical depression (?16) on the Center for Epidemiologic Studies Depression Scale (CES-D). Depression-free survival was calculated using the life table approach for discrete time whereby mothers depressed at baseline were left-censored. Binary sequence modeling for longitudinal data incorporating the Markovian condition (effect of prior status on current status) was implemented to identify risk factors for maternal depression during the follow-up. Results: Of 338 mothers who agreed to participate in the study, 38% were depressed at baseline and thus excluded from the survival analysis. By 24 months, 70% of mothers who were not depressed at baseline had not experienced the onset of depression. The probability of onset of depression and associated 95% confidence intervals by 6, 12, and 24 months was 0.13 (0.08, 0.18), 0.12 (0.07, 0.17), and 0.19 (0.10, 0.27), respectively. Of those experiencing onset of depression at baseline, 6, and 12 months, 26%, 12%, and 32% were still depressed at 24 months, respectively. Accounting for prior depression status, risk factors for developing depression during follow-up were maternal age (OR=0.94, p=0.012), number of anti-epileptic drugs child was prescribed (OR=1.41, p=0.004), family functioning (OR=0.83, p<0.001), family resources (OR=0.93, p<0.001), and family demands (OR=1.10, p=0.001). Conclusions: This study is the first to prospectively document depression in mothers of children with newly diagnosed epilepsy. Over one-third of mothers are at risk for clinical depression when their child is diagnosed with epilepsy and the probability of developing depression after epilepsy diagnosis is relatively stable over time. Given that several of the risk factors identified for maternal depression are modifiable, it is important to consider these as potential targets for clinical intervention to improve the mental health of mothers of children with epilepsy over first 24 months after diagnosis.