Abstracts

Rationale: Recent research has provided evidence regarding the burden of depression in mothers of children with epilepsy and the subsequent impact of maternal depression on child health outcomes. However, little research is available on the long-term effects of maternal depression on children, particularly as they transition to late adolescence and young adulthood. This study aimed to: 1?"estimate long-term trajectories of depression in mothers whose children were diagnosed with epilepsy; 2?"identify characteristics at diagnosis predictive of trajectories of depression; and, 3?"model the impact of maternal depression on health-related quality of life (HRQL) of children during the first eight years after epilepsy diagnosis. Methods: Data come from the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES), a multisite prospective cohort study of 373 children aged 4-12 years newly diagnosed with epilepsy. Data were collected at diagnosis, 6, 12, 24, and 96 months later. Maternal depression was measured using the Center for Epidemiological Studies Depression Scale (CES-D). Children's HRQL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55). Trajectories of maternal depression were estimated using latent class modeling; predictors of depression were identified using multinomial logistic regression; and the impact of maternal depression on child HRQL was modeled using growth curve modeling. Results: Four depression trajectories were identified (Fig. 1): Low Stable (56%), Moderate Stable (30%), Decrease-Increase (7%), and Decreasing (7%). Compared to Low Stable, the Moderate Stable trajectory was associated with being younger (OR=0.95; p=0.049), fewer family resources (OR=0.91; p < 0.001), and worse family functioning (OR=0.90; p=0.024). Decrease-Increase trajectory was associated with fewer family resources (OR=0.93; p=0.009). Decreasing trajectory was associated with being younger (OR=0.92; p=0.048), fewer family resources (OR=0.91; p < 0.001), lower child HRQL (OR=0.95; p=0.012), and lower education (PR=4.47; p=0.014). While children's HRQL tended to improve during the first two years post-diagnosis then stabilize through to eight years for children whose mothers had Low Stable depression, children in the Moderate Stable (߽-6.26; p < 0.001), Decrease-Increase (߽-1.89; p=0.577), and Decreasing (߽-13.94; p < 0.001) depression groups had blunted improvements and decreasing HRQL to eight years (Fig. 2). Conclusions: Depression in mothers of children with epilepsy remains a persistent burden throughout the disease course. Younger mothers with lower socioeconomic status, less supportive family environments, and whose children have lower initial HRQL are at elevated risk for less favourable depression trajectories. In the eight years after epilepsy diagnosis, maternal depression continues to have a negative impact on children's HRQL. Health professionals caring for children with epilepsy should screen for maternal depression and refer to allied health and community agencies to support the mental health of mothers whose children are diagnosed with epilepsy. Funding: HERQULES was funded by the Canadian Institutes for Health Research (MOP-64311).