Abstracts

Rationale: Epilepsy causes significant mortality, exceeding 20,000 deaths/year in the US. Uncontrolled seizures also cause severe morbidities including: 1) physical injuries, 2) restrictive lifestyle, 3) cognitive and mental health disorders, and 4) stigma and social isolation. These morbidities contribute to chronic impairments in quality of life (QOL), the health outcome most important to epilepsy patients (Gilliam, F. et al.,1997). Poor seizure control is confounded by ethnic and socioeconomic disparities in access to epilepsy care, and places certain populations at the highest risk for epilepsy-associated complications and worse QOL. While antiepileptic drug (AED) side effects and costs contribute to poor adherence in the underserved populations, little is known about patient-level modifiable barriers. We examined a set of modifiable psychological factors as possible correlates of QOL in this population. We hypothesize that greater depression and perceived stress and negative illness perceptions will be associated with poorer QOL in these patients and may be promising targets for patient-specific behavioral interventions to improve QOL. Methods: 47 patients with treatment-resistant epilepsy were recruited from Bellevue Hospital in New York City. The subjects completed self-report questionnaires focused on illness perception, medication adherence, perceived stress, depression symptoms, and quality of life. Medical records were reviewed for abstraction of relevant epilepsy history. Results: Mean age was 31.2 ± 10.5 years. 51% of patients were female and 57% were Hispanic. 36% of the sample reported elevated depressive symptoms consistent with a diagnosis of major depressive disorder (MDD). Elevated depressive symptoms and stress were associated with reduced QOL (β=0.34, P<0.05), (β=0.46, P<0.05), respectively. Depression and stress were also associated with a more threatening view of epilepsy (β=0.43, P<0.05), (β=0.57, P<0.05), respectively. Illness perceptions was an independent predictor of and may fully mediate the relationship between depressive symptoms and QOL and between stress and QOL. All analyses controlled for age, sex, ethnicity, seizure frequency, and number of AEDs. Conclusions: We found that negative and threatening illness perceptions may help to explain how depression and stress contribute to reduced QOL in epilepsy patients. Our results highlight the impact of illness perception on QOL and support targeted interventions to improve epilepsy patients' dysfunctional beliefs to potentially improve QOL.