Abstracts

Rationale: Previous research suggests that 12-49% of mothers caring for children with epilepsy score above clinical cutoffs for depression based on self-report measures of depressive symptoms. The objectives of this research were to: 1) estimate prevalence and course of depressive symptoms in mothers of children with new-onset epilepsy and 2) determine maternal, child, and family risk factors for depressive symptoms 24 months after a child’s diagnosis of epilepsy and changes in levels of depressive symptoms over this period. We hypothesize that maternal depressive symptoms (MDS) will decrease linearly over time and predictors of depressive symptoms will include risk for clinical depression at baseline, younger maternal age, less maternal education, multiparity, worse epilepsy severity and child health-related quality of life (HRQL), poor family functioning, more family demands, and less family resources. 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, gender, family history, seizure type, epilepsy classification, epilepsy duration, epilepsy severity, HRQL), and family (income, demands, resources, functioning, perception of family-centred care) variables were examined using mother and neurologist report at baseline, 6, 12, and 24 months. MDS were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Data were analyzed using a multilevel model for change over 24 months. Results: Of 460 eligible families, 376 (82%) participated. At baseline, there were 349 mothers who participated with a mean CES-D score of 14.6, 130 (37%) of whom were at risk for clinical depression. Proportions of mothers at risk for clinical depression decreased linearly over time. Predictors of maternal depressive symptoms at 24 months were being at risk for clinical depression at baseline (β=0.82, p<0.0001), younger maternal age (β=-0.02, p=0.008), worse child HRQL (β=-0.01, p=0.002), less family resources (β=-0.01, p<0.001), and worse family functioning (β=-0.03, p=0.005). Predictors of decline in maternal depressive symptoms were being at risk for clinical depression at baseline (β=0.19, p=0.001), having a female child with epilepsy (β=0.14, p=0.004), fewer child behaviour problems (β=-0.11, p=0.027), and better HRQL (β=0.01, p=0.009). Conclusions: This is the first study to prospectively document depressive symptoms in mothers of children with new-onset epilepsy. Over one-third of mothers of children with new-onset epilepsy are at risk for clinical depression at diagnosis. Maternal, child, and family factors each play a role in predicting MDS 24 months after a child is diagnosed with epilepsy and change in MDS within this 24 month period. It is important to consider the extent to which some of these risk factors are potentially modifiable and thus possible targets for clinical intervention.