Abstracts

Rationale: Stress is an insidious, multifactorial problem that is often under-treated in individuals with pharmacoresistant epilepsy. The goal of the current study was to characterize the relationship between stress and mood/anxiety in patients with epilepsy and determine if coping style moderates these relationships. Methods: Eighty-one adults with epilepsy (Mage=38 years; 56% female) completed measures of stress (Perceived Stress Scale; PSS), mood (Neurological Disorders Depression Inventory for Epilepsy; NDDI-E), anxiety (Generalized Anxiety Disorder Scale; GAD-7), and coping style (Brief COPE Inventory; COPE) while on the epilepsy monitoring unit at a large tertiary hospital. COPE assesses 14 coping styles, which load onto two factors: Adaptive (ACS; e.g. Acceptance, Active Coping) and Maladaptive (MCS; e.g., Substance Abuse, Denial) Coping Strategies. T-test and chi-squares examined differences between patients with high versus low stress levels on demographic and seizure variables. Bivariate correlations then examined relationships between stress, psychological status, and coping styles. Finally, a series of linear regressions were conducted with total PSS score as predictor and total NDDI-E or GAD-7 score as outcome. Interactions between PSS score and COPE factor or subscale score were also entered as predictors in these models to assess moderating effects of coping style. Due to the ordinal nature of the COPE subscale scores, coping styles were classified as high or low using a median score cutoff. Results: Fifty-three percent of patients endorsed high stress on the PSS, and mean PSS score (25.38±8.76) was above the cutoff recommended for identifying high stress (i.e., 25). There were no significant differences between high and low stress groups on any demographic or seizure variables. Stress was strongly, positively correlated with both mood (r=.699) and anxiety (rs=.734). MCS was positively associated with stress and psychological status (rs=.297 to .465) as were several MCS subscales (rs=.251 to .479; Substance Use, Behavioral Disengagement, Venting, Self-Blame), while only one ACS subscale (Acceptance) was negatively associated with these factors (r=-.207 to -.265). See Table 1. In linear regression models, neither ACS nor MCS moderated the relationship between stress and psychological status. However, the relationship between stress and depression was significantly moderated by Use of Emotional Support, and the relationship between stress and anxiety was significantly moderated by Positive Reframing. See Figures 1A and 1B. None of the other COPE subscales were significant moderators. Conclusions: Results suggest that perceived stress is strongly associated with psychological status in epilepsy and that certain coping styles moderate the relationship between stress and mood/anxiety. The use of emotional support lessens the impact of stress on depression and the use of positive reframing lessens the impact of stress on anxiety. This suggests that coping strategies/styles may be an important area to assess/address in behavioral treatments for stress management in patients with epilepsy. Funding: Epilepsy Foundation Behavioral Sciences Postdoctoral Fellowship (to M.J.R.)