Abstracts

Rationale: Depression is one of the most common co-morbidities in epilepsy, occurring in as many as 55% of adults with chronic epilepsy (Mendez, Cummings, & Benson, 1986). There is some debate regarding the nature of the relationship between epilepsy and depression. One view holds that depression and epilepsy are both manifestations of underlying neurologic disorder; the other holds that depression results from the challenges to self-esteem and the stigma that may be associated with epilepsy. This study has two purposes: first, to examine self-reported depressive symptoms in children and adolescents who were evaluated for new seizures three years earlier; and second, to examine the relationship among depressive symptoms, self-esteem, and attitude towards illness over time. Methods: As part of a larger longitudinal study, we evaluated 295 patients (150 male and 145 female) with new-onset seizures who were between 6- and 14- years-old (mean, 9.7 years). The majority (74.7%) of them had recurrent seizures by the time of the last follow-up visit. Their seizures were generally well-controlled; only 13% had failed two or more antiepileptic drugs. Each child completed the Child Depression Inventory (CDI) at the recognized onset of seizures (baseline) as well as at 18 and 36 months after onset. The Child Attitude toward Illness Scale (CATIS) was administered at 18 and 36 months. Self-esteem was measured using a subscale of the Child Health Questionnaire (CHQ) completed by the children at baseline, 18, and 36 months. Pearson’s correlations were calculated between the CHQ subscale of self-esteem and the CDI at each time point. Pearson’s correlations were also calculated between the CATIS and the CDI at 18 and 36 months. Results: There is an inverse relationship between symptoms of depression and self-esteem at baseline, 18 months, and 36 months (r = -.72 to -.74, p < .0001). In addition, depression is negatively associated with attitudes at 18 months (r = -.55, p < .0001) and 36 months (r = -.67, p < .0001). The mean score for self-esteem increased significantly over the three time points (p < .05). Similarly, the mean CATIS score increased significantly between 18 and 36 months (p < .001). Conclusions: Depressive symptoms in children with seizures who were followed for three years were related to both self-esteem and attitude toward illness, consistent with previous findings in children and adolescents as well as adults with chronic epilepsy. However, these children, as a group, do not demonstrate any decline in self-esteem or worsening in their attitude toward illness; in fact, they demonstrate significant improvements in both areas over the three-year follow-up period. This finding may reflect the fact that the majority of the patients do not have intractable epilepsy and indicates that children with successfully treated seizures do not experience the adverse mood outcomes that have been associated with chronic epilepsy in adults.