Abstracts

Personal and environmental factors are critical influences on epilepsy self-management. The burden of epilepsy from depression, stigma, and negative expectations may affect a person's coping, compliance and quality of life. Understanding their impact on self-management practices will help identify poor self-managers and those at risk for psychosocial difficulties.
This study is part of a larger study of epilepsy self-management conducted at 3 centers in Boston and Atlanta. Participants completed 3 assessments each 3 months apart addressing demographics, seizures, and personal and environmental factors associated with self-management of epilepsy. The presence of depression, perceived stigma, lack of social support and negative outcome expectancies and were correlated to self-management practices using descriptive statistics, including correlations. Structural equation modeling is being conducted to evaluate the fit of these variables into a model of epilepsy self-management.
314 adults, mean age 40, 50% female, 80.3 % Caucasian. Mean age of seizure onset 22 years with seizure duration of 17 years. 76% had a seizure in past year, but only 35 % perceived poor control of seizures. Depression scores using CES-D scale correlated highly with negative outcome expectancies for seizures (.500**) and treatment (-.418**), lack of social support (-.507**), low self-efficacy (-.467**), stigma (.428**), and low patient satisfaction (-.347**). While outcome expectancies for management were not related, medication and stress self-management practices did correlate with depression. Modeling showed that outcome expectancies appear to influence stigma, stigma links to depression, and depression is a weak predictor of self-management. The strongest link to self-management was mediated through self-efficacy. Further analysis is underway to examine the group of patients with these negative consequences in more detail. (**Significant at 0.01 level)
This study highlights the intricate relationships among personal and environmental negativity and self-management practices. Mood disorders in epilepsy are fairly common, but are often not diagnosed or treated adequately, adding to the burden of epilepsy. The weak relationship between depression and self-management may contribute to these problems being too easily overlooked in clinical practice. Further analysis of these factors may improve ability to assess and influence self-management behaviors and depression.
[Supported by: grant number: R01-NR04770 from the National Institute of Nursing Research and in part by grant number: M01-RR01032 from the National Institutes of Health to the Beth Israel Deaconess Medical Center GCRC.]