João Rafael Batista, Nogueira Mateus Henrique, Morita-Sherman Márcia Elisabete, Alvim Marina Koutsodontis Machado, Johnny Steven, Pereira Haryton, Pinheiro Hildete Prisco, Cendes Fernando, Yasuda Clarissa Lin
Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil.
The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil.
Front Neurol. 2022 Mar 9;13:766009. doi: 10.3389/fneur.2022.766009. eCollection 2022.
Although several studies have emphasized the association between epilepsy and psychiatric disorders, fewer have investigated the impact of epilepsy on caregivers' emotional status, mainly in adult people with epilepsy (PWE). Here we investigated depressive symptoms, suicidal ideation, and anxiety symptoms in a large group of adult PWE and their caregivers.
We analyzed symptoms of depression [with the Beck Depression Inventory-II (BDI-II)], suicidal ideation (with BDI-II item 9), and anxiety symptoms (with the Beck Anxiety Inventory) in a large group of adult PWE [ = 548 (60% women; median age 41)] and caregivers [ = 191 (72% women; median age 47)] from a Brazilian tertiary center, considering sociodemographic and clinical aspects. We also applied the Liverpool Adverse Events Profile to assess anti-seizure drugs adverse events.
While the presence ( = 0.026) (and intensity, = 0.007) of depressive symptoms and suicidal ideation ( = 0.02) were higher in PWE compared to caregivers, the proportion of clinical anxiety symptoms ( = 0.32) (and the intensity, = 0.13) was similar in both groups. Although the rates of suicidal ideation were higher in focal epilepsy (20%), both generalized genetic epilepsy and caregivers also presented elevated frequencies (11%) of suicidal ideation. The analyses of 120 patient-caregiver dyads revealed that the intensity of depressive symptoms in PWE (but not anxiety) correlated with the intensity of depressive ( = 0.35; < 0.001) and anxiety ( = 0.25; = 0.01) symptoms in their caregivers. In the multivariate analyses of PWE, focal epilepsy (compared to GGE) was associated with clinical depressive symptoms (odds ratio, OR 2.1) and suicidal ideation (OR 3.2), while recurrent seizures (compared to the seizure-free group) were associated with suicidal ideation (OR 2.6) and anxiety symptoms (OR 2.1). Also, caregivers with anxiety symptoms were 8 times more likely to exhibit depressive symptoms, and those with depressive symptoms were 8 times more likely to present anxiety symptoms.
Our study suggests that specific attention for the caregivers' mental health is as essential as PWE. There is an urgent need for more studies involving caregivers to identify their emotional distress and provide adequate treatment.
尽管多项研究强调了癫痫与精神障碍之间的关联，但较少有研究调查癫痫对照顾者情绪状态的影响，主要是针对成年癫痫患者（PWE）。在此，我们调查了一大群成年PWE及其照顾者的抑郁症状、自杀意念和焦虑症状。
我们分析了来自巴西一家三级中心的一大群成年PWE[ = 548（60%为女性；中位年龄41岁）]和照顾者[ = 191（72%为女性；中位年龄47岁）]的抑郁症状[使用贝克抑郁量表第二版（BDI-II）]、自杀意念（使用BDI-II第9项）和焦虑症状（使用贝克焦虑量表），同时考虑了社会人口学和临床方面。我们还应用了利物浦不良事件概况来评估抗癫痫药物的不良事件。
与照顾者相比，PWE的抑郁症状（ = 0.026）（以及强度， = 0.007）和自杀意念（ = 0.02）的发生率更高，而两组临床焦虑症状的比例（ = 0.32）（以及强度， = 0.13）相似。尽管局灶性癫痫患者的自杀意念发生率较高（20%），但全身性遗传性癫痫患者和照顾者的自杀意念发生率也较高（11%）。对120对患者-照顾者二元组的分析显示，PWE的抑郁症状强度（而非焦虑症状）与他们照顾者的抑郁（ = 0.35； < 0.001）和焦虑（ = 0.25； = 0.01）症状强度相关。在对PWE的多变量分析中，局灶性癫痫（与全身性遗传性癫痫相比）与临床抑郁症状（优势比，OR 2.1）和自杀意念（OR 3.2）相关，而发作频繁（与无发作组相比）与自杀意念（OR 2.6）和焦虑症状（OR 2.1）相关。此外，有焦虑症状的照顾者出现抑郁症状的可能性高8倍，有抑郁症状的照顾者出现焦虑症状的可能性高8倍。
我们的研究表明，对照顾者心理健康的特别关注与对PWE的关注同样重要。迫切需要更多涉及照顾者的研究，以识别他们的情绪困扰并提供适当的治疗。
