Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Front Public Health. 2022 Aug 26;10:952585. doi: 10.3389/fpubh.2022.952585. eCollection 2022.
Epilepsy is one of the most common neurological disorders with high costs for the healthcare systems and great suffering for patients. Beyond seizures, psychosocial comorbidities can have detrimental effects on the well-being of people with epilepsy. One source of social stress and reduced quality of life is epilepsy-related stigma that often occurs, e.g., due to public misconceptions or myths. Stigma has individual biological, psychological and social correlates. Moreover, environmental factors like living in remote areas are associated with stigma. However, little is known about the link between the social structure of the residence and stigma in epilepsy. Thus, we investigated the association between the structural socioeconomic status (SES) and perceived stigma in an urban epilepsy population.
This prospective, cross-sectional study examined 226 adult in-patients with epilepsy from Berlin. Multiple regression analyses were performed to check the relationship between structural SES and stigma controlling for individual-level demographic, clinical, psychological and social factors. Continuous social indices (SI) of the districts and neighborhoods ("SI district" and "SI neighborhood") of Berlin were used to measure different levels of structural SES. Non-linear relationships are tested by grouping the SI in quartiles.
Both indicators of structural SES were independently linked to stigma ( = 0.002). For "SI district", we identified a non-linear relationship with patients from the most deprived quartile feeling less stigmatized compared to those in the second ( < 0.001) or least deprived quartile ( = 0.009). Furthermore, more restrictions of daily life ( < 0.001), unfavorable income ( = 0.009) and seizure freedom in the past 6 months ( = 0.05) were related to increased stigma. A lower "SI neighborhood" was associated with higher stigma ( = 0.002).
Strategies to reduce epilepsy-related stigma need to consider the sociostructural living environment on different regional levels. Unfavorable relations with the immediate living environment may be directly targeted in patient-centered interventions. Non-linear associations with the structural SES of broader regional levels should be considered in public education programs. Further research is needed to examine possible underlying mechanisms and gain insight into the generalizability of our findings to other populations.
癫痫是最常见的神经障碍之一，给医疗保健系统带来了高昂的成本，也给患者带来了极大的痛苦。除了癫痫发作之外，心理社会共病还会对癫痫患者的幸福感产生不利影响。癫痫相关耻辱感是社交压力和生活质量下降的一个来源，这种耻辱感常常发生，例如由于公众的误解或神话。耻辱感具有个体生物学、心理学和社会学的相关性。此外，居住在偏远地区等环境因素与耻辱感有关。然而，人们对居住的社会结构与癫痫耻辱感之间的联系知之甚少。因此，我们研究了柏林的城市癫痫患者中结构社会经济地位（SES）与感知耻辱感之间的关系。
本前瞻性、横断面研究共纳入 226 名柏林成年癫痫住院患者。进行多元回归分析，以检查结构 SES 与控制个体水平人口统计学、临床、心理和社会因素后的耻辱感之间的关系。柏林区和街区的连续社会指数（SI）（“SI 区”和“SI 街区”）用于衡量不同层次的结构 SES。通过将 SI 分为四等份来测试非线性关系。
结构 SES 的两个指标都与耻辱感独立相关（ = 0.002）。对于“SI 区”，我们发现与第二（ < 0.001）或最不贫困（ = 0.009） quartile 的患者相比，来自最贫困 quartile 的患者感觉耻辱感较少，存在非线性关系。此外，日常生活受限更多（ < 0.001）、收入不利（ = 0.009）和过去 6 个月无发作（ = 0.05）与增加的耻辱感相关。较低的“SI 街区”与较高的耻辱感相关（ = 0.002）。
减少癫痫相关耻辱感的策略需要考虑不同区域层面的社会结构生活环境。在以患者为中心的干预中，可以直接针对与直接生活环境的不利关系。需要在公共教育计划中考虑与更广泛区域层面的结构 SES 的非线性关联。需要进一步研究以检查潜在的机制，并深入了解我们的发现对其他人群的普遍性。
