Multifactorial evaluation of depressive symptoms, suicidal ideation and anxiety symptoms in people with Epilepsy and caregivers

Author(s)

Rafael Batista João

• Document type: Master's Dissertation
• Press: Campinas, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Ciências Médicas
• Defense date: 2021-07-14

Examining board members

Clarissa Lin Yasuda; Maria Emilia Cosenza Andraus; Cláudia Vianna Maurer Morelli

• Advisor: Clarissa Lin Yasuda

Abstract

Introduction: Although several studies have emphasized the association between epilepsy and psychiatric disorders, few have investigated the impact of epilepsy on caregivers' emotional status. Aim: To investigate the presence of depressive symptoms, suicidal ideation and anxiety symptoms in a large group of people with epilepsy (PWE) and their caregivers. To compare the accuracy between newer and briefer inventories with classic inventories for the screening of depressive and anxiety symptoms in the PWE. Method: We analyzed depressive symptoms (with Beck Depression Inventory-II [BDI-II]), suicidal ideation (with BDI-II item 9) and anxiety symptoms (with Beck Anxiety Inventory [BAI]) in a large group of PWE (N = 548 [60% women; median age 41 years]) and caregivers (N = 191 [72% women; median age 47 years]) from a tertiary center, considering sociodemographic and clinical aspects. The adverse events related to antiseizures drugs (ASDs) were evaluated with the application of the Liverpool Adverse Events Profile (LAEP). The PWE also fulfilled the Neurological Depression Inventory for the Epilepsy (NDDIE) and the Generalized Anxiety Disorder-7 (GAD-7) as we aimed to perform comparisons with BDI-II and BAI. Results: While the presence (p = 0.026) (and intensity, p = 0.007) of depressive symptoms and suicidal ideation (p = 0,02) were higher in PWE compared to caregivers, the proportion (p = 0.32) and intensity (p = 0.13) of anxiety symptoms were 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%). 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 (r = 0.35; p < 0.001) and anxiety (r = 0.25; p = 0.01) symptoms in their caregivers. In PWE, we identified high positive correlation between ASD adverse events (evaluated with the LAEP) and depressive and anxiety symptoms. In the multivariate analyses, the presence of ASD adverse events was associated to anxiety (Odds Ratio = 12) and depressive symptoms (Odds Ratio = 4.9). Focal epilepsy (Odds Ratio = 2 compared to EGG) was associated with depressive symptoms, whereas pharmacoresistant seizures (Odds Ratio = 2 compared to seizure-free status) were associated with anxiety symptoms. The presence of anxiety symptoms (Odds Ratio = 4.4), ASD adverse events (Odds Ratio = 2) and pharmacoresistant seizures (Odds Ratio = 3) were associated with suicidal ideation in PWE. In addition, the cross-accuracy analysis demonstrated a moderate to substantial strength (SA) of agreement between the NDDI-E x BDI-II and a moderate SA between the GAD-7 x BAI. Conclusion: Our study suggests that specific attention for the mental health of caregivers is as essential as for PWE. There is an urgent need for more studies involving caregivers to identify their emotional distress and provide adequate treatment. In addition, we emphasize that the choice of ASDs with a low profile of adverse events may have a great impact on symptoms of depression and anxiety in PWE. Lastly, the use of briefer inventories for the screening of depressive and anxiety symptoms in PWE also deserves studies with larger populations, considering the great relevance of this association in clinical practice (AU)

• FAPESP's process: 19/11457-8 - Multifactorial analysis of anxiety disorders and depression in patients with epilepsy and caregivers
• Grantee: Rafael Batista João
• Support Opportunities: Scholarships in Brazil - Master