Depression, anxiety levels and sleep quality indexes among the spouses of people with epilepsy

ABSTRACT

Background: Psychiatric problems and sleep disturbances are comorbidities that are frequently encountered among people with epilepsy. However, their presence among the spouses of peoples with epilepsy remains to be elucidated. Objective: The objective of this study was to evaluate the spouses of people with epilepsy (PWE), with and without a history of seizures during sleep, in terms of depression, anxiety and sleep quality. Methods: This prospective, cross-sectional study was conducted in three groups of 18 to 65-year-olds. Group 1 consisted of healthy spouses of 127 healthy volunteers without any known neurological disease; group 2 comprised spouses of 63 PWE who had no history of seizure during sleep; and group 3 consisted of spouses of 63 PWE who had a history of at least one seizure during sleep in the course of the previous year. Questionnaires seeking demographic data and the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory and Beck Anxiety Inventory were applied to all participants. Results: The depression scores of the group of spouses of PWE were higher than those of the control group and were higher in group 3 than in group 2 (p = 0.017). The anxiety scores of the group of spouses of PWE were significantly higher than those of the control group, but no difference in anxiety scores was found between group 2 and group 3 (p = 0.170). The mean PSQI score of group 3 was higher than that of group 2 (p = 0.029). However, regression analyses did not show any difference between these groups. Conclusion: We found that the PSQI scores, which reflected sleep quality, were higher among the spouses of PWE who had seizures during sleep and who had more severe epilepsy.

RESUMO

Introdução: Problemas psiquiátricos e distúrbios do sono são comorbidades muito encontradas em pessoas com epilepsia. No entanto, sua presença nos cônjuges de pessoas com epilepsia ainda precisa ser elucidada. Objetivo: O objetivo do presente estudo foi avaliar os cônjuges de pessoas com epilepsia (PCE) com e sem histórico de convulsões durante o sono em termos de depressão, ansiedade e qualidade do sono. Métodos: Este estudo transversal prospectivo foi realizado com três grupos de jovens de 18 a 65 anos. O Grupo 1 era formado por cônjuges saudáveis de 127 voluntários saudáveis sem uma doença neurológica conhecida; o grupo 2 era composto por cônjuges de 63 PCE que não tinham histórico de convulsões durante o sono; o grupo 3 consistiu em cônjuges de 63 PCE que tinham história de pelo menos uma convulsão durante o sono no ano anterior. O questionário incluindo dados demográficos, Índice de Qualidade do Sono de Pittsburgh (PSQI), Inventário de Beck para Depressão e Inventário de Beck para Ansiedade foi aplicado a todos os participantes. Resultados: Os escores de depressão do grupo de cônjuges de PCE foram maiores que os do grupo controle e foram maiores no grupo 3 em relação ao grupo 2 (p=0,017). Os escores de ansiedade do grupo de cônjuges de PCE foram significativamente maiores do que os do grupo controle. No entanto, não foi encontrada diferença nos escores de ansiedade entre o grupo 2 e o grupo 3 (p=0,170). Os escores médios do PSQI do grupo 3 foram maiores do que a pontuação média do grupo 2 (p=0,029). Apesar disso, as análises de regressão não revelaram nenhuma diferença entre esses grupos. Conclusão: Verificamos que os escores do PSQI que refletem a qualidade do sono foram maiores nos cônjuges de PCE, que tiveram convulsões durante o sono e que apresentaram epilepsia mais grave.

Keywords:

Epilepsy - Sleep - Seizures - Anxiety - Depression

Palavras-chave:

Epilepsia - Sono - Convulsões - Ansiedade - Depressão

Authors’ contributions:

HO: was involved in data synthesis, study drafting, study design, study conceptualization, data collection, analysis or interpretation of the data, manuscript preparation and manuscript revision; EKU: was involved in data synthesis, data collection and study conceptualization; CB: was involved in data synthesis, data collection and study conceptualization; MK: was involved in data synthesis and data collection; MOO: was involved in data synthesis and data collection; ZK: was involved in data synthesis and data collection; MB: was involved in the analysis or interpretation of the data and manuscript preparation; AT: was involved in data synthesis, data collection and study conceptualization.

Compliance with ethical standards:

This research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. Ethical approval was obtained from the local ethics committee of the hospital.

Publication History

Received: 22 May 2020

Accepted: 16 September 2020

Article published online:
07 June 2023

• References

• 1 Kwan P, Trinka E, Van Paesschen W, Rektor I, Johnson ME, Lu S. Adjunctive brivaracetam for uncontrolled focal and generalized epilepsies: results of a phase III, double-blind, randomized, placebo-controlled, flexible-dose trial. Epilepsia. 2014 Jan;55(1):38-46. https://doi.org/10.1111/epi.12391
• 2 Yates SL, Fakhoury T, Liang W, Eckhardt K, Borghs S, D'Souza J. An open-label, prospective, exploratory study of patients with epilepsy switching from levetiracetam to brivaracetam. Epilepsy Behav. 2015 Nov;52(Pt A):165-8. https://doi.org/10.1016/j.yebeh.2015.09.005
• 3 Jones JE, Hermann BP, Barry JJ, Gilliam F, Kanner AM, Meador KJ. Clinical assessment of Axis I psychiatric morbidity in chronic epilepsy: a multicenter investigation. J Neuropsychiatry Clin Neurosci. 2005 Spring;17(2):172-9. https://doi.org/10.1176/jnp.17.2.172
• 4 Zhu XR, Zhao T, Gu H, Gao YJ, Wang N, Zhao P, el al. High risk of anxiety and depression in caregivers of adult patients with epilepsy and its negative impact on patients' quality of life. Epilepsy Behav. 2019 Jan:90:132-6. https://doi.org/10.1016/j.yebeh.2018.11.015
• 5 Lin CY, Saffari M, Koenig HG, Pakpour AH. Effects of religiosity and religious coping on medication adherence and quality of life among people with epilepsy. Epilepsy Behav. 2018 Jan;78:45-51. https://doi.org/10.1016/j.yebeh.2017.10.008
• 6 Penovich PE, Buelow J, Steinberg K, Sirven J, Wheless J. Burden of Seizure Clusters on Patients With Epilepsy and Caregivers: Survey of Patient, Caregiver, and Clinician Perspectives. Neurologist. 2017 Nov;22(6):207-14. https://doi.org/10.1097/nrl.20200207202002070140
• 7 Thompson R, Kerr M, Glynn M, Linehan C. Caring for a family member with intellectual disability and epilepsy: practical, social and emotional perspectives. Seizure. 2014 Nov;23(10):856-63. https://doi.org/10.1016/j.seizure.2014.07.005
• 8 Lai ST, Tan WY, Wo MC, Lim KS, Ahmad SB, Tan CT. Burden in caregivers of adults with epilepsy in Asian families. Seizure. 2019 Oct;71:132-9. https://doi.org/10.1016/j.seizure.2019.07.008
• 9 Dehghani M, Fayyazi A, Cheraghi F, Hakimi H, Mosazadeh S, Almasi S. The Relationship Between Severity of Epilepsy and Sleep Disorder in Epileptic Children. Iran J Child Neurol. 2019 Spring;13(2):77-88. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc6451861/
• 10 Planas-Ballve A, Grau-Lopez L, Jimenez M, Ciurans J, Fumanal A, Becerra JL. Insomnia and poor sleep quality are associated with poor seizure control in patients with epilepsy. Neurologia. 2020 Jan;S0213-4853(19)30139-2. https://doi.org/10.1016/j.nrl.2019.07.006
• 11 Chan SY. Sleep architecture and homeostasis in children with epilepsy: a neurodevelopmental perspective. Dev Med Child Neurol. 2019 Apr;62(4):426-33. https://doi.org/10.1111/dmcn.14437
• 12 Cilliler AE, Guven B. Sleep quality and related clinical features in patients with epilepsy: A preliminary report. Epilepsy Behav. 2020 Jan;102:106661. https://doi.org/10.1016/j.yebeh.2019.106661
• 13 Hamamci M, Hacimusalar Y, Karaaslan O, Inan LE. Evaluation of sleep quality in spouses of people with epilepsy. Epilepsy Behav. 2019 May:94:233-8. https://doi.org/10.1016/j.yebeh.2019.03.027
• 14 Tsai SY, Lee WT, Lee CC, Jeng SF, Weng WC. Sleep in mothers of children with epilepsy and its relation to their children's sleep. Res Nurs Health. 2020 Apr;43(2):168-75. https://doi.org/10.1002/nur.22008
• 15 Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014 Apr;55(4):475-82. https://doi.org/10.1111/epi.12550
• 16 Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961 Jun;4:561-71. https://doi.org/10.1001/archpsyc.1961.01710120031004
• 17 Hisli N. Beck Depresyon Envanterinin Geçerliği Üzerine Bir Çalışma (A study on the validity of Beck Depression Inventory). Psikoloji Dergisi. 1988 Aug;6:118-22. Available at: https://www.academia.edu/1472683/Beck_Depresyon_Envanterinin_Ge%C3%A7erli%C4%9Fi_%C3%9Czerine_bir_%C3%87al%C4%B1%C5%9Fma
• 18 Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988 Dec;56(6):893-7. https://doi.org/10.1037//0022-006x.56.6.893
• 19 Ulusoy M, Sahin NH, Erkmen H. Beck Anxiety Inventory: Psychometric Properties. J Cogn Psychother. 1998;12(2):163-72. Available at: https://www.researchgate.net/profile/Nesrin-Hisli-Sahin/publication/233792003_Turkish_Version_of_the_Beck_Anxiety_Inventory_Psychometric_Properties/links/0912f50b89f36c598c20200207/Turkish-Version-of-the-Beck-Anxiety-Inventory-Psychometric-Properties.pdf
• 20 Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213. https://doi.org/10.1016/0165-1781(89)90047-4
• 21 Yücel Ağargün M, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi Indeksinin Geçerliği ve Güvenirliği. Turk Psikiyatri Dergisi. 1996;7(2):107-15. Available at: http://www.turkpsikiyatri.com/default.aspx?modul=turkceOzet&gFPrkMakale=210
• 22 O'Donoghue MF, Duncan JS, Sander JW. The National Hospital Seizure Severity Scale: a further development of the Chalfont Seizure Severity Scale. Epilepsia. 1996 Jun;37(6):563-71. https://doi.org/10.1111/j.1528-1157.1996.tb00610.x
• 23 Canuet L, Ishii R, Iwase M, Ikezawa K, Kurimoto R, Azechi M, et al. Factors associated with impaired quality of life in younger and older adults with epilepsy. Epilepsy Res. 2009 Jan;83(1):58-65. https://doi.org/10.1016/j.eplepsyres.2008.09.001
• 24 Pham T, Sauro KM, Patten SB, Wiebe S, Fiest KM, Bulloch AGM, et al. The prevalence of anxiety and associated factors in persons with epilepsy. Epilepsia. 2017 Aug;58(8):e107-10. https://doi.org/10.1111/epi.13817
• 25 Scott AJ, Sharpe L, Hunt C, Gandy M. Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia. 2017 Jun;58(6):973-82. https://doi.org/10.1111/epi.13769
• 26 Chapieski L, Brewer V, Evankovich K, Culhane-Shelburne K, Zelman K, Alexander A. Adaptive functioning in children with seizures: impact of maternal anxiety about epilepsy. Epilepsy Behav. 2005 Sep;7(2):246-52. https://doi.org/10.1016/j.yebeh.2005.05.002
• 27 Farnalls SL, Rennick J. Parents' caregiving approaches: facing a new treatment alternative in severe intractable childhood epilepsy. Seizure. 2003 Jan;12(1):1-10. https://doi.org/10.1016/s1059131102001693
• 28 Ferro MA, Avison WR, Campbell MK, Speechley KN. Prevalence and trajectories of depressive symptoms in mothers of children with newly diagnosed epilepsy. Epilepsia. 2011 Feb;52(2):326-36. https://doi.org/10.1111/j.1528-1167.2010.02899.x
• 29 Bompori E, Niakas D, Nakou I, Siamopoulou-Mavridou A, Tzoufi MS. Comparative study of the health-related quality of life of children with epilepsy and their parents. Epilepsy Behav. 2014 Dec;41:11-7. https://doi.org/10.1016/j.yebeh.2014.09.009
• 30 Iqbal M, Amirsalari S, Radfar S, Haidari MR. Effects of parental gender and level of education on the quality of life and general health of pediatric patients with epilepsy: An outpatient cross-sectional survey. Epilepsy Behav. 2016 Jul;60:118-23. https://doi.org/10.1016/j.yebeh.2016.04.037
• 31 Singh G, Ganguly KK, Banerji M, Addlakha R, Shah U, Tripathi M, et al. Marriage in people with epilepsy: A compelling theme for psycho-behavioral research. Seizure. 2018 Nov;62:127-30. https://doi.org/10.1016/j.seizure.2018.08.005
• 32 Gutierrez-Angel AM, Martinez-Juarez IE, Hernandez-Vanegas LE, Crail-Melendez D. Quality of life and level of burden in primary caregivers of patients with epilepsy: Effect of neuropsychiatric comorbidity. Epilepsy Behav. 2018 Apr;81:12-7. https://doi.org/10.1016/j.yebeh.2018.01.034
• 33 Hansen B, Szaflarski M, Bebin EM, Szaflarski JP. Affiliate stigma and caregiver burden in intractable epilepsy. Epilepsy Behav. 2018 Aug;85:1-6. https://doi.org/10.1016/j.yebeh.2018.05.028
• 34 Harden CL, Maroof DA, Nikolov B, Fowler K, Sperling M, Liporace J, et al. The effect of seizure severity on quality of life in epilepsy. Epilepsy Behav. 2007 Sep;11(2):208-11. https://doi.org/10.1016/j.yebeh.2007.05.002
• 35 Perucca P, Gilliam FG. Adverse effects of antiepileptic drugs. Lancet Neurol. 2012 Sep;11(9):792-802. https://doi.org/10.1016/s1474-4422(12)70153-9