Abstracts
Objective
To assess depression and anxiety symptoms of adolescents with epilepsy compared with adolescents without epilepsy.
Method
The study sample consisted of: case participants (50 subjects) attending the pediatric epilepsy clinic of a tertiary hospital and control participants (51 subjects) from public schools. The instruments utilized were: identification card with demographic and epilepsy data, Beck Depression Inventory and State-Trait Anxiety Inventory.
Results
No significant differences were founded between the groups regarding scores for depression and anxiety symptoms but both groups presented moderate scores of anxiety. A correlation was found between low scores anxiety and not frequent seizures, low scores anxiety and perception of seizure control, high scores of anxiety and depression and occurrence of seizures in public places.
Conclusion
Low scores of anxiety are associated with not frequent seizures; high scores of anxiety and depression are associated with occurrence of seizures in public places.
epilepsy; adolescence; depression; anxiety; seizure frequency; perception of seizure control; occurrence of seizure in public places
Objetivo
O presente estudo teve como objetivo avaliar os sintomas de ansiedade e depressão de adolescentes com epilepsia comparados com adolescentes sem epilepsia.
Método
A amostra consistiu: grupo caso (50 indivíduos) atendidos no ambulatório de epilepsia infantil do Hospital Universitário e grupo controle (51 indivíduos) de escolas públicas. Os instrumentos utilizados foram: cartão com dados demográficos e de epilepsia, Beck Depression Inventory e State-Trait Anxiety Inventory.
Resultados
Os resultados não mostraram diferenças significativas entre os grupos em relação à depressão e ansiedade, mas ambos os grupos apresentaram escores moderados de ansiedade. Foi encontrada correlação entre baixa pontuação de ansiedade e crises não frequentes e percepção de controle de crises; altas pontuações de ansiedade e depressão e ocorrência de crises em lugares públicos.
Conclusão
Variáveis psicossociais e da doença são contingências importantes no comportamento adaptativo e controle do humor em uma doença crônica como a epilepsia.
epilepsia; adolescência; depressão; ansiedade; frequência de crises; percepção de controle de crises; ocorrência de crises em público
Epilepsy has been recognized as a risk factor for negative outcomes in many aspects of the lives of people with this diagnosis, including emotional, psychological, academic, and social problems11 Mitchell WG, Scheier LM, Baker SA. Psychosocial, behavioral, and medical outcomes in children with epilepsy: a developmental risk factor model using longitudinal data. Pediatrics. 1994;94(4):471-7.. Prone to the social limitations that the diagnosis of epilepsy brings, many people with epilepsy suffer from moderate to severe depression and anxiety22 Valente KDR, Souza ST, Kuczynski, Negrão N. Depressão em crianças e adolescentes com epilepsia. Rev Psiq Clín. 2004;31(6):290-9..
Depression per se is one of the most commonly occurring major
psychiatric disorders, and it has become increasingly recognized that the disease often
begins in adolescence. Depressive patients are often diagnosed with other illnesses,
especially anxiety and disruptive behavioral disorders33 Hankin BL. Adolescent depression: description, causes, and
interventions. Epilepsy Behav. 2006;8(1):102-14.
http://dx.doi.org/10.1016/j.yebeh.2005.10.012
https://doi.org/10.1016/j.yebeh.2005.10....
.
In adults with epilepsy depression and anxiety are the most prevalent psychiatric
disorders, affecting about 55% of subjects44 Jacoby A, Baker GA, Steen N, Potts P, Chadwick DW. The clinical
course of epilepsy and its psychosocial correlates: findings from a U.K.
Community study. Epilepsia. 1996;37(2):148-61.
http://dx.doi.org/10.1111/j.1528-1157.1996.tb00006.x
https://doi.org/10.1111/j.1528-1157.1996...
. In children and adolescents, many studies were also carried
out, developed with different designs and assessment tools, and presenting diverse
outcomes.
Ettinger et al.55 Ettinger AB, Weisbrot DM, Nolan EE, Gadow KD, Vitale SA, Andriola MR
et al. Symptoms of depression and anxiety in pediatric epilepsy patients.
Epilepsia. 1998;39(6):595-9.
http://dx.doi.org/10.1111/j.1528-1157.1998.tb01427.x
https://doi.org/10.1111/j.1528-1157.1998...
applied the
quantitative scales Revised Child Manifest Anxiety Scale (RCMAS)66 Reynolds CR, Richmond BO. Revised Children’s Martijest
Anxiety Scale (RCMAS). Los Angeles: Western Psychological Services;
1985. and Child Depression Inventory (CDI)77 Kovacs M. The Children’s Depression Inventory (CDI). North
Tonawanda: Multi-Health Systems; 1992. to assess depression and anxiety in a
population of 44 children and adolescents (from 7 to 18 years) with epilepsy and found
that 26% of patients had increased depression scores and 16% had anxiety
symptomatology.
Dunn et al.88 Dunn DW, Austin JK, Huster GA. Symptoms of depression in adolescents
with epilepsy. J Am Acad Child Adolesc Psychiatry. 1999;38(9):1132-8.
http://dx.doi.org/10.1097/00004583-199909000-00017
https://doi.org/10.1097/00004583-1999090...
studied adolescents with
epilepsy aged 12-16 years in a cross-sectional design with 115 subjects and found that
23% of those had symptoms of depression (based on the CDI). Oguz et al.99 Oguz A, Kurul S, Dirik E. Relationship of epilepsy-related factors
to anxiety and depression scores in epileptic children. J Child Neurol.
2002;17(1):37-40. http://dx.doi.org/10.1177/088307380201700109
https://doi.org/10.1177/0883073802017001...
reported subjects aged 12-18 years to
have higher scores of depression (using the CDI) when compared with a control group with
normal children, but both of the case groups (9-11 years and 12-18 years) showed
increased anxiety based on the State Trait Anxiety Inventory (STAI)1010 Spielberger CD, Gorsuch RL, Lushene RE. Manual for State-Trait
Anxiety Inventory. Palo Alto: Consulting Psychologists; 1970., when compared with the control group.
Ott et al.1111 Ott D, Siddarth P, Gurbani S, Koh S, Tournay A, Shields WD et al.
Behavioral disorders in pediatric epilepsy: unmet psychiatric need. Epilepsia.
2003;44(4):591-7.
http://dx.doi.org/10.1046/j.1528-1157.2003.25002.x
https://doi.org/10.1046/j.1528-1157.2003...
investigated psychiatric
illnesses in 114 children with epilepsy aged 5-16 years and found that 61% of the sample
carried a psychiatric diagnosis, and, of those, only a third was receiving adequate
mental health treatment. Caplan et al.1212 Caplan R, Siddarth P, Gurbani S, Hanson R, Sankar R, Shields WD.
Depression and anxiety disorders in pediatric epilepsy. Epilepsia.
2005;46(5):720-30.
http://dx.doi.org/10.1111/j.1528-1167.2005.43604.x
https://doi.org/10.1111/j.1528-1167.2005...
, with a similar sample (children with epilepsy aged 5-16
years) and tool approach, but with a comparison control group, observed increased rates
of affective and anxiety disorders diagnoses (33% vs 6% - control) as well as suicidal
ideation (20% vs 9% - control) for the case group.
More recently, Loney et al.1313 Loney JC, Wirrell EC, Sherman EMS, Hamiwka LD. Anxiety and
depressive symptoms in children presenting with a first seizure. Pediatr Neurol.
2008;39(4):236-40.
http://dx.doi.org/10.1016/j.pediatrneurol.2008.07.005
https://doi.org/10.1016/j.pediatrneurol....
assessed
anxiety and depressive signs in children and adolescents from 7 to 17 years presenting
at their clinic with a first seizure, using CDI and RCMAS. For anxiety, there was a
higher score for case group versus published norms, but no difference when compared with
the control group; for depression, scores were higher for case group when compared with
both published norms and control group.
Depression and anxiety in children and adolescents with epilepsy requires further
attention because it carries a risk of reduced quality of life and complications in
life1414 Ekinci O, Titus JB, Rodopman AA, Berkem M, Trevathan E. Depression
and anxiety in children and adolescents with epilepsy: prevalence, risk factors,
and treatment. Epilepsy Behav. 2009;14(1):8-18.
http://dx.doi.org/10.1016/j.yebeh.2008.08.015
https://doi.org/10.1016/j.yebeh.2008.08....
. Although most studies
agree that children and adolescents with epilepsy have a high level of depression and
anxiety, it is possible to perceive differences among the numbers presented in these
studies. Some of the reasons for the variability in prevalence may include an inadequate
consideration of both biological and psychosocial factors1515 Souza EAP, Salgado PCB. A psychosocial view of anxiety and
depression in epilepsy. Epilepsy Behav. 2006;8(1):232-8.
http://dx.doi.org/10.1016/j.yebeh.2005.10.011
https://doi.org/10.1016/j.yebeh.2005.10....
. These factors, including the developmental stages of a
person, may be related to the subject age. The studies previously cited evaluated
different age intervals, defined not by preexisting formal criteria for the age range
for children and age range for adolescents, and their possible subdivisions1616 United Nations Children’s Fund - UNICEF. adolescent
development: perspectives and frameworks - a discussion paper. New York: United
Nations Children’s Fund; 2006.,1717 Sacks D, Canadian Paediatric Society. Age limits and adolescents.
Paediatr Child Health. 2003;8(9):577-8..
Moreover, the studies quoted took place in countries such as USA, Turkey and Canada. Due to the very nature of adolescence, a stage extremely affected by the environment, the previous studies may not be generalized or applicable to a population of adolescents residing in a South American developing country1616 United Nations Children’s Fund - UNICEF. adolescent development: perspectives and frameworks - a discussion paper. New York: United Nations Children’s Fund; 2006..
With that in mind, the present study focused on a defined population – adolescents with epilepsy belonging to an age interval based on criteria from the World Health Organization1818 Organización Mundial de la Salud. Programación para la salud y el desarrollo de los adolescentes: informe de un grupo de estúdio OMS/FNAUAP/UNICEF sobre Programación para la salud de los. Ginebra: Organización Mundial de la Salud; 1996. (Serie de informes técnicos, 886). in Brazil not yet studied at this present time. In this background, we aimed to assess, using available psychological tools common to our service and different from the ones used in the quoted studies, the scores of anxiety and depression within the described population and compare the results with a control group.
METHOD
Participants
The study sample consisted of 101 adolescents assessed in the year 2011-2012. Case participants (50 subjects with epilepsy) attended the pediatric Epilepsy Outpatient Department of the University Hospital (UNICAMP, Campinas, Brazil). Control participants (51 subjects without epilepsy) were selected from public schools in Campinas-SP, Brazil. The inclusion criteria were: age between 10 and 19 years, according to the WHO criteria1818 Organización Mundial de la Salud. Programación para la salud y el desarrollo de los adolescentes: informe de un grupo de estúdio OMS/FNAUAP/UNICEF sobre Programación para la salud de los. Ginebra: Organización Mundial de la Salud; 1996. (Serie de informes técnicos, 886)., elementary and high school education level, ability to answer the questions by himself/herself, medical diagnosis of epilepsy for more than 2 years (criteria established in service for epilepsy diagnosis) for the group with epilepsy (case group) and no diagnosis of epilepsy for the group without epilepsy (control group). The exclusion criteria for both groups were: if they had had brain surgery, used a concomitant medication with central nervous system effects (except the anticonvulsant used to treat the epilepsy), or had another progressive neurological or psychiatric illness.
Mean years of age of case group was 14.02 (Standard Deviation (SD) = 1.99) and of control group was 12.63 (SD = 1.62); this difference was statistically significant (p < 0.01). The majority of adolescents of the case group were male (68%), students (96%), and attending elementary school (72%). Most adolescents of control group were female (58.82%), students (100%), and attending elementary school (90.19%). The difference of gender was statistically significant (p = 0.007). For specific features of the case group, with respect to medical data, most adolescents had focal seizures (62%), had frequent seizures (56%), were on monotherapy (58%), and mean of onset seizure was 6.4 years; with respect to psychological variables, 84% of adolescents reported perception of seizure control; and with respect to social aspects, 58% reported occurrence of seizures in public places.
Measures
1) Identification card with demographic data (age, sex, education level, and job)
for both groups and, for case group only, epilepsy data (age of onset, seizure
frequency, type of seizure and drug treatment); all these data was collected by
the researcher that used medical records available at the pediatric epilepsy
clinic. Regarding frequency of seizures, two groups were considered: frequent
seizures (seizures that occur within one year) and not frequent seizures
(patients without seizures for one year). Type of seizure was classified
according to the International League Against Epilepsy classification of
epileptic seizures1919 Commission on Classification and Terminology of the International
League Against Epilepsy. Proposal for revised clinical and
electroencephalographic classification of epileptic seizures. Epilepsia.
1981;22(4):489-501.
http://dx.doi.org/10.1111/j.1528-1157.1981.tb06159.x
https://doi.org/10.1111/j.1528-1157.1981...
: focal
seizures, generalized seizures, focal + generalized seizures. Drug treatment was
classified in monotherapy (one type of medication) and polytherapy (two or more
medications). Data on psychological variable were also collected. Perception of
seizure control data was obtained through patient reports, in which they
evaluated whether their seizures were controlled or not; these data were
subjective and may reflect alterations in the intensity and/or frequency of the
seizures1515 Souza EAP, Salgado PCB. A psychosocial view of anxiety and
depression in epilepsy. Epilepsy Behav. 2006;8(1):232-8.
http://dx.doi.org/10.1016/j.yebeh.2005.10.011
https://doi.org/10.1016/j.yebeh.2005.10....
. Patients were
also questioned if they had had occurrence of seizures in public places
(yes/no).
2) Beck Depression Inventory (BDI)2020 Beck AT, Ward CH, Mendelson M, Mock JU, Erbaugh J. An inventory for
measuring depression. Arch Gen Psychiatry. 1961;4(6):561-71.
http://dx.doi.org/10.1001/archpsyc.1961.01710120031004
https://doi.org/10.1001/archpsyc.1961.01...
, validity and reliability have been tested by
Cunha2121 Cunha J. Escalas Beck. São Paulo: Casa do Psicólogo;
2001.. The BDI includes
a 21-item self-report was used to measure depression. Each of the items contains
a 4-point severity rating scale. The scoring algorithm defines scores of 0-9
points as indicating minimum depression; 10-16 points as indicating low
depression; 17-29 points as indicating moderate depression; and 30-63 points as
indicating major depression. The BDI is being used as a standard reference and
is one of the most common self-report scales used to assess depression2222 Del Porto JÁ. Aspectos gerais das escalas para
avaliação de depressão. In Centro de Pesquisa em Psicobiologia
Clínica do Departamento de Psicobiologia da Escola Paulista de Medicina.
Escalas de avaliação para monitorizarão de tratamento com
psicofármacos. 93-100. São Paulo: Escola Paulista de Medicina;
1989. including in adolescents2323 Benett DS, Ambrosini PJ, Bianchi M, Barnett D, Metz C, Rabinovich H.
Relationship of Beck Depression Inventory factors to depression among
adolescents. J Affect Disord.1997;45(3):127-34.
http://dx.doi.org/10.1016/S0165-0327(97)00045-1
https://doi.org/10.1016/S0165-0327(97)00...
.
3) State-Trait Anxiety Inventory (STAI)1010 Spielberger CD, Gorsuch RL, Lushene RE. Manual for State-Trait
Anxiety Inventory. Palo Alto: Consulting Psychologists; 1970. validated in Portuguese language by Biaggio and
Natalício2424 Biaggio AMB, Natalício. Manual para o Inventário de
Ansiedade Traço Estado (IDATE). Rio de Janeiro: Centro Editor de Psicologia
Aplicada; 1979.. The test
is divided in two sections: I - presents 20 statements related to how the person
feels most of the time (Trait); II - presents 20 statements related to how the
person feels at the time of assessment (State). To assess the level of trait
anxiety and/or state, it is necessary to first apply a correction to the scores
obtained on each item: the values of items 1, 6, 7, 10, 13, 16 and 19 of the
Trait scale and 1, 2, 5, 8, 10, 11, 15, 16, 19 and 20 of the State scale must be
inverted (in a way that 1 becomes 4, 2 becomes 3, 3 becomes 2 and 4 becomes 1).
After that, scores obtained on each item are summed up and classified
accordingly, to assess the level of anxiety: low, scores between 20 and 34;
moderate, scores between 35 and 49; high, scores between 50 and 64; and very
high, between 65 and 802525 Salles LF, Silva MJP. Effect of flower essences in anxious
individuals. Acta Paul Enferm. 2012;25(2):238-42.
http://dx.doi.org/10.1590/S0103-21002012000200013
https://doi.org/10.1590/S0103-2100201200...
.
STAI is widely used in monitoring anxiety states2626 Fankhauser MP, German ML. Understanding the use of behavioral rating
scales in studies evaluating the efficacy of antianxiety and antidepressant
drugs. Am J Hosp Pharm. 1987;44(9):2087-100. and is also an instrument used to assess anxiety
in children and adolescents1010 Spielberger CD, Gorsuch RL, Lushene RE. Manual for State-Trait
Anxiety Inventory. Palo Alto: Consulting Psychologists; 1970..
Procedure
Initially the Ethics Committee of Universidade Estadual de Campinas (UNICAMP) approved the research (number 176/2005). After that, written informed consent was obtained from all subjects and their companions (the one with legal responsibility over the subject), on the day of the outpatient consultation, in an interview to explain the procedures. Subjects were assessed individually at the outpatient clinic of Psychology Applied to Neurology at the University Hospital of UNICAMP. On this first day, the objective was to create a positive bond between the professional and subject (interview/presentation stage). On the second day, one week later, the objective was to apply the tools of research (the assessment stage). The selection of subjects for the case group obeyed the demand of our neurology outpatient clinic, according to the criteria for inclusion and exclusion, acceptance of the subject and responsibility to take the research.
The selection of subjects of control group was according to the criteria of inclusion and exclusion, acceptance of the subject and responsibility to take the research. Two public schools in Campinas-SP, Brazil, both of elementary and high-school levels, were chosen by lottery. After the headmaster’s authorization, the students were taught about the research and those who had an interest in participating took the written informed consent home to get their parents’ signed authorization (interview or presentation stage). All the adolescents of control group were assessed at the individual class of their school, when the researcher returned to the school to apply the tools of the research (assessment stage).
Statistics analysis
To describe the sample profile according to the study variables, data was comprised of: categorical variables with values of percentage (%), and descriptive statistics (with measurements of position and dispersion - mean, standard deviation, minimum, maximum and median) for continuous variables (scores of scales).
To compare numerical variables between two groups we used the Mann-Whitney test and Analysis of Covariance (ANCOVA) when needed to adjust for age and sex.
The level of significance for statistical test was 5% (p < 0.05).
RESULTS
Data on depression (BDI), state anxiety and trait anxiety scores (STAI) from both groups is listed in Table 1.
Regarding symptoms of depression, no statistically significant differences were found between the two groups. On average, the case group was found in the minimum depression sub-category while the control group was found in the low depression sub-category (Table 1).
The absence of statistically significant differences between the two groups was also a finding for anxiety symptoms (Table 1).
Table 2 show correlations between frequency of seizures, perception of seizure control, occurrence of seizure in public places and STAI and BDI.
A statistically significant result was found in the correlation between low trait and state anxiety versus not frequent seizures (medical data, p = 0.012 and p = 0.027, respectively). Similar results were observed for low trait and state anxiety versus perception of seizure control (psychological variable, p = 0.039 and p = 0.010, respectively).
A statistically significant result was observed when correlating occurrence of seizures in public places (social aspect) with high depression scores (p = 0.046) and trait anxiety (p = 0.003).
Despite the difference in the mean points, in terms of percentages, the majority of adolescents from both case group (72%) and control group (66%) remained in the minimum depression sub-category of the BDI (Figure 1).
In the trait anxiety component, the majority of adolescents of both case group (56.86%) and control group (47.05%) scored for moderate anxiety. In the state anxiety component, the majority of adolescents from case group scored for low anxiety (48%), and the majority of adolescents from control group was divided between low and moderate anxiety (43.13% each) (Figure 2).
Anxiety in case group (state and trait domains) vs control group (state and trait domains).
DISCUSSION
In recent decades there has been a great interest in the study of variables that
control the impact of epilepsy, variables that go beyond the seizures. It has been
noted the importance of psychosocial and psychiatric conditions and their influence
in determining the well-being of individuals in a chronic medical condition2727 Siqueira NF, Guerreiro MM, Souza EAP. Self-esteem, social support
perception and seizure controllability perception in adolescents with epilepsy.
Arq Neuropsiquiatr. 2011;69(5):770-4.
http://dx.doi.org/10.1590/S0004-282X2011000600009
https://doi.org/10.1590/S0004-282X201100...
.
First of all, our study showed that there were no statistically significant
differences between the group of adolescents with epilepsy and control group when
comparing depression scores and anxiety scores. These new findings are particularly
surprising, because epilepsy was reported to correlate with high prevalence of
depression and anxiety22 Valente KDR, Souza ST, Kuczynski, Negrão N. Depressão em
crianças e adolescentes com epilepsia. Rev Psiq Clín.
2004;31(6):290-9.,33 Hankin BL. Adolescent depression: description, causes, and
interventions. Epilepsy Behav. 2006;8(1):102-14.
http://dx.doi.org/10.1016/j.yebeh.2005.10.012
https://doi.org/10.1016/j.yebeh.2005.10....
,1313 Loney JC, Wirrell EC, Sherman EMS, Hamiwka LD. Anxiety and
depressive symptoms in children presenting with a first seizure. Pediatr Neurol.
2008;39(4):236-40.
http://dx.doi.org/10.1016/j.pediatrneurol.2008.07.005
https://doi.org/10.1016/j.pediatrneurol....
. One must consider the conditions that make difficult to
compare the studies already mentioned1515 Souza EAP, Salgado PCB. A psychosocial view of anxiety and
depression in epilepsy. Epilepsy Behav. 2006;8(1):232-8.
http://dx.doi.org/10.1016/j.yebeh.2005.10.011
https://doi.org/10.1016/j.yebeh.2005.10....
. The use of different instruments, different
methodologies, characteristics of the population, form of assessment tests,
different countries in which the research took place, and sub-categories analyzed
may be factors of variability.
In the demographic analysis of the groups, a statistically significant difference was
found; the subjects of case group presented a mean age higher than the subjects in
the control group. Associated to this piece of information, we recall that we found
no statistically significant difference between the scores of depression and anxiety
for both groups even after adjusting for age and sex. Considering the data
altogether, this higher age for case group may be related to a more mature
development state and to more access to mental health treatment, as described by Ott
et al.1111 Ott D, Siddarth P, Gurbani S, Koh S, Tournay A, Shields WD et al.
Behavioral disorders in pediatric epilepsy: unmet psychiatric need. Epilepsia.
2003;44(4):591-7.
http://dx.doi.org/10.1046/j.1528-1157.2003.25002.x
https://doi.org/10.1046/j.1528-1157.2003...
from his study, it was
found that children of older age were more likely to have received mental health
treatment. The access to treatment may be related to a better knowledge of the
disease and, therefore, associated with better coping with the epilepsy –
leading to scores no different from the ones of the control group.
In a chronic disease like epilepsy, the subject may be controlled by different physical, psychological and social variables, contingencies that are linked to the manner with which individuals perceive themselves and perceive their relationship with the environment.
When our present results (scores of anxiety/depression) were analyzed against the disease variables (medical, psychological and social), meaningful correlations were observed. Concerning frequency of seizures (medical data), the correlations showed positive results between low frequency of seizures and low scores of trait and state anxiety. Perception of seizure control (psychological variable) was positively correlated to low scores of trait and state anxiety. With regards to occurrence of seizures in public places (social aspect), the correlations showed positive results between high scores of depression and trait anxiety and occurrence of seizures in public places.
We could notice the conjugated influence of medical, psychological and social variables in controlling the studied adolescents’ responses. Such influence guides us to the importance of the bio-psycho-social aspects for a better comprehension of the human being in its totality.
Of all the factors that may influence the results we believe that, from the psychological perspective, the development phases influence deserves to be discussed. Adolescence is a life stage characterized by intense emotional and physical transformation, and is determined by culture. These young people are overwhelmed by intense feelings while going through significant changes and assuming new behaviors2929 Polanczyk GV, Denardin D, Laufer T, Pianca T, Rohde LA. O transtorno de déficit de atenção/hiperatividade na adolescência. Adolesc Latinoam. 2002;3(2):1-23.. These significant changes may come laden with feelings of inadequacy, insecurity, loss of control, and fear of the unknown, all of which can lead to the emergence of heightened anxiety experiences. Since the majority of adolescents in both groups had moderate scores of anxiety trait, we can assume that this trait is inherent to the stage itself – adolescence -, regardless of the disease – epilepsy.
Epilepsy patients have the perception of their illness through their seizures. Souza
and Salgado1515 Souza EAP, Salgado PCB. A psychosocial view of anxiety and
depression in epilepsy. Epilepsy Behav. 2006;8(1):232-8.
http://dx.doi.org/10.1016/j.yebeh.2005.10.011
https://doi.org/10.1016/j.yebeh.2005.10....
draw attention to
the perception of seizure control as an important factor in the control of the
disease, even if, from the medical perspective, the disease is not considered
controlled. Patient may have frequent seizures, but these decreased in the current
period as he may deem it under control. According to the authors, the positive
perception of seizure control seems to be an important factor to mitigate the impact
of potentially stressful experiences. The correlations between positive perception
of seizure control and low scores of anxiety found in our results seem to support
the influence of the psychological aspects that control the well-being in this
sample of adolescents.
These results are corroborated by recent studies with this same population. Siqueira
et al.2727 Siqueira NF, Guerreiro MM, Souza EAP. Self-esteem, social support
perception and seizure controllability perception in adolescents with epilepsy.
Arq Neuropsiquiatr. 2011;69(5):770-4.
http://dx.doi.org/10.1590/S0004-282X2011000600009
https://doi.org/10.1590/S0004-282X201100...
investigated aspects that
show that these adolescents have good knowledge of epilepsy, good social support
perception, perception of seizure control and no significant differences when
compared with a control group in rates of self esteem. Cancian3030 Cancian F. Significação e enfrentamento de adolescentes
portadores de epilepsia [dissertação]. Campinas:
Universidade Estadual de Campinas; 2011. observed that the same adolescents with epilepsy
seem to have better coping with the disease. In this sense, it is possible to infer
that, in the status of a well-managed disease, epilepsy may not be of great
influence in the development of depression and anxiety.
Our study had limitations. The sample was relatively small, and restricted to one research center and country; there was no randomization due to selection difficulties and dropouts. Even though following the WHO criteria for the classification of adolescence, the age range still showed to be too large for the analysis of the results.
When considering the medical and psychosocial factors of development, we suggest that future studies in this area focus on analysis of age subcategories within the age range previously established for adolescence, increased number of subjects, different assessment tools and different settings for must prove valuable in designing comprehensive and effective interventions to promote better social outcomes in adolescence bearing this illness.
References
-
1Mitchell WG, Scheier LM, Baker SA. Psychosocial, behavioral, and medical outcomes in children with epilepsy: a developmental risk factor model using longitudinal data. Pediatrics. 1994;94(4):471-7.
-
2Valente KDR, Souza ST, Kuczynski, Negrão N. Depressão em crianças e adolescentes com epilepsia. Rev Psiq Clín. 2004;31(6):290-9.
-
3Hankin BL. Adolescent depression: description, causes, and interventions. Epilepsy Behav. 2006;8(1):102-14. http://dx.doi.org/10.1016/j.yebeh.2005.10.012
» https://doi.org/10.1016/j.yebeh.2005.10.012 -
4Jacoby A, Baker GA, Steen N, Potts P, Chadwick DW. The clinical course of epilepsy and its psychosocial correlates: findings from a U.K. Community study. Epilepsia. 1996;37(2):148-61. http://dx.doi.org/10.1111/j.1528-1157.1996.tb00006.x
» https://doi.org/10.1111/j.1528-1157.1996.tb00006.x -
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Publication Dates
-
Publication in this collection
Mar 2015
History
-
Received
09 Apr 2014 -
Reviewed
26 Oct 2014 -
Accepted
14 Nov 2014