Low quality of life, increased number of anti-seizure drugs, and the lack of caregiver support are associated with internalized stigma in adult Mexican patients with epilepsy

Adriana Ochoa-Morales; Ana Fresan-Orellana; Miguel Ángel Ramírez-García; Horacio Márquez-González; Iris E Martínez-Juárez; Mayra López-Uribe; Carol Zuniga-García; Aurelio Jara-Prado; Jorge Luis Guerrero-Camacho; David José Dávila-Ortiz de Montellano

doi:10.1016/j.yebeh.2023.109268

Low quality of life, increased number of anti-seizure drugs, and the lack of caregiver support are associated with internalized stigma in adult Mexican patients with epilepsy

Epilepsy Behav. 2023 Jul:144:109268. doi: 10.1016/j.yebeh.2023.109268. Epub 2023 May 26.

Affiliations

¹ Genetics Department. National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico.
² Clinical Epidemiology Laboratory, Clinical Research Directorate. National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
³ Clinical Research Department. Children's Hospital of Mexico, Federico Gómez, Mexico City, Mexico.
⁴ Epilepsy Clinic. National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico.
⁵ Social Work Department. National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico.
⁶ Genetics Department. National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico. Electronic address: david.montellano@innn.edu.mx.

PMID: 37245482
DOI: 10.1016/j.yebeh.2023.109268

Abstract

Background: People with epilepsy (PWE) have been subject to stigma throughout history, a factor that could compromise their performance in daily life. In Mexico, little is known about the factors that may be affecting internalized stigma.

Objective: To evaluate the internalized stigma in adult PWE, its relationship with the quality of life, cognitive and depressive symptomatology, and clinical-demographic characteristics.

Material and methods: We conducted a cross-sectional study with a consecutive sampling approach in patients with epilepsy treated at the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez (NINNMVS). Sociodemographic and clinical data, depressive symptomatology (Beck's depression inventory, DBI), cognition (MoCA test), quality of life (QOLIE-31 scale), and internalized stigma (King's internalized stigma scale, ISS) were evaluated. Correlations were made between the continuous variables and the ISS to select those with statistical significance and include them in a multiple linear regression model, along with the dummy variables, to explain internalized stigma.

Results: Of 128 patients, 74 (58%) were women; 38% of the patients had more than 20 years of epilepsy evolution. In addition, 39% presented depressive symptoms, and around 60% manifested a possible cognitive impairment. The variables that showed statistical significance concerning the ISS were selected along with dummy variables for multiple linear regression analysis. The resultant model considers the QOLIE-31 total score (β = -0.489), the number of anti-seizure drugs (ASD, β = 0.253), and those patients without caregiver support (β = -0.166) with an adjusted R² value of 0.316.

Conclusions: A diminishing quality of life, an increased number of ASD, and patients without caregiver support influence a slight to moderate variation of internalized stigma in Mexican PWE. Therefore, it is necessary to continue studying other possible factors that influence internalized stigma to generate effective strategies to reduce its negative effects on PWE.

Keywords: Anti-seizure drugs; Depressive Symptoms; Epilepsy; Internalized Stigma; QOLIE-31.

MeSH terms

Adult
Caregivers / psychology
Cross-Sectional Studies
Epilepsy* / psychology
Female
Humans
Male
Mexico
Quality of Life* / psychology
Social Stigma