The relationships of both coping strategies and perceived control to psychological and physiological adjustment were investigated in 115 adults (65 women, 50 men) with Type 2 diabetes. Results showed that (a) emotional preoccupation and palliative coping were positively correlated with depression and state anxiety, whereas perceived control was negatively correlated with depression, state anxiety, and hemoglobin A tc (HbA lc ); (b) instrumental coping predicted lower depression; (c) perceived control moderated the relationships between instrumental coping and depression, and emotional preoccupation coping and HbA lc ; and (d) emotional preoccupation coping mediated the relationships between perceived control and depression, and perceived control and state anxiety. Results are discussed in terms of the goodness-of-fit hypothesis (V. J. Conway & D. J. Terry, 1992), optimal coping, and the importance of perceived control in psychological and physiological adjustment.

SUMMARYPurpose: The objective of this systematic review was to identify: (1) prevalence and severity of psychiatric conditions before and after resective epilepsy surgery, (2) incidence of postsurgical psychiatric conditions, and (3) predictors of psychiatric status after surgery. Methods: A literature search was conducted using PubMed, EmBase, and the Cochrane database as part of a larger project on the development of an appropriateness and necessity rating tool to identify patients of all ages with potentially resectable focal epilepsy. The search yielded 5,061 articles related to epilepsy surgery and of the 763 articles meeting the inclusion criteria and reviewed in full text, 68 reported psychiatric outcomes. Thirteen articles met the final eligibility criteria. Key Findings: The studies demonstrated either improvements in psychiatric outcome postsurgery or no changes in psychiatric outcome. Only one study demonstrated deterioration in psychiatric status after surgery, with higher anxiety in the context of continued seizures postsurgery. One study reported a significantly increased rate of psychosis after surgery. The two main predictors of psychiatric outcome were seizure freedom and presurgical psychiatric history. De novo psychiatric conditions occurred postsurgery at a rate of 1.1-18.2%, with milder psychiatric issues (e.g., adjustment disorder) being more common than more severe psychiatric issues (e.g., psychosis). Significance: Overall, studies demonstrated either improvement in psychiatric outcomes postsurgery or no change. However, there is a need for more prospective, well-controlled studies to better delineate the prevalence and severity of psychiatric conditions occurring in the context of epilepsy surgery, and to identify specific predictors of psychiatric outcomes after epilepsy surgery.

Summary Purpose:  The objective of this study was to systematically review the literature to assess social outcomes after epilepsy surgery. Methods:  A systematic literature search was conducted as part of a larger project on the development of an appropriateness and necessity rating tool to identify patients with focal epilepsy that may benefit from an epilepsy surgery evaluation. Studies were included if they reported postsurgical data on social outcomes (employment, driving, social relationships, marriage, education, financial status, behavior, and social interactions) and had a follow‐up period of at least 24 months. Our search strategy yielded 5,061 studies. Sixty‐five of these studies addressed social outcomes, but only 19 met all eligibility criteria. Key Findings:  In adults, a significant improvement in full‐time employment postsurgery was documented. The ability to drive was significantly increased after surgery and was dependent on seizure freedom. Patients generally perceived improved relationships, independence, and overall lifestyle postsurgery. Marital status generally remained unchanged when compared to controls, education improved modestly, and income/financial status changes depended on how it was assessed (e.g., income level vs. receipt of disability pension). In children, a study examining behavior showed improved social interactions in those who underwent surgery compared to controls. The results for other social outcome categories were more variable. Significance:  Overall, the majority of studies reported improvement in social outcomes after surgery. However, prospective controlled observational studies using objective social outcome measures are necessary prior to making specific conclusions about the influence of surgery on social outcomes other than employment or driving status in all age groups, but particularly in children and the elderly.

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