Discrimination, domestic violence, abuse, and other adverse life events in people with epilepsy: Population‐based study to assess the burden of these events and their contribution to psychopathology

Abstract

General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms Discrimination, domestic violence, physical and sexual abuse, and other stressful life events were assessed using computerised self-completion and a face to face interview respectively. Results:People with epilepsy were seven-fold more likely to have reported experiencing discrimination due to health problems (adjusted OR=7.1; 95% CI=3·1 -16.3), than the general population without epilepsy. This estimate was substantially greater in people with epilepsy than for people with other chronic conditions. People with epilepsy also had greater odds of experiencing domestic violence and sexual abuse than the general population, although these associations were also found in people with other chronic conditions. There was less evidence of an association between epilepsy and a history of physical abuse or having a greater burden of other stressful life events. In exploratory analyses, assuming they lie on the causal pathway, discrimination, domestic violence and sexual abuse explained 42.7% of the total effect of the relationship between epilepsy and depression or anxiety disorders.Significance: People with epilepsy can face a range of psychosocial adversities and extensively report feeling discriminated against as compared to the general population. In addition, if confirmed in longitudinal studies, the results suggest that these psychosocial adversities may have a significant role in the development of psychiatric comorbidity and may be targets for future interventions.

Welfare consequences for people with epilepsy and their partners: A matched nationwide study in Denmark

“…There may be various explanations for the higher costs incurred by the partners of people with epilepsy: the disorder may affect family life, through the increased need for care, the lower employment rate and greater need for social care. Another explanation might patients with epilepsy suffers from problems in education, employment [20] but also psychosocial adversities and feeling discriminated may add to the negative social outcome [6].…”

“…Despite diagnostic and therapeutic improvements, refractory epilepsy is relatively frequent and, due to significant comorbidity, is still one of the most common serious brain disorders worldwide. Epilepsy is associated with social stigma, psychosocial adversities, and reduced quality of life for patients and their caregivers and, thus, has a substantial socioeconomic impact [3][4][5][6].…”

“…Studies of the economic impact of epilepsy have mainly focused on questionnaires and other direct or indirect information obtained from selected groups of people with epilepsy, and have documented the combined socioeconomic consequences [7,8]. Furthermore, those with epilepsy may also find that the disorder has adverse consequences for their partner [3,6,9]. We have previously evaluated these combined costs in people with epilepsy by comparing a national sample of persons with epilepsy with controls, documenting significant health and social consequences for adults [2] and long-term consequences for children and their parents [10][11][12] compared to controls without epilepsy.…”

Network Dysfunction in Comorbid Psychiatric Illnesses and Epilepsy

“…For example, previous adverse life events are a major risk factor for anxiety and depression and may contribute to psychiatric illnesses comorbid with epilepsy. 45 Beautiful studies in animal models have elucidated patterns in network communication between the prefrontal cortex, ventral striatum, amygdala, ventral tegmental area, and ventral hippocampus which predict the behavioral changes following chronic social defeat stress, potentially relevant to depression and the interaction between adverse life events (stress) and psychiatric illnesses. 46 Further, combined electroencephalogram and functional magnetic resonance imaging studies demonstrate abnormalities in these networks associated with seizures in patients with epilepsy.…”

Psychological trauma, somatization, dissociation, and psychiatric comorbidities in patients with psychogenic nonepileptic seizures compared with those in patients with intractable partial epilepsy

“…The prevalence of depression is estimated to be 20-55% in individuals with refractory epilepsy [6]. Persons with epilepsy are also known to experience considerable psychosocial adversities including domestic violence, abuse, other traumas, and discrimination [7].…”