Individual and family factors associated with self-esteem in young people with epilepsy: A multiple mediation analysis

Abstract

. Individual and family factors associated with self-esteem in young people with epilepsy: A multiple mediation analysis. Epilepsy and Behavior, 66, 19-26. DOI: 10.1016/j.yebeh.2016.09.039 Peer reviewed version Link to publication record in Explore Bristol Research PDF-document This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://www.sciencedirect.com/science/article/pii/S1525505016303407. Please refer to any applicable terms of use of the publisher. University of Bristol -Explore Bristol Research 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 AbstractObjective: As young people experience added demands from living with epilepsy, which may lead to poor psychosocial adjustment, it is essential to examine mechanisms of change to provide practitioners with knowledge to develop effective interventions. The aim of this study was to examine individual and family-level factors -stress and illness perceptions, coping behaviours and family resilience -that promote or maintain young people's self-esteem.Methods: From November 2013 to August 2014, young people attending a neurology clinic in KK Women's and Children's Hospital, Singapore, participated in a cross-sectional survey (n=152; 13-16 years old). Multiple mediation analyses were conducted to evaluate whether these variables mediated the relationship between illness severity (i.e., low, moderate, high) and self-esteem.Results: Multiple mediation analyses demonstrated that illness severity had a direct effect on young people's self-esteem. Compared to those with moderate illness severity (reference group), young people with low severity had significantly higher self-esteem (c=3.42, p<0.05); while those with high severity had a more negative view of themselves (c=-3.93, p<0.001).Illness severity also had an indirect influence on self-esteem through its effects on mediators, such as perceived stress, illness perceptions and family resilience (D1: Total ab=3. 46, 95% CI 1.13, 5.71;). However, young people's coping levels did not predict their self-esteem, when accounting for the effects of other variables.Significance: The continued presence of seizure occurrences is likely to place greater demands on young people and their families: in turn, increased stress and negative illness perceptions, negatively affected family processes that promote resilience. As the mediating effect of these modifiable factors were above and beyond the contributions of illness characteristics and young people's levels of coping, this has implications for developing individual and family interventions aimed to support young people living with epilepsy.

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“…For example, one participant shared their unpleasant experience seeking a job after disclosing their disease. Consistent with this study, a previous study reported that negative illness perception negatively affected self-esteem in adolescents with epilepsy (Chew, Haase, & Carpenter, 2017). The school experience can provide chronically ill children with opportunities for successes and failures that can contribute to self-esteem as well as opportunities for developing peer relationships and the ability to learn and cope effectively (Vitulano, 2003).…”

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“…From this research, skewness ranges between À0.361 and À0.831, whereas the kurtosis level ranges between À0.052 and 2.952 (Xiong et al, 2015). It is worth noting that in this study sample, it fell within the acceptable parameters (not > 3.29) for the sample size on the study variables that are part of this research (Tabachnick and Fidell, 2007;Chew et al, 2017).…”

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“…Räty et al [30] found that illness severity condition was significantly related to the participants' general self-concept but more research is needed to understand the causality of the relationship. Chew et al [31] in a study with adolescents with epilepsy found that illness severity was negatively associated with young people's self-esteem and suggest that young people might have had existing negative views of themselves prior to their illness, and on this basis conclude that self-esteem does not vary as function of illness severity.…”