CHICAGO – Depressive symptoms are common in mothers of children with newly diagnosed epilepsy, and they follow four distinct trajectories, new data suggest.
Researchers in Ontario evaluated 339 mothers of children aged 4-12 years with new-onset epilepsy who were enrolled in the national, prospective Health-Related Quality of Life of Children With Epilepsy Study (HERQULES).
About one-third of the mothers were at risk for clinical depression during the first 24 months after diagnosis, Mark Ferro reported in a poster at the Epilepsy and Depressive Disorders Conference.
The prevalence of women with depressive symptoms, as measured using the Center for Epidemiological Studies Depression Scale, was 38% at baseline, 30% at 6 months, 32% at 12 months, and 30% at 24 months.
Previous cross-sectional studies have reported similar rates, but the surprise finding was that maternal depressive symptoms followed four distinct trajectories: high decreasing, moderate increasing, borderline, and low stable, said Mr. Ferro, a doctoral student in epidemiology and biostatistics at the University of Western Ontario, London.
The researchers had anticipated just three trajectories, but found that some women fell in and out of risk for depression. Although the reason for this borderline trajectory is unclear, Mr. Ferro suggests that it may reflect the unpredictable nature of epilepsy, or a family’s search for effective pharmacologic or cognitive-based therapies to manage their child’s illness.
“There’s a big trial-and-error period during the first 2 years after diagnosis,” he said.
At several points during the conference, speakers noted the profound effect that witnessing a seizure and living with epilepsy can have on families. A subsequent unpublished study by the same group found that as a mother’s depressive symptoms increase, a child’s quality of life decreases.
“It’s not just the child suffering the seizures, but the entire family,” Mr. Ferro said. “In terms of putting the patient at the center of care, we’re also asking physicians to put the family at the center of care. We’re hoping that by addressing the mother’s mental health status, clinicians can improve the quality of care for children with epilepsy.”
In the current study, mothers in the low-stable group were significantly more likely to be university educated (63%) than were those in the borderline (46%), moderate-increasing (41%), or high-decreasing groups (21%), and to be older (mean, 39 years) than women in the moderate-increasing group (mean, 34 years).
Child quality of life predicted membership in the high-decreasing group, whereas the presence of cognitive problems in the child predicted membership in the moderate-increasing group. Child cognitive disability was the strongest predictor for any of the variables examined in the model, with an odds ratio of 9.3 in a multinomial regression analysis, Mr. Ferro reported.
Mothers whose depressive symptoms took a low-stable trajectory were significantly more likely than women in the other three groups to have a greater degree of satisfaction with family function, as measured by the APGAR (Adaptability, Partnership, Growth, Affection and Resolve) scale; a greater repertoire of family resources, as measured by the FIRM (Family Inventory of Resources for Management) assessment; and fewer potentially stressful life events, as measured by the FILE (Family Inventory of Life Events and Changes) scale.
The conference was jointly sponsored by the EDDC and the office of continuing medical education of Elsevier. The study was supported by the Canadian Institutes of Health Research. The authors reported no conflicts of interest.