Comorbid mental disorders and quality of life of people with epilepsy attending primary health care clinics in rural Ethiopia.

Ruth Tsigebrhan,Abebaw Fekadu,Charles R Newton,Girmay Medhin,Charlotte Hanlon,Martin J Prince

doi:10.1371/journal.pone.0238137

Abstract

Evidence from high-income countries demonstrates that co-morbid mental disorders in people with epilepsy adversely affect clinical and social outcomes. However, evidence from low-income countries is lacking. The objective of this study was to measure the association between co-morbid mental disorders and quality of life and functioning in people with epilepsy. A facility-based, community ascertained cross-sectional survey was carried out in selected districts of the Gurage Zone, Southern Ethiopia. Participants were identified in the community and referred to primary health care (PHC) clinics. Those diagnosed by PHC workers were recruited. Co-morbid mental disorders were measured using a standardised, semi-structured clinical interview administered by mental health professionals. The main outcome, quality of life, was measured using the Quality of Life in Epilepsy questionnaire (QOLIE-10p). The secondary outcome, functional disability, was assessed using the 12-item World Health Organization Disability Assessment Schedule (WHODAS-2). The prevalence of comorbid mental disorders was 13.9%. Comorbid mental disorders were associated with poorer quality of life (Adjusted (Adj.) β -13.27; 95% CI -23.28 to-3.26) and greater disability (multiplier of WHODAS-2 score 1.62; 95% CI 1.05, 2.50) after adjusting for hypothesised confounding factors. Low or very low relative wealth (Adj. β = -12.57, 95% CI -19.94 to-5.20), higher seizure frequency (Adj.β coef. = -1.92, 95% CI -2.83 to -1.02), and poor to intermediate social support (Adj. β coef. = -9.66, 95% CI -16.51 to -2.81) were associated independently with decreased quality of life. Higher seizure frequency (multiplier of WHODAS-2 score 1.11; 95% CI 1.04, 1.19) was associated independently with functional disability. Co-morbid mental disorders were associated with poorer quality of life and impairment, independent of level of seizure control. Integrated and comprehensive psychosocial care is required for better health and social outcomes of people with epilepsy.

Highlights

The lifetime prevalence of epilepsy is estimated to be 0.76%, with a higher prevalence seen in low and middle income countries (LMICs) (0.88%) [1]
Participants were identified in the community and referred to primary health care (PHC) clinics
Integrated and comprehensive psychosocial care is required for better health and social outcomes of people with epilepsy

Summary

Introduction

The lifetime prevalence of epilepsy is estimated to be 0.76%, with a higher prevalence seen in low and middle income countries (LMICs) (0.88%) [1]. In previous research conducted in high-income countries (HIC), co-morbid mental health conditions were associated strongly with poor quality of life, increased disability, an increased suicide rate, poorer adherence to treatment and higher levels of stigma [3, 6, 7, 10,11,12]. In recognition of the high burden of co-morbid mental disorders, guidelines for care of people with epilepsy in HICs emphasise the importance of integrated evaluation and management of mental disorders in order to achieve better seizure control and improved quality of life [7]. Evidence from high-income countries demonstrates that co-morbid mental disorders in people with epilepsy adversely affect clinical and social outcomes. The objective of this study was to measure the association between co-morbid mental disorders and quality of life and functioning in people with epilepsy

Objectives

Methods

Results

Conclusion