Contribution of the family environment to depression in Korean adults with epilepsy

PURPOSE Depression is common in adults with epilepsy and an important factor that affects quality of life in these individuals. However, there are few studies on the interactions between epilepsy and family factors in adults and we here investigate this association. METHODS This cross-sectional, multicenter study collected data on 391 adults with epilepsy and their caregivers recruited from 27 hospitals throughout Korea. The Beck Depression Inventory (BDI), Stigma Scale, and Caregiver Burden Inventory (CBI) were used to evaluate the study population. Multivariate analysis was conducted using hierarchical linear regression. The Sobel test and structural equation modeling were used to examine interrelationships among the potential factors. RESULTS The mean patient BDI score was 16.3 (SD=11.1). Depressive symptoms (BDI≥10) were in 68.3% and 57.0% in patients and their caregivers, respectively. Hierarchical linear regression analysis only identified caregiver BDI (β=0.219; p<0.001) as an independent factor related to patient BDI. The mediational model suggested that caregiver BDI mediated the effects of other family factors on patient BDI: caregiver's educational level (p=0.002), caregiver's CBI score (p<0.001), caregiver's Stigma Scale score (p<0.001), and family APGAR score (p<0.001). In addition, structural equation modeling showed that the relation between caregiver and patient BDI was unidirectional. CONCLUSION Caregiver depression is the most important contributor to depression in adults with epilepsy. The other family factors such as caregiver's perception of burden and the level of family function are indirectly correlated with patient depression via the mediating effects of caregiver depression.