Those With Epilepsy Report High Psychological Distress During Public Health Emergencies

Findings from a cross-sectional case-control study of patients with epilepsy treated at West China Hospital in the month of February 2020 suggest that this patient population may be experiencing high rates of psychological distress amid the COVID-19 pandemic.

The data, which were compiled by Bo Yan, MD, PhD, and colleagues in the Department of Neurology at West China Hospital and Sichuan University, showed that on the Kessler 6&#8208;item (K&#8208;6) psychological distress scale, those with epilepsy had significantly higher scores (median, 5 [range, 8.75—2]) compared to a matching control group (median, 2 [range, 5–1]; P <.001), indicating that psychological distress is highly prevalent among patients with epilepsy during public health emergencies.

All told, 13.1% (n = 33) of those in the epilepsy group qualified as having severe psychological distress, compared to 1.6% (n = 4) of the control group (P <.001). Additionally, those with epilepsy reported spending significantly more daily time following news on the COVID-19 pandemic outbreak compared to the healthy controls (P <.001).

“During public health outbreaks, clinicians and caregivers should focus not only on seizure control but also on the mental health of epilepsy patients, especially those with drug&#8208;resistant epilepsy,” Yan and colleagues wrote. “K&#8208;6 scores more than 12 should be indicated as severe psychological distress. This may mean, for example, encouraging patients to engage in other activities instead of excessively following media coverage of the outbreak.”

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In total, the study included 252 consecutive patients older than 15 years and 252 controls who were sex&#8208; and age&#8208;matched healthy visitors of inpatients (unrelated to the patients) enrolled during the same period.

The 252 patients and 252 controls in this study were similar along all demographic variables except family income. Aside from family income, the groups were statistically similar, with those in the epilepsy group reported significantly lower family income than controls. Data on demographics and attention paid to COVID&#8208;19 were collected by an online questionnaire, and data on epilepsy features were collected from electronic medical records.

Most patients (81%) had focal epilepsy, while 14% had generalized epilepsy. The temporal lobe was involved in 10.3% (n = 26) of patients, and 36.9% (n = 93) of patients had drug-resistant epilepsy.

After multivariate logistic regression, the 2 independent predictors of severe psychological distress were a diagnosis of drug-resistant epilepsy and time spent following media reports of the COVID-19 pandemic, with odds ratios (ORs) of 1.172 (95% CI, 1.073—1.280), and 0.283 (95% CI, 0.128–0.623), respectively.

“Less than 2% of our control group reported severe psychological distress, defined as a K-6 score greater than 12, which is consistent with the 3% prevalence of mental health problems reported for healthy individuals in Japan in the absence of an international disaster,” Yan and colleagues detailed. “Over 13% of our patients showed severe psychological distress during the COVID-19 outbreak, this result supports the fact that patient with epilepsy has a high risk for mental disease. Although only 1 of our patients had been diagnosed with COVID-19 at the time of the survey, patients’ psychological distress level was similar to that of evacuees from the Fukushima Daiichi nuclear power plant accident in 2011.”

Notably, the investigators noted that the results contrast with a number of meta-analyses that suggest there is no relationship between drug-resistant epilepsy and severe psychological distress in the absence of an international public health emergency. This discrepancy, they wrote, might imply that those with drug-resistant epilepsy are particularly vulnerable to emergency induced stresses.

“It is not surprising that this situation should contribute to greater psychological distress among epilepsy patients. Indeed, a previous study of university undergraduates found that excessive dependence on information obtained from smartphones can significantly increase the risk of mental illness. Likely, the same was true among our patients,” they concluded. “Our results suggest that encouraging epilepsy patients to cultivate hobbies and providing them with online learning opportunities may help protect them from severe psychological distress during public health emergencies.”

REFERENCE

Hao X, Zhou D, Li Z, et al. Severe psychological distress among epilepsy patients during the COVID&#8208;19 outbreak in southwest China. Epilepsia. Published online April 30, 2020. doi:10.1111/epi.16544