Drug-resistant epilepsy associated with severe psychological distress during COVID-19
A Chinese cross-sectional case-control study has identified time spent following news on coronavirus disease 2019 (COVID-19) and drug-resistant epilepsy as two independent predictors of severe psychological distress among epilepsy patients during the COVID-19 pandemic.
The study enrolled 252 epilepsy patients and 252 age- and sex-matched healthy controls, all of whom completed an online questionnaire on demographics, clinical data, epidemiological contact history, and concerns regarding and attention paid to the COVID-19 outbreak. [Epilepsia 2020, doi: 10.1111/epi.16544]
Patients with epilepsy had significantly higher total scores on the Kessler 6-item psychological distress scale (K-6) than healthy controls (p<0.001). “Psychological distress is highly prevalent among patients with epilepsy during public health emergencies,” noted the researchers.
In spite of similar numbers of healthy controls and epilepsy patients reporting close contact with confirmed COVID-19 cases and significantly fewer patients than controls reporting living in communities with confirmed COVID-19 cases, the proportion of epilepsy patients with K-6 scores higher than 12, defined as severe psychological distress, was significantly higher than the corresponding proportion of healthy controls (13.1 percent vs 1.6 percent; p<0.001).
“Although only one of our [epilepsy] patients had been diagnosed with COVID-19 at the time of the survey, the patients’ [average] psychological distress level was similar to that of evacuees from the Fukushima Daiichi nuclear power plant accident in 2011,” wrote the researchers. [PLoS One 2016;11:e0158821] “Our results are consistent with previous work suggesting a high prevalence of mental health problems among individuals with epilepsy.” [Epilepsy Behav 2019;101:106569]
The average daily amount of time spent following media reports of the COVID-19 outbreak was significantly greater among patients with epilepsy vs healthy controls (2.34 hours vs 1.45 hours; p<0.001). A univariate analysis identified the length of time dedicated to following COVID-19 news and drug-resistant epilepsy as the only two (of the 12 assessed) clinicodemographic factors significantly associated with severe psychological distress (p<0.001). Both associations remained significant in multivariate logistic regression, with respective odds ratios of 0.283 (95 percent confidence interval [CI], 0.128 to 0.623) and 1.172 (95 percent CI, 1.073 to 1.280).
“While scientifically framed information can help people understand the developing situation, excessive attention to media reports about disasters can increase the risk of mental illness,” commented the researchers. [Glob Health Res Policy 2020;5:9; Psychiatry Res 2019;275:261-268] “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.”
“Early identification of mental illness in epilepsy patients can improve their management and prognosis, and the ability to recognize psychiatric comorbidities is as a key competency [in treating epilepsy], according to the American Academy of Neurology and the International League against Epilepsy … Patients with K-6 scores higher than 12 should be … consulted by a psychiatrist during a public health emergency,” concluded the researchers. [Epileptic Disord 2019;21:129-140; Neurology 2015;84:1483-1487]