Impact of co-morbid common mental disorder symptoms in people with epilepsy in Ethiopia on quality of life and functional disability: cohort study

Abstract

Background There is very limited prospective evidence on the impact of co-morbid mental health conditions in people with epilepsy living in low and middle-income countries. The objective of this study was to investigate the impact of common mental disorder (CMD; depression/anxiety) symptoms and risky substance use in people with epilepsy in Ethiopia on quality of life and functioning over six months. Methods A prospective cohort study of people with epilepsy was carried out in four districts of south-central Ethiopia. Comorbid CMD symptoms, risky substance uses (exposures) and the primary outcome, quality of life (QoL) was measured at baseline and 6 months follow-up. Secondary outcomes functional disability and seizure frequency were measured at follow-up. Multivariable linear regression was employed to evaluate whether comorbid CMD symptoms predicted a change in QoL and functional disability. Structural equation modelling (SEM) was employed to examine direct and indirect pathways linking co-morbid CMD symptoms with QoL or functional disability. Results In the multivariable regression model, neither CMD symptoms (β coef= -0.37, 95%CI -1.30, + 0.55) nor moderate to high risk of alcohol use (β= -0.70, 95% CI -9.20, + 7.81) were significantly associated with a change in QoL, and there was no effect modification by treatment engagement. In SEM, QoL at 6 months was significantly predicted by seizure frequency. The summative effect of CMD on QoL was significant (B= -0.27, 95%CI -0.48, -0.056), although direct and indirect associations were non-significant. Change in functional disability was not significantly associated with baseline CMD symptoms (β coef.= -0.03, 95% CI-0.48,+0.54) or with moderate to high risk of alcohol use (β coef.= -1.31, 95% CI -5.89, 3.26). However, in the SEM model, functional disability at 6 months was predicted by both baseline CMD symptoms (B = 0.24, 95% CI 0.06, 0.41) and seizure frequency (B = 0.67, 95% CI 0.46, 0.87). Conclusions In this rural Ethiopian setting, co-morbid CMD symptoms and seizure frequency in PWE independently predicted functional disability in people with epilepsy. The association between CMD symptoms and QoL was less conclusive. Integrated management of mental health and neurological conditions is needed to better address the psychosocial needs and improved functioning of people with epilepsy.