Abstract
Objective: Children and adolescents with epilepsy suffer from stigma. Stigma associated with epilepsy is closely related to poor physical activity (PA) and high levels of psychological distress. However, the internal relationships are not well understood in China. This study aims to investigate the mediating effect of PA to determine whether PA mediates the relationship between stigma and psychological distress among children and adolescents with epilepsy.
Methods: A multicenter cross-sectional design was used to study children and adolescents with epilepsy admitted to 9 tertiary hospitals in China. Data were collected using a questionnaire measuring the Kilifi Stigma Scale for Epilepsy, the Depression Anxiety and Stress Scale, and the Physical Activity Rating Scale. The PROCESS macro in SPSS was used to examine the mediation model.
Results: 226 children and adolescents with epilepsy participated in the study. Psychological distress increased considerably as stigma levels increased, while a decrease was observed with increasing levels of PA. The results showed PA mainly plays partial mediating roles in the relationship between stigma and depression (ab = 0.042, 95% CI: 0.016 to 0.068), anxiety (ab = 0.077, 95% CI: 0.054 to 0.099) and stress (ab = 0.092, 95% CI: 0.061 to 0.122) dimensions of psychological distress. Additionally, intensity (ab = 0.027, 95% CI: 0.007 to 0.048) and frequency (ab = 0.028, 95% CI: 0.010 to 0.049) respectively only intermediated the relationship between stigma and anxiety and stress; duration (ab = 0.023, 95% CI: 0.002 to 0.044; ab = 0.034, 95% CI: 0.015 to 0.055; ab = 0.037, 95% CI: 0.012 to 0.061) all mediated between stigma and the psychological distress dimensions.
Conclusion: Stigma could increase psychological distress by indirectly influencing PA and its components. Interventions to improve physical activity may prevent or reduce psychological distress among children and adolescents with epilepsy.