The influence of patient, caregiver, and family factors on symptoms of anxiety and depression in children and adolescents with intractable epilepsy

- Caregiver anxiety was a key contributor to adolescents' anxiety/depression.
- Caregiver depression and unemployment were associated with patient depression.
- Adolescent girls had greater anxiety symptoms relative to boys.
- Depression was negatively associated with duration of epilepsy in children.

ObjectiveThe objective was to evaluate the association of caregiver and family factors with symptoms of anxiety and depression in children and adolescents with medically refractory localization-related epilepsy (i.e., failed at least two epilepsy medications).MethodForty-four children (ages 6-11 years) and 65 adolescents (ages 12-18 years) and their parents participated in this multicentered, observational, cross-sectional study. Univariable and multivariable linear regressions were used to evaluate the influence of multiple patient, caregiver, and family characteristics on self-reported symptoms of anxiety and depression in the children and adolescents.ResultsAmong children, depressive symptoms were associated with a lower proportion of life with seizures (β = .344, p = .022), caregiver depression (β = .462, p = .002), poorer family relationships (β = .384, p = .010), and poorer family mastery and social support (β = .337, p = .025); in multivariable analysis, proportion of life with epilepsy and parental depression remained significant. No significant predictors of anxiety were found among children. Among adolescents, depressive symptoms were associated with caregiver unemployment (β = .345, p = .005) and anxiety (β = .359, p = .003), low household income (β = .321, p = .012), poorer family mastery and social support (β = .334, p = .007), and greater family demands (β = .326, p = .008); in multivariable analysis, caregiver unemployment and anxiety remained significant. Greater anxiety symptoms among adolescents were associated with females (β = .320, p = .009) and caregiver depression (β = .246, p = .048) and anxiety (β = .392, p = .001) and poorer family mastery and social support (β = .247, p = .047); in multivariable analysis, female sex and caregiver anxiety remained significant.SignificanceThese findings highlight the central role of caregiver psychopathology, which is amenable to intervention, on children and adolescents' symptoms of anxiety and depression. Addressing caregiver psychopathology may improve children and adolescents' quality of life even if seizure control is not attained.