Perceived stigma is a critical factor for interictal aggression in people with epilepsy

• We studied predictors of interictal aggression and their interrelations in epilepsy.
• The predictors for aggression were perceived stigma, anxiety, and depression.
• Perceived stigma is the strongest factor for aggression in people with epilepsy.
• Various predictors of aggression have complex interrelations.
• We elucidated interrelations among various predictors of aggression.

PurposeAggression in people with epilepsy (PWE) is not well understood. We investigated interictal aggression in PWE and clarified predictors and the interrelationships among them.MethodThis was a case–control study. Eligible subjects who consecutively visited the epilepsy clinic completed several questionnaires including the Aggression Questionnaire (AQ), the Revised Stigma Scale (RSS), the Korean version of the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), and the Generalized Anxiety Disorder-7 (GAD-7).ResultsPWEs had higher overall AQ scores and anger and hostility subscale scores than controls. Patients with uncontrolled epilepsy also had higher physical and verbal aggression subscale scores than controls. Univariate analyses revealed associations between the overall AQ score and job, household income, marriage, antiepileptic drug (AED) load, seizure control, co-administration of psychiatric drugs, the RSS score, the K-NDDI-E score, and the GAD-7 score. Multivariate analyses indicated that the strongest predictor for the overall AQ score was the RSS score (β = 0.346, p < 0.001), followed by the GAD-7 score (β = 0.244, p = 0.003), and the K-NDDI-E score (β = 0.172, p = 0.047). The RSS score exerted a direct effect on the overall AQ score under the influences of the GAD-7 score and the K-NDDI-E score. The GAD-7 score also exerted a direct effect on the overall AQ score, but the K-NDDI-E score only had an indirect effect on the overall AQ score through the RSS score.ConclusionThe degree of interictal aggression is higher in PWE than controls. Perceived stigma is a critical factor for aggression under the influence of depression and anxiety.