Factors predictive of resilience and vulnerability in new-onset epilepsy
Factors predictive of resilience and vulnerability in new-onset epilepsy
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DOI：
10.1111/j.1528-1167.2010.02775.x
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发表时间：
2011-03-01
期刊：
影响因子：
5.6
通讯作者：
Whitehead, Margaret
中科院分区：
文献类型：
--
作者：
Taylor, Joanne;Jacoby, Ann;Whitehead, Margaret
目的：癫痫与生活质量（QOL）降低有关，但生活质量结果是不一致的。有些人在癫痫控制不佳的情况下仍能保持良好的生活质量，而另一些人在癫痫控制良好的情况下仍报告生活质量较差。在逆境中保持良好的生活质量体现在弹性的概念上。我们探讨了与癫痫患者（PWE）有弹性结果相关的因素。我们对逆境的定义包括社会经济劣势和持续发作。方法：我们分析作为标准和新型抗癫痫药物（SANAD）试验的一部分收集的数据。在4年随访结束时，根据癫痫控制（好/差）和社会经济地位（有利/不利）将患者分为4组。我们确定了具有弹性和脆弱结果的个体以及与之相关的因素。主要发现：癫痫控制在决定生活质量方面比物质优势更重要，但社会经济地位似乎是生活质量的额外保护或危险因素。有弹性结局的重要预测因素是4年无抑郁和较少的不良治疗效果，基线时的生活质量良好。易受伤害的结果的显著预测因子是健康感知公平/不良、抑郁的存在、掌控感降低和随访时更多的不良治疗效果。意义：尽管临床和社会经济环境不佳，但减少治疗的不良影响，以及增加自我控制的心理社会干预，减少健康问题，治疗抑郁症，促进对诊断的积极适应，可能会改善PWE的生活质量。
P>Purpose:Epilepsy has been associated with reduced quality of life (QOL), but QOL outcomes are heterogeneous. Some people are able to maintain a good QOL despite poorly controlled epilepsy and others report poor QOL despite well-controlled epilepsy. Maintaining a good QOL in the face of adversity is embodied by the concept of resilience. We explored the factors associated with having a resilient outcome in people with epilepsy (PWE). Our definition of adversity included socioeconomic disadvantage as well as continuing seizures.Methods:We analyzed data collected as part of the Standard and New Antiepileptic Drugs (SANAD) trial. At the end of 4-year follow-up, patients were classified into four groups on the basis of seizure control (good/poor) and socioeconomic status (advantaged/disadvantaged). We identified individuals with resilient and vulnerable outcomes and the factors associated with having them.Key Findings:Seizure control was more important in determining QOL than material advantage, but socioeconomic status appeared to act as an additional protective or risk factor for QOL. Significant predictors of a resilient outcome were absence of depression and fewer adverse treatment effects at 4 years and good QOL at baseline. Significant predictors of a vulnerable outcome were fair/poor health perception, presence of depression, reduced sense of mastery, and more adverse treatment effects at follow-up.Significance:Reducing the adverse effects of treatment, along with psychosocial interventions to increase self-mastery, reduce health concerns, treat depression, and promote positive adjustment to a diagnosis will likely improve the QOL of PWE despite less favorable clinical and socioeconomic circumstances.