Moderators of the effect of preoperative emotional adjustment on postoperative depression after surgery for temporal lobe epilepsy.
OBJECTIVE
Other outcome measures besides seizure control must be considered when assessing the benefit of epilepsy surgery. We investigated the effect of preoperative psychosocial adjustment on postoperative depression in epilepsy patients followed up prospectively for 2 years after temporal lobectomy.


METHODS
The Washington Psychosocial Seizure Inventory (WPSI) evaluated psychosocial functioning; the Centre for Epidemiological Studies Depression Scale (CES-D) measured depression. Both were completed at baseline and follow-up.


RESULTS
Follow-up occurred in 39 temporal lobectomy patients at 2 years after surgery. Greatest improvement in depression scores was limited to patients with good seizure outcomes (seizure free, or marked reduction in seizure frequency), and seizure outcome was a significant predictor of postoperative depression. Despite this, preoperative scores on the emotional adjustment scale of the WPSI were most highly correlated with depression 2 years after surgery. To clarify this relation, moderated hierarchic regression suggested that good preoperative emotional adjustment (WPSI) was generally associated with less depression after surgery. Moreover, poorer preoperative adjustment combined with older age, generalized seizures, the finding of preoperative neurologic deficits, a family history of psychiatric illness, and/or a family history of seizures was related to higher depression scores 2 years after surgery.


CONCLUSIONS
Depression after temporal lobectomy is dependent on a complex interaction of variables and can have a significant effect on indices of postoperative adjustment. The WPSI emotional adjustment scale may help to predict which patients are likely to be chronically depressed after surgery.
Derry
P A
PA
Department of Psychology, London Health Sciences Centre, University of Western Ontario, Canada. pderry@julian.uwo.ca
Rose
K J
KJ
McLachlan
R S
RS
D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D004833:Epilepsy, Temporal Lobe / Q000523:psychology / Q000601:surgery*; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D009422:Nervous System Diseases / Q000453:epidemiology; D010555:Personality Inventory / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012044:Regression Analysis; D012640:Seizures / Q000453:epidemiology; D012917:Social Adjustment; D013702:Temporal Lobe / Q000601:surgery; D016896:Treatment Outcome