title: Association of subjective anxiety, depression, and sleep disturbance with quality-of-life ratings in adults with epilepsy.
abstract: OBJECTIVE
  To determine the relative contributions of subjective anxiety, depression, sleep disturbance, and seizure-related variables to quality-of-life scores in adults with epilepsy, and the interrelationships among these factors.
  
  
  METHODS
  Consecutive adult patients with epilepsy attending neurology outpatient clinics were recruited. Patients completed the following scales: Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Rating Scale, Medical Outcomes Study (MOS) Sleep Scale, Epworth Sleepiness Scale, and Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Univariate and multivariate linear regression models were used to identify variables associated with QOLIE-31 overall score. Path analysis model was constructed to test for interrelations between the variables.
  
  
  RESULTS
  Two hundred forty-seven patients completed the questionnaires. By multivariate analysis, in order of degree of contribution, HADS anxiety subscale score, MOS Sleep Scale Sleep Problems Index score, HADS depression subscale score, number of current antiepileptic drugs used, and seizure freedom in the past 4 weeks, significantly correlated with QOLIE-31 overall score, accounting for 65.2% of the variance. Complex interrelationships were present between these factors. A general linear model to predict QOLIE-31 overall score in the presence of these factors was constructed.
  
  
  CONCLUSIONS
  Subjective anxiety, depression, and sleep disturbance exerted greater effect than short-term seizure control on quality of life scores of patients with epilepsy. These factors should be considered simultaneously when evaluating effects of treatment on quality of life.
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. patrickkwan@cuhk.edu.hk
authors.forename: Patrick
authors.initials: P
authors.lastname: Kwan
authors.forename: Evelyn
authors.initials: E
authors.lastname: Yu
authors.forename: Howan
authors.initials: H
authors.lastname: Leung
authors.forename: Teresa
authors.initials: T
authors.lastname: Leon
authors.forename: Marko A
authors.initials: MA
authors.lastname: Mychaskiw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology* / Q000523:psychology; D003863:Depression / Q000209:etiology* / Q000523:psychology; D004827:Epilepsy / Q000150:complications* / Q000523:psychology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011788:Quality of Life; D012189:Retrospective Studies; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000523:psychology; D055815:Young Adult