title: Enacted stigma among patients with epilepsy and intellectual impairment.
abstract: BACKGROUND
  The limited research on stigma and its determinants in patients with epilepsy and intellectual impairment motivated our study in this area.
  
  
  OBJECTIVE
  We assessed enacted stigma and its determining factors in Bulgarian patients with refractory epilepsy and intellectual impairment.
  
  
  METHODS
  We conducted a study of 64 patients with refractory epilepsy and intellectual impairment based on a questionnaire designed for people with intellectual impairment (stigma scale) and a purposeful interview on clinical factors and real experiences of discrimination, insults and/or threats, and attacks.
  
  
  RESULTS
  A real experience of discrimination was reported by 51 (91.07%) of the interviewed participants, 34 (60.71%) of whom had been insulted and/or threatened and attacked because of their health problems. The experience of insults and/or threats and attacks was more frequent in cases with moderate intellectual impairment (χ(2)=5.17, P<0.05). Discrimination was reported more rarely by older patients (F=3.23, P<0.05). The participants who gave a greater number of positive answers about experienced discrimination or insults and/or threats and attacks reported a more pronounced perceived stigma (F=19.30, P<0.001 and F=12.91, P<0.001, respectively). Perceived stigma and the experience of insults and/or threats and attacks proved to be predictors of discrimination on multivariate regression analysis (F=40.54, P<0.001).
  
  
  CONCLUSIONS
  We have affirmed very frequent enacted stigmatization in Bulgarian patients with refractory epilepsy and intellectual impairment and its correlation with the degree of intellectual impairment, age, and perceived stigma.
authors.affiliation: Department of Neurology, University of Medicine, Plovdiv, Bulgaria. Electronic address: eiviteva@abv.bg.
authors.forename: E
authors.initials: E
authors.lastname: Viteva
authors.affiliation: Department of Social Health, University of Medicine, Plovdiv, Bulgaria.
authors.forename: M
authors.initials: M
authors.lastname: Semerdjieva
mesh_terms: D000328:Adult; D000368:Aged; D058445:Bullying / Q000523:psychology*; D015897:Comorbidity; D004827:Epilepsy / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D057545:Social Stigma; D055815:Young Adult
keywords: Intellectual impairment; Refractory epilepsy; Stigma