title: Do expressed emotions result in stigma? A potentially modifiable factor in persons with epilepsy in India.
abstract: OBJECTIVE
  Feeling stigmatized or having comorbid depression in a PWE may significantly influence epilepsy care and treatment. An important contributory factor to this can be the expressed emotions (EEs) from family, friends, or society. The present study aimed at understanding the influence of EEs, as exhibited by close relatives, on the perception of stigma and comorbid depression experienced by PWEs.
  
  
  METHODS
  Eighty PWEs aged 18 years and above, both genders, visiting neurology OPD in AIIMS Hospital, were recruited. Using the PHQ-09, we subdivided them into Group I (PWEs with comorbid depression) and Group II (PWEs without comorbid depression), followed by administration of Levels of Expressed Emotions Scale and Stigma Scale for Epilepsy, respectively.
  
  
  RESULTS
  The comparative analysis, using independent t-test (for categorical data), Pearson's correlation (for continuous data), and multivariate regression analysis, reflected significant influence of EEs on depression and stigma, with more than 20% of the participants reporting comorbid depression, out of which more than 50% further expressed feelings of inferiority or disgrace due to the ways in which family or society discriminated them from healthy persons, thereby highlighting a greater associations of high EEs as opposed to low EEs from key individuals on patients' perception of stigma or feeling of depression.
  
  
  CONCLUSIONS
  The result suggested that EEs from a relative might go unnoticed but may significantly overwhelm the patient, thereby making him succumb to depression or feeling stigmatized. The analysis of such a clinical profile and relationship between EEs and perceived stigma/depression may help us understand the pattern of attribution styles adopted by PWEs, thereby utilizing it further for enhancing the efficacy of cognitive-behavioral therapy for facilitating sustained recovery and improved quality of life for PWEs.
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Electronic address: mansi.verma.cp@gmail.com.
authors.forename: Mansi
authors.initials: M
authors.lastname: Verma
authors.affiliation: Department of Neurology, AIIMS, Delhi, India. Electronic address: dr81arora@gmail.com.
authors.forename: Amit
authors.initials: A
authors.lastname: Arora
authors.affiliation: Centre of Excellence Epilepsy, AIIMS, Delhi, India. Electronic address: shristats.m@gmail.com.
authors.forename: Shrividya
authors.initials: S
authors.lastname: Malviya
authors.affiliation: Department of Neuropsychology, AIIMS, Delhi, India. Electronic address: ashimanwadhawan@gmail.com.
authors.forename: Ashima
authors.initials: A
authors.lastname: Nehra
authors.affiliation: Department of Psychiatry, AIIMS, Delhi, India. Electronic address: rsagar29@gmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sagar
authors.affiliation: Department of Neurology, AIIMS, Delhi, India. Electronic address: manjari2tripathi@gmail.com.
authors.forename: Manjari
authors.initials: M
authors.lastname: Tripathi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003863:Depression / Q000150:complications; D004827:Epilepsy / Q000523:psychology*; D019260:Expressed Emotion; D005190:Family; D005260:Female; D033062:Friends; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D057545:Social Stigma; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Attitude; Epilepsy; Knowledge; Practice; Psychosocial; Stigma