title: Individual and family factors associated with self-esteem in young people with epilepsy: A multiple mediation analysis.
abstract: As young people experience added demands from living with epilepsy, which may lead to poor psychosocial adjustment, it is essential to examine mechanisms of change to provide practitioners with knowledge to develop effective interventions. The aim of this study was to examine individual and family-level factors - stress and illness perceptions, coping behaviors and family resilience - that promote or maintain young people's self-esteem.
  
  
  
  From November 2013 to August 2014, young people attending a neurology clinic in KK Women's and Children's Hospital, Singapore, participated in a cross-sectional survey (n=152; 13-16years old). Multiple mediation analyses were conducted to evaluate whether these variables mediated the relationship between illness severity (i.e., low, moderate, high) and self-esteem.
  
  
  
  Multiple mediation analyses demonstrated that illness severity had a direct effect on young people's self-esteem. Compared to those with moderate illness severity (reference group), young people with low severity had significantly higher self-esteem (c=3.42, p<0.05); while those with high severity had a more negative view of themselves (c=-3.93, p<0.001). Illness severity also had an indirect influence on self-esteem through its effects on mediators, such as perceived stress, illness perceptions and family resilience (D1: Total ab=3.46, 95% CI 1.13, 5.71; D2: Total ab=-2.80, 95% CI -4.35, -1.30). However, young people's coping levels did not predict their self-esteem, when accounting for the effects of other variables.
  
  
  
  The continued presence of seizure occurrences is likely to place greater demands on young people and their families: in turn, increased stress and negative illness perceptions negatively affected family processes that promote resilience. As the mediating effect of these modifiable factors were above and beyond the contributions of illness characteristics and young people's levels of coping, this has implications for developing individual and family interventions aimed to support young people living with epilepsy.
authors.affiliation: School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom. Electronic address: judith.chew.fh@kkh.com.sg.
authors.forename: Judith
authors.initials: J
authors.lastname: Chew
authors.affiliation: School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Haase
authors.affiliation: School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Carpenter
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D012649:Self Concept; D012720:Severity of Illness Index
keywords: Adaptation; Adolescents; Chronic illness; Psychosocial