title: Female sexual function mediates the effects of medication adherence on quality of life in people with epilepsy.
abstract: The purpose of this study was to understand the mediating effects of female sexual functioning in the association between medication adherence and quality of life (QoL) in Iranian women with epilepsy (WWE).
  
  
  
  Women's sexual functioning was measured using Female Sexual Function Index; QoL using Quality of Life in Epilepsy; epilepsy severity using Liverpool Seizure Severity Scale; subjective medication adherence using Medication Adherence Report Scale; and objective medication adherence using serum level for antiepileptic drugs in 567 WWE. Medication adherence was measured at baseline, while women's sexual functioning, QoL, and epilepsy severity were measured at the 6-month follow-up. Structural equation modeling and regression models were conducted to examine the mediating role of women's sexual functioning.
  
  
  
  The mediating effects of sexual functioning in the relationship between medication adherence (including subjective and objective measures) and QoL were supported in the total score of Female Sexual Function Index (coefficient=0.415, SE=0.117, p<0.001 for subjective medication adherence; coefficient=1.980, SE=0.446, p<0.001 for objective medication adherence). Seizure severity was significantly associated with QoL but only when objective medication adherence was measured (coefficient=-0.094, SE=0.036, p=0.009).
  
  
  
  Our results extended the importance of medication adherence from symptom reduction to the beneficial effects of women's sexual functioning and QoL. Health care providers should be aware of these additional benefits of medication adherence and use these arguments to encourage female patients to take their medication, which can eventually increase their sexual satisfaction and overall QoL.
authors.affiliation: Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
authors.forename: Chung-Ying
authors.initials: CY
authors.lastname: Lin
authors.affiliation: School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand.
authors.forename: Andrea
authors.initials: A
authors.lastname: Burri
authors.affiliation: School of Health and Welfare, Jönköping University, Jönköping, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Fridlund
authors.affiliation: Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahounar BLV, Qazvin 3419759811, Iran; Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden. Electronic address: Pakpour_Amir@yahoo.com.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Pakpour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000494:pharmacology / Q000627:therapeutic use*; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012725:Sexual Behavior / Q000187:drug effects / Q000502:physiology / Q000523:psychology*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Epilepsy; Mediation; Medication adherence; Quality of life; Sexual functioning