Improving outcomes in childhood epilepsy: the role of psychological family factors

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Hennessy, Emma
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University College Cork
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Abstract Paper 1: Objectives: This systematic review 1) charted the relationships between psychological family factors and psychosocial outcomes in childhood epilepsy, 2) identified which factors have acted as risk or protective factors for psychosocial outcomes, and 3) explored whether psychological family factors contributed to psychosocial outcome, over and above those of seizure and epilepsy variables where the relative significance of all such factors were considered. Methods: A comprehensive search of six electronic databases was conducted. A total of 30 studies (34 articles), met inclusion criteria for review. Psychological family factors included family environment factors (e.g., family functioning, family resources, family stress/demands, resilience, etc.) and parent/caregiver factors (parental mental health, parenting style, parental worry about epilepsy, parent-child relationships etc.). Psychosocial outcomes pertained to emotional and behavioural adjustment, quality of life, social outcomes and adaptive functioning skills. The adapted Downs and Black Quality Checklist was applied to included articles. Results: Psychological family factors were significantly associated with psychosocial outcomes, with 29/30 studies reporting at least a small association between at least one family factor measured and child outcomes. Parent/caregiver factors were most consistently associated with outcomes, with significant moderate associations at both univariate and multivariate level for all studies. 15/21 studies, which assessed the relationship between both family and epilepsy factors, found that psychological family factors were more strongly associated with outcomes than epilepsy factors. The overall quality of studies was very satisfactory (mean ± SD = 12 ± 2.3). Significance: Providing front-line clinicians with appropriate training and tools for assessment and brief intervention, could reduce the negative psychosocial impact that some families and children with epilepsy experience.
Abstract Paper 2: Objectives: The current study is the first to profile psychosocial outcomes for children with epilepsy attending a regional paediatric centre in Ireland. Both parent and teacher informants are utilised and disease – v- family factor associations with outcomes were examined. Methods: Forty-eight children with epilepsy (6-16 years) and their caregivers participated in this cross-sectional survey research. Both parents and teachers reported on psychosocial adjustment, social competencies and quality of life. Exploratory bivariate correlations and then confirmatory multiple regressions were utilised to evaluate the relationship between family, child and disease related factors and psychosocial outcomes. Results: Parental worry about their child with epilepsy, as opposed to disease severity per se was most strongly associated with child outcomes. Measures of disease severity (seizure frequency and number of medications) did not show any associations with child outcomes based on parent reports. However, when teacher reports were considered, the seizure frequency, as opposed to parental worry, showed more consistent associations with child psychosocial outcomes. Other family factors (resilience, cohesion and conflict) did not show any strong associations with child psychosocial outcomes. Significance: The current study provides an insight into the profile of children and young people with epilepsy attending paediatric outpatient neurology services in Ireland. Positively, families demonstrated high levels of functioning and resilience. However, high levels of illness related parental worry were evident. Results suggest that a multi-layered approach is required for intervention, including psychoeducation from the medical and psychological fields as well as family-based support in improving outcomes for childhood epilepsy.
Epilepsy , Family , Caregiver , Paediatric , Psychological , Outcomes , Systematic review
Hennessy, E. 2019. Improving outcomes in childhood epilepsy: the role of psychological family factors. DClinPsych Thesis, University College Cork.