Depression, anxiety, and associated factors among caregivers of children and adolescents with epilepsy attending Muhimbili Paediatric Neurology Clinic

Abstract

ABSTRACT Background: Epilepsy continues to be one of the most prevalent neurological disorders, it affects 50 million people globally. The diagnosis of epilepsy has psychological impacts on the families, particularly the caregivers. The stigma associated with the disease, the economic burden of care, and the unpredictability of seizures contribute to psychological distress in caregivers. Little is known about the prevalence of depression, anxiety, and associated factors among caregivers of children with epilepsy in Tanzania. Objective: We aimed to determine the prevalence of depression, anxiety, and their associated factors among caregivers of children and adolescents with epilepsy attending the Paediatric neurology clinic at Muhimbili National Hospital (MNH). Methodology: This was a hospital-based cross-sectional study conducted among caregivers of children and adolescents with epilepsy attending MNH Paediatric neurology clinic between July 2023 to November 2023. Demographic data were collected using a structured questionnaire, and depression as well as anxiety were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7) tools respectively. Logistic regression was used to assess factors independently associated with depression and anxiety. A p-value less than 0.05 was considered statistically significant. Results: A total of 427 participants were enrolled with a mean age of 34.2 ± 6.8 years. Most caregivers were female 397 (93.0%), married 333 (78.0%), and mothers of children 381 (89.2%). Depression was observed in 17.3% of the participants, anxiety was found in another 17.3%, and 9.0% of caregivers were found to have both depression and anxiety. Factors associated with depression were having a child who is: less than 5 years old (adjusted odds ratio (aOR) =8.65; 95% CI: 1.79- 41.82, p=0.007), epilepsy duration more than 5 years (aOR= 3.25; 95% CI: 1.08 – 9.77), history of epilepsy-related injuries (aOR =2.90; 95% CI:1.26 – 6.66, p=0.012) and three or more hospital admissions (aOR=2.70; 95% CI: 1.02 - 7.11, p= 0.044). Caregivers whose children had not started school or were in primary school had lesser odds of depression compared to counterparts in secondary school (aOR=0.01; 95% CI: 0.001 – 0.28, p=0.0004) and (aOR=0.02; 95% CI: 0.002 - 0.36, p= 0.007), respectively. Factors associated vi with caregivers’ anxiety were having a child with: another comorbidity (aOR=2.01; 95% CI: 1.13 - 3.58, p=0.017), history of epilepsy-related injuries (aOR=2.52; 95% CI: 1.10 – 5.78, p=0.028), 3 or more hospital admissions (aOR= 3.22; 95% CI: 1.27 – 8.12, p= 0.013) and if caregiver was aged between 41 to 50 years (aOR = 3.30; 95% CI: 1.06 – 10.23, p= 0.039). Having a child with a duration of epilepsy of more than 5 years was associated with having concurrent depression and anxiety (aOR = 4.63; 95% CI 1.00 – 26.26, p= 0.049). Conclusion: Our study revealed that depression and anxiety are common among caregivers of children with epilepsy (CWE). Most of the factors associated with caregivers' depression and anxiety were epilepsy-related. Recommendations: Integration of mental health services in regular Paediatric neurology clinic offering screening for depression and anxiety and linkage of caregivers for counselling and psychoeducation.