Summary: Phobic and agoraphobic symptoms are common in those with epilepsy and result in a poorer quality of life.
Source: Wake Forest University
About 5.1 million people in the U.S. have a history of epilepsy, which causes repeated seizures. According to the Epilepsy Foundation, epilepsy is the fourth most common neurological disorder.
While current research has shown an increase in anxiety and depression among people with epilepsy, little is known about this population and agoraphobia, an anxiety disorder that involves the fear of being in a public place or in a situation that might cause panic or embarrassment.
However, a recent study from Heidi Munger Clary, M.D., M.P.H., associate professor of neurology at Wake Forest University School of Medicine, shows that phobic and agoraphobic symptoms are common and associated with poor quality of life in people with epilepsy.
The study appears online in Epilepsy Research.
“We know that agoraphobia can lead to delays in patient care because of a reluctance to go out in public, which includes appointments with health care providers,” said Munger Clary, the study’s principal investigator. “So, this is an area that needs more attention in clinical practice.”
In the study, researchers conducted a cross-sectional analysis of baseline clinical data from a neuropsychology registry cohort study. Researchers analyzed a diverse sample of 420 adults, ages 18 to 75, with epilepsy who underwent neuropsychological evaluation over a 14-year period at Columbia University Medical Center in New York.
“More than one-third of the participants reported significant phobic/agoraphobic symptoms,” Munger Clary said. “We also found that phobic/agoraphobic symptoms, along with depression symptoms, were independently associated with poor quality of life, but generalized anxiety symptoms were not.”
According to Munger Clary, because phobic/agoraphobic symptoms are not routinely assessed by clinicians, the findings may suggest a need for future studies to develop more comprehensive screeners for psychiatric comorbidity in epilepsy.
“Symptoms of agoraphobia do not fully overlap with generalized anxiety or depression symptoms that are often screened in routine practice,” Munger Clary said.
“Providers might want to consider more robust symptom screening methods to identify and better assist these patients. This may be important to improve health equity, given other key study findings that show those with lower education and non-white race/ethnicity had increased odds of significant phobic/agoraphobic symptoms.”
Funding: This work was supported in part by the National Institutes of Health under grants R01 NS035140, KM1 CA156709, UL1 TR001420 and 5KL2TR001421-04.
Afraid to go out: Poor quality of life with phobic anxiety in a large cross-sectional adult epilepsy center sample
People with epilepsy (PWE) have unmet healthcare needs, especially in the context of mental health. Although the current literature has established increased incidence of anxiety and depression in PWE and their contribution to poor quality of life, little is known regarding the presence and impact of specific phobia and agoraphobia. Our aim was to assess factors associated with high phobic/agoraphobic symptoms in a large, single tertiary epilepsy center sample, and to assess their impact on quality of life.
In a diverse sample of 420 adults with epilepsy, cross-sectional association of demographic, epilepsy and cognitive factors with high phobic symptoms were assessed using multiple logistic regression. Symptoms were measured with the SCL-90R validated self-report subscale (T-score ≥ 60 considered high phobic symptom group). Multiple logistic regression modeling was used to assess for independent association of demographic and clinical variables with presence of high phobic symptoms, and multiple linear regression modeling was used to evaluate for independent cross-sectional associations with epilepsy-specific quality of life (QOLIE-89).
Lower education (adjusted OR 3.38), non-White race/ethnicity (adjusted OR 2.34), and generalized anxiety symptoms (adjusted OR 1.91) were independently associated with high phobic/agoraphobic symptoms, all p < 0.005. Phobic/agoraphobic symptoms were independently associated with poor quality of life as were depression symptoms, older age, and non-White race/ethnicity. Generalized anxiety did not demonstrate a significant independent association with quality of life in the multivariable model.
In this study sample, phobic/agoraphobic symptoms were independently associated with poor quality of life. Clinicians should consider using more global symptom screening instruments with particular attention to susceptible populations, as these impactful symptoms may be overlooked using generalized-anxiety focused screening paradigms.