A total of 296 patients with epilepsy were recruited in the study. The overall response rate was 100%.
Sociodemographic Characteristics.
All of the respondents were in the age group of 13–65 years with the mean, age of 31.6 ± 13.04.SD. The median & mode age of respondent was 29 and 24 respectively. Among all participants, 163(55.1%) were male, 186(62.8%) were live in urban area & geographically 268(90.5) were Tigran in ethnicity. Majority of the participant 239(80.7%) were orthodox in religion, 96(32.4%) were unable to read & write, 95(32.1%) were married, 135 (45.6%) had no any specified monthly income and 162(54.7%) were had moderate social support (Table 1).
Table 1
Distribution of study subjects by socio demographic factors peoples with epilepsy (n = 296) on follow up at Ayder comprehensive specialized hospital and Mekelle hospital, Mekelle, Tigray, Ethiopia, 2019.
| Variables | Frequency | Percentage |
Age | 12–17 years | 34 | 11.5 |
18–24 years | 77 | 26.0 |
24–34 years | 70 | 23.6 |
35–44 years | 63 | 21.3 |
> 44 years | 52 | 17.6 |
Sex | Male | 163 | 55.1 |
Female | 133 | 44.9 |
Residency | Urban | 186 | 62.8 |
Rural | 110 | 37.2 |
Ethnicity | Tigray | 268 | 90.5 |
Amhara | 11 | 3.7 |
Afar | 16 | 5.4 |
Other | 1 | .3 |
Religion | Orthodox | 239 | 80.7 |
Catholic | 4 | 1.4 |
Protestant | 4 | 1.4 |
Muslim | 49 | 16.5 |
Educational status | Unable to read & write | 96 | 32.4 |
Primary 1–8 | 84 | 28.4 |
Secondary 9–12 | 48 | 16.2 |
Techniques | 8 | 2.7 |
Diploma | 9 | 3.1 |
first degree and above | 51 | 17.2 |
Marital status | Married | 95 | 32.1 |
Single | 150 | 50.7 |
Divorced | 22 | 7.4 |
Widowed | 26 | 8.8 |
Other | 3 | 1.0 |
Employment | No | 41 | 13.9 |
Student | 69 | 23.3 |
Farmer | 32 | 10.8 |
house wife | 56 | 18.9 |
Government | 16 | 5.4 |
Private | 33 | 11.1 |
Merchant | 24 | 8.2 |
Others | 25 | 8.4 |
Monthly income | No | 135 | 45.6 |
301–600 | 23 | 7.8 |
< 300 | 21 | 7.1 |
601–1000 | 24 | 8.1 |
> 1000 | 93 | 31.4 |
Social support | Low | 72 | 24.3 |
Moderate | 162 | 54.8 |
High | 62 | 20.9 |
Description of respondents by clinical factors
From the total 296 respondents, 120(40.5%) were start epilepsy at the age of 18 & above, 135(45.6%) were live with epilepsy for at least 11 years and 134 (45.3%) were experienced seizure related physical trauma. 163 (55.1%) of the participant were reported that they experience at most 2 seizures in a month & 82 (27.7%) experience seizure frequency 3–5 time per month. Majority of the respondent 216(73.0%) were on monotherapy, 88(28.7%) were taken the medication for more than 11 years and 243 (82.1%) were had good improvement with medication (Table 2).
Table 2
Distribution of study subjects by clinical related factors of peoples with epilepsy (n = 296) on follow up at Ayder comprehensive specialized hospital and Mekelle hospital, Mekelle, Tigray, Ethiopia, 2019.
| Variables | Frequency | Percentage |
Age of onset | < 6 years | 32 | 10.8 |
6–11 years | 76 | 25.7 |
12–17 years | 68 | 23.0 |
18 & above years | 120 | 40.5 |
Total duration of the illness | ≤ 1 year | 11 | 3.7 |
2–5 years | 64 | 21.6 |
6–10 years | 86 | 29.1 |
11 years or above | 135 | 45.6 |
Number of seizures | ≤ 2 per month | 163 | 55.1 |
3–5 per month | 82 | 27.6 |
6–10 per 6 months | 41 | 13.9 |
≥ 11 per year | 10 | 3.4 |
Seizures related physical trauma | No | 162 | 54.7 |
Yes | 134 | 45.3 |
Number of AEDs | Monotherapy | 216 | 73.0 |
Polytherapy | 80 | 27.0 |
Length of time with medication | 0–11 month | 31 | 10.5 |
Less than 2 years | 40 | 13.5 |
2–5 years | 85 | 28.7 |
6–10 years | 52 | 17.6 |
11 or more years | 88 | 29.7 |
Improvement with medication | No | 53 | 17.9 |
Yes | 243 | 82.1 |
Medication related side effect. | No | 207 | 69.9 |
Yes | 89 | 30.1 |
Life time substance use history | No | 220 | 74.3 |
Yes | 76 | 25.7 |
Substance use history in the past 3 months. | No | 267 | 90.2 |
Yes | 29 | 9.8 |
Presence of chronic medical illness | No | 250 | 84.5 |
Yes | 46 | 15.5 |
Perceived stigma | No | 193 | 65.2 |
Yes | 103 | 34.8 |
Anxiety | No | 200 | 67.6 |
Yes | 96 | 32.4 |
Stress | No | 227 | 76.7 |
Yes | 69 | 23.3 |
History of physical abused | No | 284 | 95.9 |
Yes | 12 | 4.1 |
History of sexual abused | No | 293 | 99.0 |
Yes | 3 | 1.0 |
Suicidal attempt history | No | 285 | 96.3 |
Yes | 11 | 3.7 |
Presence of suicidal wish | No | 238 | 80.4 |
Yes | 58 | 19.6 |
Description of Respondents Patient’s Contagion Belief, and Causal Belief of Epilepsy.
Regarding the cause of epilepsy, 94(31.8% ) were believe that it is caused by walks around garbage, dumps, ashes, walking along a river & 69(23.3%) were not know. Out of the total participant 181(61.1%) were believe that epilepsy is a mental illness, 263 (88.9) were believe that epilepsy is treatable (Table 3).
Table 3
Distribution of study subjects by ( causal, contagion, heritability, treatability & mental illness Belief) of people with epilepsy (n = 296) up at Ayder on- follow comprehensive specialized hospital and Mekelle hospital, Mekelle, Tigray, Ethiopia, 2019.
| Variables | Frequency | Percentage |
Cause of epilepsy | I don't know | 69 | 23.3 |
spiritual possession | 39 | 13.2 |
evil eye | 19 | 6.4 |
family history | 32 | 10.8 |
Pathogens | 6 | 2.0 |
sinful act | 37 | 12.5 |
walks around garbage, dumps, ashes, walking along a river ……. | 94 | 31.8 |
Contagious | No | 255 | 86.1 |
Yes | 41 | 13.9 |
Heritable | No | 235 | 79.4 |
Yes | 61 | 20.6 |
Mental illness | No | 115 | 38.9 |
Yes | 181 | 61.1 |
Treatable | No | 33 | 11.1 |
Yes | 263 | 88.9 |
By what means? | Hole water | 1 | 0.3 |
Traditional treatment | 2 | 0.6 |
Modern medicine | 222 | 75.0 |
Hole water & modern medicine | 41 | 14.0 |
Depression Scores of Participants.
Overall, the prevalence of perceived stigma was found to be 34.8%. Regarding the proportion of depression toward each item, most of the participants 213 (71.9%) reported that they Trouble falling or staying asleep, or sleeping too much, 210 (70.9%) were reported feeling down, depressed or hopeless and 197 (66.6%) also reported that having little interest or pleasure in doing things (Table 4).
Table 4
Proportion of responses to PHQ-9 by study participants of patients with epilepsy (n = 296) on follow up at Ayder comprehensive specialized hospital and Mekelle hospital, Mekelle, Tigray, Ethiopia, 2019.
| Scale | Not at all | Several days | More than half of the days. | Every day |
| | n/296 | % | n/296 | % | n/296 | % | n/296 | % |
1 | Little interest or pleasure in doing things | 99 | 33.4 | 111 | 37.5 | 63 | 21.3 | 23 | 7.8 |
2 | Feeling down, depressed or hopeless | 86 | 29.1 | 128 | 43.2 | 67 | 22.6 | 15 | 5.1 |
3 | Trouble falling or staying asleep, or sleeping too much | 82 | 27.7 | 136 | 46.2 | 63 | 21.3 | 14 | 4.8 |
4 | Feeling tired or having little energy | 101 | 34.1 | 121 | 40.9 | 59 | 19.9 | 15 | 5.1 |
5 | Poor appetite or overeating | 126 | 42.6 | 102 | 34.5 | 54 | 18.2 | 14 | 4.7 |
6 | Feeling bad about yourself – or that you are a failure or have let yourself or your family down | 143 | 48.3 | 100 | 33.8 | 46 | 15.5 | 7 | 2.4 |
7 | Trouble concentrating on things, such as reading the newspaper or watching television | 133 | 44.9 | 90 | 30.4 | 61 | 20.6 | 12 | 4.1 |
8 | Moving or speaking so slowly that other people could have noticed, or the opposite | 205 | 69.3 | 77 | 26.0 | 14 | 4.7 | 0 | 0 |
9 | Thoughts that you would be better off dead or of hurting yourself in some way | 196 | 66.2 | 90 | 30.4 | 10 | 3.4 | 0 | 0 |
The lowest score of the data was 0 and the highest score was 19. The mean, median and mode the respondent was 7.2, 6, 5 respectively. Scores above 9 were considered to show the PWE who had depression. Accordingly, out of the 296 study subjects recruited in the study, 103 (34.8%) scored above 9 as measured by the PHQs.
Factors associated with depression
Bivariate analyses were done between depression and response variables of socio-demographic variables ( Age, Residency, educational status, Marital status, employment & social support), Clinical factors ( total duration of the illness, seizure frequency, number of AEDs, side effect of medication, seizure related trauma, feeling perceived stigma, anxiety symptoms, stress symptoms and history of suicidal attempt) and patients belief factors (contagious belief, heritability belief, perceived as a mental illness & treatability belief ) were found to be significantly associated with depression at p value less than 0.3. All individual factors < 0.30 at bivariate analyses were entered to multivariate logistic regression for further analysis.
Accordingly, Unable to read & write (AOR = 0.400, 95% CI: 0.162, 0.986), long duration of the medication intake at least for 11 years (AOR = 3.715, 95% CI: 1.498, 9.212), poor improvement with medication (AOR = 0.216, 95% CI: 0.101, 0.460), feeling of perceived stigma (AOR = 0.244, 95% CI: 0.129, 0.462), stress symptoms( AOR = 0.452, 95% CI: 0.220, 0.928), were significantly associated with depression ( Table 5).
Table 5
Factors associated with depression in people with epilepsy (bivariate and multivariate analysis) for the study of the prevalence of depression and associated factors among epileptic patients in ACSH & MGH, 2019.
| Depression | Bivariate | Multivariate analysis |
Variables | No | Yes | P-value | COR(95%,CI) | AOR (95%,CI) |
Age | |
12–17 years | 23 | 11 | 1 | | |
18–24 years | 52 | 25 | 0.588 | 1.298 (0.505, 3.338) | 1.392 (0.279,6.953) |
24–34 years | 37 | 33 | 0.502 | 1.305 (0.600, 2.837) | 1.136 (0.301,4.285) |
35–44 years | 43 | 20 | 0.025* | 2.421 (1.119, 5.238) | 2.261 (0.7007.305) |
> 45 years | 38 | 14 | 0.573 | 1.262 (0.561, 2.839) | 1.517 (0.5234.400) |
Sex | | |
Male | 102 | 61 | 1 | | |
Female | 91 | 42 | 0.294 | 1.296 (0.799, 2.103) | |
Residency | | |
Urban | 125 | 61 | 0.348 | 1.266 (0.774, 2.069) | |
Rural | 68 | 42 | 1 | | |
Educational status | | |
Unable to read & write | 58 | 38 | 0.300 | 0.723 (0.391, 1.336) | 0.400 (0.162, 0.986 )** |
Primary 1–8 | 57 | 27 | 0.809 | 0.916(0.449, 1.869) | 0.692 (0.2551.877) |
Secondary 9–12 | 30 | 18 | 0.566 | 1.526 (0.360, 6.474) | 3.189 (0.61516.543) |
Techniques | 4 | 4 | 0.714 | 0.763 (0.180, 3.237) | 0.335 (0.0532.106) |
Diploma | 6 | 3 | 0.090 | 0.522 (0.246, 1.106) | 0.348 (0.1151.055) |
First degree and above | 38 | 13 | 1 | | 1 |
Marital status | |
Married | 66 | 29 | 1 | | |
Single | 94 | 56 | 0.999 | 0.000 (0.000, -- ) | |
Divorced | 15 | 7 | 0.999 | 0.000 (0.000, --- ) | |
Widowed | 18 | 8 | 0.999 | 0.000 (0.000, --- ) | |
Other | 0 | 3 | 0.999 | 0.000 (0.000, ---- ) | |
Employment | | |
No | 25 | 16 | 0.655 | 0.833 (0.375, 1.854 ) | 1.273 (0.4723.432) |
Student | 45 | 24 | 0.492 | 0.710 (0.268, 1.885) | 1.695 (0.5035.715) |
Farmer | 22 | 10 | 0.705 | 1.172 (0.516, 2.663 ) | 1.628 (0.5844.540) |
House wife | 32 | 24 | 0.744 | 1.215 (0.377, 3.916) | 1.470 (0.3615.986) |
Governmental | 9 | 7 | 0.104* | 0.421 (0.148, 1.195) | 2.405 (0.1071.532) |
Private | 26 | 7 | 0.903 | 0.937 (0.332, 2.646) | 1.971 (0.5277.372) |
Others/day labor | 15 | 9 | 0.213* | 0.493 (0.162, 1.500) | 0.592 (0.1542.279) |
Merchant | 19 | 6 | 1 | | |
Monthly income | | |
No | 95 | 44 | 0.836 | 1.103 (0.435, 2.797) | 0.708 (0.2062.432) |
< 300 | 15 | 8 | 0.183* | 1.880 (0.743, 4.760) | 2.655 (0.8028.787) |
301–600 | 11 | 10 | 0.213* | 1.750 (0.726, 4.219) | 1.395 (0.4364.461) |
601–1000 | 13 | 11 | 0.958 | 0.985 (0.560, 1.732) | 1.265 (0.5612.853) |
> 1001 | 63 | 30 | 1 | | |
Social support | | |
Low | 44 | 28 | 0.587 | 0.853 (0.481, 1.513) | 1.143 (0.5402.420) |
Moderate | 105 | 57 | 0.232* | 0.643 (0.311, 1.327) | .819 (0.3162.123) |
High | 44 | 18 | 1 | | |
Age of onset | | |
< 6 years | 20 | 12 | 1 | | 1 |
6–11 years | 44 | 32 | 0.657 | 1.212 (0.519, 2.831) | 1.128 (0.3263.899) |
12–17 years | 50 | 18 | 0.264* | 0.600 (0.245, 1.470) | 1.602 (0.5964.306) |
18 & above years | 79 | 41 | 0.725 | 0.865 (0.385, 1.942) | 0.854 (0.3242.248) |
Total duration | | |
≤ 1 year | 8 | 3 | 1 | | |
2–5 years | 43 | 21 | 0.581 | 0.680 (0.172, 2.683) | |
6–10 years | 55 | 31 | 0.704 | 0.885 (0.4721.661) | |
11 years or above | 87 | 48 | 0.941 | 1.022 (0.5811.795) | |
Seizures frequency | | |
≤ 2 per month | 112 | 51 | 0.568 | 0.683 (0.1852.526) | |
3–5 per month | 54 | 28 | 0.714 | 0.778 (0.2032.985) | |
6–10 per 6 months | 21 | 20 | 0.619 | 1.429 (0.3505.825) | |
11 or above per year | 6 | 4 | 1 | | |
No of AEDs | | |
Monotherapy | 142 | 74 | 1 | | |
Polytherapy | 51 | 29 | 0.750 | 0.916 (0.536, 1.566) | |
Treatment duration | | |
0–11 month | 18 | 13 | 0.132* | 1 | 1 |
less than 2 years | 29 | 11 | | 1.926 (0.8204.523) | 2.850 (0.9278.761) |
2–5 years | 54 | 31 | 0.979 | 1.011 (0.4382.338) | 1.975 (0.6535.972) |
6–10 years | 28 | 24 | 0.195* | 1.531 (0.8042.916) | 1.820 (0.7644.337) |
11 or more years | 64 | 24 | 0.024* | 2.286 (1.1134.692) | 3.715 (1.498, 9.212)** |
Adherence with medication | | |
No | 20 | 33 | 0.000* | 0.245 (0.1320.456) | 0.216 (0.101, 0.460)** |
Yes | 173 | 70 | 1 | | 1 |
Side effect | | |
No | 137 | 70 | 1 | | |
Yes | 56 | 33 | 0.589 | 0.867 (0.5171.455) | |
Substance use in life time | | |
No | 143 | 77 | 1 | | |
Yes | 50 | 26 | 0.901 | 1.036 (0.5981.793) | |
Substance use within 3 months | | |
No | 175 | 92 | 1 | | |
Yes | 18 | 11 | 0.709 | 0.860 (0.3901.898) | |
Seizure related trauma | | |
No | 108 | 54 | 1 | | |
Yes | 85 | 49 | 0.561 | 0.867 (0.5371.402) | |
Chronic medical illness | | |
No | 166 | 84 | 1 | | |
Yes | 27 | 19 | 0.315 | 0.719 (0.3781.368) | |
Feeling Perceived stigma | | |
No | 146 | 47 | 1 | | |
Yes | 47 | 56 | 0.000* | 0.270 (0.1630.449) | 0.244 (0.129, 0.462)** |
Anxiety | | |
No | 133 | 67 | 1 | | |
Yes | 60 | 26 | 0.499 | 0.840 (0.5061.394) | |
Stress | | |
No | 157 | 70 | 1 | | |
Yes | 36 | 33 | 0.010* | 0.486 (0.281,0.843) | 0.452 (0.220, 0.928)** |
Physical abused | | |
No | 186 | 98 | 1 | | |
Yes | 7 | 5 | 0.611 | 0.738 (0.2282.385) | |
Sexual abuse | | |
No | 192 | 101 | 1 | | |
Yes | 1 | 2 | 0.278* | 0.263 (0.0242.936) | |
Suicidal attempt | | |
No | 185 | 100 | 1 | | |
Yes | 8 | 3 | 0.595 | 1.441 (0.3745.555) | |
Suicidal wish | | |
No | 155 | 83 | 1 | | |
Yes | 38 | 20 | 0.955 | 1.017 (0.5561.860) | |
Contagious belief | | |
No | 169 | 86 | 1 | | |
Yes | 24 | 17 | 0.336 | 0.718 (0.3661.409) | |
Heritability belief | | |
No | 161 | 74 | 1 | | |
Yes | 32 | 29 | 0.020* | 0.507 (0.2860.899) | |
Belief of mental illness | | |
No | 81 | 34 | 1 | | |
Yes | 112 | 69 | 0.133* | 0.681 (0.4131.124) | |
Treatable belief | | |
No | 23 | 10 | 0.566 | 1.258 (0.5742.757) | |
Yes | 170 | 93 | 1 | | |
Note * :- Significantly associated at p < 0.30 & ** :- Stastically significant at p < 0.05 |
P-value of Hosmer and Lemeshow goodness of fit test was = 0.593 |