The role of depression and quality of life in psychological flexibility among patients with epilepsy

Abstract

Aims: To assess symptoms of depression and quality of life (QoL) as predictors of psychological flexibility in patients with epilepsy. Specifically, the study aims to explore how depressive symptoms and different dimensions of QoL can affect the ability of epilepsy patients to adapt to challenges and engage in flexible thinking and behavior. Method: Patients were recruited during their regular appointments at the Department for Epilepsy and Clinical Neurophysiology of the Institute of Mental Health in Belgrade (N = 104, M age = 39.84, SD = 13.60, 66.3% were female, 33.7% were male). The study utilized several self-assessment instruments, including the Psychological Flexibility in Epilepsy Questionnaire (PFEQ), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Sociodemographic and clinical data were collected via interviews and patient records. Results: To test the predictions, a hierarchical multiple regression was conducted, with two blocks of predictors and one criterion being psychological flexibility. The first block included subscale scores from QOLIE-31. In block two, symptoms of depression in patients with epilepsy were included as predictors. The model including both sets of predictors (QOLIE31 subscales and NDDI-E depression scale) was statistically significant, F(8, 95) = 138.93, p < .001, accounting for 41.8% of the variance in psychological flexibility scores (R² = .418). Among the QOLIE-31 subscales, only Seizure Worry (β = -0.24, p < .05) and Social Functioning (β = -0.38, p < .01) were significant negative predictors of psychological flexibility. Depression symptoms showed a positive relationship with psychological (in)flexibility (β = 0.21, p < .05). However, the inclusion of depression symptoms contributed a small additional variance of 2.8% to the model (ΔR² = 0.028), indicating a modest incremental effect on the prediction of psychological flexibility. Discussion: Concerns about seizures and diminished functioning in the social sphere have been identified as significant factors contributing to a decrease in psychological flexibility. Furthermore, patients with more severe depressive symptoms experience greater difficulty in fully engaging with the present moment and exhibit a more rigid dominance of certain psychological processes. Therefore, a psychological approach that promotes acceptance, mindfulness, and value-based actions may play a significant role in adopting a new perspective on seizures, improving social life, and alleviating depressive symptoms, such as Acceptance and Commitment Therapy (ACT), thereby enhancing psychological flexibility. Conclusions: Quality of life and depression play a significant role in predicting psychological flexibility in patients with epilepsy