217855 Associates of Stigma in an Incident Epilepsy Population from Northern Manhattan, New York City

Monday, November 8, 2010

Emily Leaffer, BA , Department of Epidemiology, Columbia University, New York, NY
Ann Jacoby, PhD , Neurosciences, University of Liverpool, Liverpool, United Kingdom
Emma Benn, MPH , Department of Biostatistics, Columbia University, New York, NY
W. Allen Hauser, MD , Professor of Neurology and Epidemiology, Columbia University, New York, NY
Tina Shih, MD , Neurology, University of California San Francisco, San Francisco, CA
Peter Dayan, Msc, MD , Department of Pediatrics, Columbia University, New York, NY
Robert Green, MD , Department of Emergency Medicine, Columbia University, New York, NY
Howard Andrews, PhD , Mailman School of Public Health, Columbia University, New York, NY
Dale Hesdorffer, PhD , GH Sergievsky Center, Columbia University, New York, NY
Background: We identified the incidence of epilepsy and first unprovoked seizure in the racially and ethnically diverse population of Northern Manhattan, an impoverished community. We analyzed the relationship between health status, lifetime depression and current feelings of stigma.

Methods: 209 children and adults were identified over a 1 year period and data abstracted from medical records. By design, a subset (n=135) of subjects was interviewed at baseline about various factors including lifetime history of depression, health status, medical history, and stigma, including feelings of inferiority, being avoided, and discomfort with others.

Results: 13.0% of patients reporting at least good current health experienced stigma versus 31.4% of those endorsing fair or poor health (p=0.02). 10.1% versus 17.7% felt uncomfortable (ns), 5.7% versus 25.5% felt inferior (p=0.002), and 8.6% versus 23.5% felt avoided (p=0.02). 52.9% of patients with depression experienced stigma versus 12.8% without depression (p=0.0001). Depressed patients were more likely than non-depressed to feel uncomfortable (35.3% vs. 7.0%, p=0.0009), inferior (44.4% vs. 8.1%, p<0.0001), and avoided (44.4% vs. 7.0%, p<0.0001). Burden of other comorbid medical conditions was unassociated with stigma.

Conclusions: Previous work by Jacoby (1,2) has revealed negative effects of prevalent epilepsy on stigma, social identity, and quality of life. In the low-income, predominantly Hispanic community of Northern Manhattan, we found that incident epilepsy may be associated with feelings of stigma when lifetime history of depression is present or current health status is fair or worse. Interventions are needed to prevent stigma in epilepsy, particularly among people with depression.

Learning Areas:
Social and behavioral sciences

Learning Objectives:
Evaluate the association between health status, lifetime history of depression and stigma at baseline in a cohort with incident epilepsy.

Keywords: Underserved Populations, Quality of Life

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I asked the question, analyzed the data and drafted the abstract. Please note that I am a first time student submitter.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.