A systematic review of the predictors of depression among people with epilepsy: Placing correlates in an ecological perspective

Depression is a common among people with chronic conditions, particularly among people with epilepsy (PWE). Depression negatively affects functioning, quality of life, and the ability to perform self-management behaviors necessary for controlling epilepsy. Researchers have examined various combinations of predictors of depression among PWE, including individual, seizure-related, and psychosocial factors. Ecological models, which delineate the personal and environmental factors that may influence health, can be useful in classifying and describing the predictors of depression in PWE. A systematic review was conducted, utilizing an ecological framework, to further examine the extent to which different factors have been investigated, the impact of these factors on depression in PWE, and the quality of the research. Preliminary analysis indicates that individual factors include employment status and income, seizure-related variables include seizure frequency, and psychosocial factors include social support and stigma. In general, psychosocial factors were examined less frequently and mixed results emerged for some variables. While the burgeoning literature on epilepsy and depression has begun to elucidate the relationships between the two conditions, differences in the combinations and measurement of variables examined and the prevalence of cross-sectional studies hinders the formation of a comprehensive model. This review, however, highlights the multiple levels of factors associated with depression in PWE and offers suggestions for future research and interventions.