Clinical characteristics and factors associated with psychiatric comorbidity among people with epilepsy in Ganzi Tibetan autonomous prefecture of China: a cross-sectional study

BACKGROUND: This study was conducted to determine the prevalence of epilepsy in Daofu County, Sichuan Province, China, and to identify factors associated with comorbid depression, anxiety, and impaired quality of life among people with epilepsy (PWE). METHODS: In this community-based, cross-sectional study, a door-to-door survey of epilepsy was performed among 37,390 permanent residents of Daofu County. The survey identified 164 confirmed cases of epilepsy. Of them, 127 participants (aged ≥ 16 years) who were able to complete self-reported questionnaires were enrolled for final analysis. Depression and anxiety symptoms were assessed using the Chinese versions of the Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E) and the Generalized Anxiety Disorder-7 (GAD-7) scale, respectively. Health-related quality of life was evaluated with the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Factors associated with depression and anxiety were examined using logistic regression analyses, while factors influencing QOLIE-31 scores were assessed by linear regression. RESULTS: The estimated prevalence of epilepsy in Daofu County was 4.4‰ (95% CI: 3.7-5.1‰). Independent factors associated with the comorbid depression included a low monthly household income per capita (aOR = 4.41, 95% CI: 1.82-10.71; P = 0.001) and active epilepsy (aOR = 4.87, 95% CI: 1.74-13.62; P = 0.003). Independent factors associated with the comorbid anxiety included a low monthly household income per capita (aOR = 5.03, 95% CI: 1.88-13.5; P = 0.001) and active epilepsy (aOR = 4.84, 95% CI: 1.95-12.01; P = 0.001). Furthermore, factors including a low monthly household income per capita, a history of status epilepticus, and active epilepsy were significantly associated with a lower QOLIE-31 score. CONCLUSIONS: There is a high burden of depression and anxiety among PWE in the Tibetan areas of China. Active epilepsy is the most potent, independent risk factor of psychiatric comorbidities and poorer quality of life. These findings suggest the urgent need for integrated epilepsy management and mental health services in this resource-limited region.