Quality of life and depressive symptoms in older adults: findings from an integrated epilepsy self-management data set

Background In the U.S., about one million people with active epilepsy are adults aged 55+. Older adults with epilepsy (OAWE) experience complex health conditions that compromise quality of life (QOL). The contribution of depressive symptom dimensions to health-related QOL remains underexplored in OAWE. Methods We analyzed baseline data from 13 epilepsy self-management studies in the CDC-sponsored MEW-DB (Managing Epilepsy Well Database), including adults ages 55 and older (N = 198). The primary outcome was health-related QOL, assessed via the 10-item Quality of Life in Epilepsy scale (QOLIE-10), which was inverse rank normalized (mean = 0, SD = 1). Primary predictors included the Patient Health Questionnaire (PHQ-9) total score, cognitive and somatic symptom sub scores, and suicide ideation. Multivariable mixed-effects linear regression was used to assess associations. Models included a random intercept for originating study. Results Participants were x̄ = 60.8 years (range: 55–79); 60.6% female and 68.7% White. On average, participants had mild depressive symptoms (mean PHQ-9 = 8.3). Depressive symptom severity was significantly associated with worse QOL. Cognitive (β = 0.17 SD, 95% CI: 0.12–0.21, p = 5.6 × 10 −13 ), somatic (β = 0.19 SD, 95% CI: 0.14–0.23, p = 3.3 × 10 −17 ), and total depressive (PHQ-9 total) symptoms (β = 0.10 SD, 95% CI: 0.08–0.12, p = 3.8 × 10 −21 ) were associated with worse QOLIE-10 total scores when adjusting for likely confounders. Suicide ideation was not associated with QOLIE-10 (β = 0.07 SD, 95% CI: −0.15 to 0.29, p = 0.51). Past 30-day seizure occurrence was associated with worse total QOLIE-10 only when depressive terms were excluded from the multivariable model (β = 0.38 SD, 95% CI: 0.05–0.72, p = 0.024). Conclusions Among OAWE, depressive symptoms are strongly linked to reduced QOL. These findings underscore the importance of integrated mental health screening and intervention for OAWE.