Resilience as a mediating mechanism between psychological distress and quality of life in epilepsy

INTRODUCTION: Psychological distress is a major determinant of impaired health-related quality of life (HRQoL) in people with epilepsy. Although resilience has been associated with better psychosocial adjustment and well-being, its contribution to this relationship remains unclear. We investigated whether resilience mediates the association between psychological distress and HRQoL while adjusting for seizure frequency. METHODS: In this cross-sectional study, 89 adults with focal and generalized epilepsy completed measures of HRQoL (QOLIE-31), psychological symptoms (DASS-42), and resilience (CD-RISC-10). Regression analyses and bootstrapped mediation models (PROCESS Model 4) were conducted to examine the mediating role of resilience. RESULTS: Resilience was significantly associated with psychological symptoms and HRQoL, but not with demographic or most clinical variables. Mediation analyses demonstrated that stress was associated with poorer HRQoL both directly and indirectly through lower resilience, indicating partial mediation (effect = -0.36, 95% CI [-0.66, -0.02]). Seizure frequency (β = -0.37, p < 0.001) independently predicted poorer HRQoL but was not significantly associated with resilience, suggesting that psychological and clinical factors contribute through distinct pathways to patient well-being. CONCLUSION: These findings identify resilience as a potential mechanism linking stress to HRQoL in epilepsy and support a multidimensional understanding of overall well-being that encompasses both psychological and clinical determinants. Interventions targeting stress reduction and resilience enhancement may contribute to improved patient-reported outcomes.