Mark A. Ferro

Depressive symptoms among mothers of children with epilepsy: A review of prevalence, associated factors, and impact on children

The impact of epilepsy is not limited to the child experiencing seizures, but affects all members of the family. As primary caregivers, mothers are particularly at risk for experiencing increased depressive symptoms and risk for clinical depression. The objective of this systematic review was to critically assess available evidence regarding the prevalence, associated factors, and impact of maternal depressive symptoms on child outcomes in epilepsy. Using a modified version of the Quality Index, studies were rigorously evaluated in terms of reporting, external validity, and internal validity. Limitations in the study designs and analytic techniques of previous research are discussed, and study methods to overcome these barriers are presented in order to advance this research area. Up to 50% of mothers of children with epilepsy are at risk for clinical depression. Correlates of maternal depressive symptoms include a number of modifiable risk factors such as role ambiguity, worry, and satisfaction with relationships. In addition, studies suggest that depressive symptoms in mothers have a negative impact on child outcomes in epilepsy including behavior problems and health‐related quality of life. The overall mean score on the Quality Index was 9.7, indicating a midrange quality score, suggesting a need for more methodologically robust studies.

Quality of life in children with new-onset epilepsy: a 2-year prospective cohort study.

Objectives: To assess health-related quality of life (HRQL) over 2 years in children 4−12 years old with new-onset epilepsy and risk factors. Methods: Data are from a multicenter prospective cohort study, the Health-Related Quality of Life Study in Children with Epilepsy Study (HERQULES). Parents reported on childrens HRQL and family factors and neurologists on clinical characteristics 4 times. Mean subscale and summary scores were computed for HRQL. Individual growth curve models identified trajectories of change in HRQL scores. Multiple regression identified baseline risk factors for HRQL 2 years later. Results: A total of 374 (82) questionnaires were returned postdiagnosis and 283 (62%) of eligible parents completed all 4. Growth rates for HRQL summary scores were most rapid during the first 6 months and then stabilized. About one-half experienced clinically meaningful improvements in HRQL, one-third maintained their same level, and one-fifth declined. Compared with the general population, at 2 years our sample scored significantly lower on one-third of CHQ subscales and the psychosocial summary. After controlling for baseline HRQL, cognitive problems, poor family functioning, and high family demands were risk factors for poor HRQL 2 years later. Conclusions: On average, HRQL was relatively good but with highly variable individual trajectories. At least one-half did not experience clinically meaningful improvements or declined over 2 years. Cognitive problems were the strongest risk factor for compromised HRQL 2 years after diagnosis and may be largely responsible for declines in the HRQL of children newly diagnosed with epilepsy.

The impact of maternal depressive symptoms on health-related quality of life in children with epilepsy: a prospective study of family environment as mediators and moderators.

Purpose:  To examine the impact of maternal depressive symptoms (DS) on health‐related quality of life (HRQL) in children with new‐onset epilepsy and to identify family factors that moderate and mediate this relationship during the first 24 months after epilepsy diagnosis.

Trajectories of health‐related quality of life in children with epilepsy: A cohort study

Little is known about subgroups of children with epilepsy who may experience less favorable outcomes over time. The objectives of this study were to document trajectories of health‐related quality of life (HRQL) and to identify predictors of the trajectory group in children with new‐onset epilepsy.

Prevalence and trajectories of depressive symptoms in mothers of children with newly diagnosed epilepsy.

Purpose:  To examine the prevalence, trajectories, and predictors of depressive symptoms (DS) in mothers of children with new‐onset epilepsy.

Emotional and behavioral problems in adolescents and young adults with food allergy

Adolescents with food allergy have poorer psychosocial outcomes compared with their nonallergic counterparts; however, few studies have prospectively examined the mental health of adolescents and young adults in this vulnerable population. Our objectives were to estimate the prevalence of emotional and behavioral problems in an epidemiological sample of adolescents and young adults with food allergy; determine whether food allergy is associated with adolescent and maternal reports of such problems; and examine the patterns of change in emotional and behavioral problems from adolescence to young adulthood among individuals with and without food allergy.

Longitudinal Invariance of Measurement and Structure of Global Self-Concept: A Population-Based Study Examining Trajectories Among Adolescents With and Without Chronic Illness

OBJECTIVE The objectives of this study were to determine whether a measure of global self-concept demonstrated longitudinal measurement invariance between adolescents aged 10-19 years with and without chronic illness and to document differences in their global self-concept trajectories over time. METHODS Data were obtained from the National Longitudinal Survey of Children and Youth (N = 10,064). Global self-concept was measured using a scale based on the Self-Determination Questionnaire. RESULTS 16 percent of adolescents had chronic illness. There was evidence of partial longitudinal invariance in global self-concept between adolescents with and without chronic illness. Controlling for sociodemographic characteristics, adolescents with a chronic illness exhibited lower levels of global self-concept and more precipitous declines over time. CONCLUSIONS The results from this study suggest that comparisons of global self-concept between adolescents with and without chronic illness are meaningful and, compared to healthy controls, adolescents with chronic illness are at risk for low global self-concept.

Medial prefrontal cortical synapsin II knock-down induces behavioral abnormalities in the rat: Examining synapsin II in the pathophysiology of schizophrenia

Synapsin II is a synaptic vesicle-associated phosphoprotein that has been implicated in the pathophysiology of schizophrenia. Studies have demonstrated reductions in synapsin II mRNA and protein in medial prefrontal cortical post-mortem samples from patients with schizophrenia, genetic associations between synapsin II and schizophrenia, and synapsin II protein regulation by dopamine receptor activation. Collectively, this research indicates a relationship between synapsin II dysregulation and schizophrenia; however, it remains unknown whether perturbations in synapsin II play a role in the pathophysiology of this disease. The aim of this project was to evaluate animals with selective knock-down of synapsin II in the medial prefrontal cortex. After continuous infusion of synapsin II antisense sequences, animals were examined for the presence of schizophrenic-like behavioral phenotypes and assessed on the response to clinically relevant antipsychotic drugs. Our results indicate that rats with selective reductions in medial prefrontal cortical synapsin II demonstrate deficits in sensorimotor gating (prepulse inhibition), reduced social behavior, and hyperlocomotion, which are corrected by the atypical antipsychotic drug olanzapine. Additionally, synapsin II knock-down disrupts serial search efficiency. These behavioral changes are accompanied by reductions in vesicular neurotransmitter transporter protein concentrations for glutamate (VGLUT1 and VGLUT2) and GABA (VGAT), without affecting dopamine (VMAT2). These results implicate a causal role for decreased synapsin II in the medial prefrontal cortex in the pathophysiology of schizophrenia and the mechanisms of aberrant prefrontal cortical circuitry, and suggest that synapsin II may potentially serve as a novel therapeutic target for this disorder.

Risk factors for health-related quality of life in children with epilepsy: A meta-analysis

The aims of this study were to conduct a meta‐analysis of risk factors for health‐related quality of life (HRQL) in children with epilepsy; interpret the results in terms of study quality; and, assess the nature and source of heterogeneity of estimates.

Trajectories of depressive symptoms during the transition to young adulthood: The role of chronic illness

BACKGROUND Little is known about the natural course of depressive symptoms among youth with chronic illness during their transition from adolescence to young adulthood. METHODS A representative epidemiological sample of 2825 youth aged 10-11 years from the National Longitudinal Survey of Children and Youth were followed until 24-25 years of age. Presence of chronic illness was measured using self-report and symptoms of depression were assessed using the Center for Epidemiological Studies Depression Scale. Multilevel modeling was used to investigate trajectories of depressive symptoms, adjusting for family environment and sociodemographic characteristics during the transition to young adulthood. RESULTS Trajectories showed cubic change over time - increasing from early to mid-adolescence, decreasing to early young adulthood, increasing again to late young adulthood. Youth with chronic illness (n=753) had significantly less favorable trajectories and significantly higher proportions of clinically relevant depressive symptoms over time compared to their peers without chronic illness (n=2072). LIMITATIONS This study is limited by selective attrition, self-reported chronic illness and no assessment of illness severity, and mediating effects of family environment factors could not be examined. CONCLUSIONS Findings support the diathesis-stress model; chronic illness negatively influenced depressive symptoms trajectories, such that youth with chronic illness had higher depression scores and less favorable trajectories over time. The health and school system are uniquely positioned to support youth with chronic illness navigate this developmental period in an effort to prevent declines in mental health.