Depression and anxiety in children with epilepsy: A case-control study

Document Type : Research Paper


1 Associate professor of child and adolescent psychiatry, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Resident of psychiatry, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Resident of community medicine department, Tehran University of Medical Sciences, Tehran, Iran

4 General practitioner, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction:  Epilepsy is a chronic disease which affects child's behavior and function. Children with epilepsy in comparison to healthy children are more at risk for behavorial and cognitive disorders. In this study we examined the depression and anxiety in children with epilepsy compared to healthy control group.
Materials and Methods: This case-control study was conducted on patients who referred to child and adolescent psychiatric clinics of Dr. Sheykh and Ibn-e-Sina Hospitals in Mashhad (Iran) during 2015-2016. In this study 30 epileptic children aged 8-12 years and 30 healthy children with the same age and gender were selected. Depression–anxiety symptoms were measured by Children Depression Inventory (CDI), Children's Behavioral Issues List (CBCL) tests and demographic data. The major stressors and information about characteristics of epilepsy were achieved by questionnaire. Data were analyzed through descriptive statistics, chi-square, Fisher's exact tests, independent t-test and U Mann-Whitney tests by using SPSS version 16.0.
Results: According to the findings, level of depression and anxiety symptoms in epileptic children were higher than healthy children (P=0.01). There was no significant relation between mother's age, number of used medications and duration of taking medication and depression and anxiety in epileptic children.
Conclusion: Based on the results, epileptic children have the higher Frequency of depression and anxiety than the healthy children. However the frequency of depression and anxiety in epileptic children was independent to number of medications, duration of taking medications and mother's age.


Main Subjects

  1. Curatolo P, Moavero R, de Vries PJ. Neurological and neuropsychiatric aspects of tuberous sclerosis complex. Lancet Neurology 2015; 14(7): 733-45.
  2. Kwong KL, Lam D, Tsui S, Ngan M, Tsang B, Lai TS, et al. Anxiety and depression in adolescents with epilepsy. J Child Neurol 2016; 31(2): 203-10.
  3. Kwon O-Y, Park S-P. Depression and anxiety in people with epilepsy. J Clin Neurol 2014; 10(3): 175-88.
  4. Scott AJ, Sharpe L, Hunt C, Gandy M. Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia 2017; 58(6): 973-82.
  5. Altalib HH, Berg AT, Cong X, Vickrey BG, Sperling MR, Shinnar S, et al. Presurgical depression and anxiety are not associated with worse epilepsy surgery outcome five years postoperatively. Epilepsy Behav 2018; 83: 7-12.
  6. Fisher PL, Noble AJ. Anxiety and depression in people with epilepsy: The contribution of metacognitive beliefs. Seizure 2017; 50: 153-9.
  7. Mazur JE. Learning and behavior. USA: Routledge; 2016.
  8. Carson J, Weir A, Chin RF, McLellan A. Socioeconomic deprivation is an independent risk factor for behavioral problems in children with epilepsy. Epilepsy Behav 2015; 45: 105-9.
  9. Dunn DW, Austin J. Behavioral issues in pediatric epilepsy. Neurology1999; 53(5 Suppl 2): S96-100.
  10. Hutchison AK, Kelsay K, Talmi A, Noonan K, Ross RG. Thought disorder in preschool children with Attention Deficit/Hyperactivity Disorder (ADHD). Child Psychiatry Hum Dev 2016; 47(4): 618-26.
  11. Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388(10053): 1659-724.
  12. Reilly C, Atkinson P, Das KB, Chin RF, Aylett SE, Burch V, et al. Neurobehavioral comorbidities in children with active epilepsy: a population-based study. Pediatrics 2014: peds. 2013-3787.
  13. van Iterson L, Zijlstra BJ, Augustijn PB, van der Leij A, de Jong PF. Duration of epilepsy and cognitive development in children: A longitudinal study. Neuropsychology 2014; 28(2): 212.
  14. Mitchell WG, Scheier LM, Baker SA. Psychosocial, behavioral, and medical outcomes in children with epilepsy: a developmental risk factor model using longitudinal data. Pediatrics 1994; 94(4): 471-7.
  15. Austin JK, Dunn DW, Caffrey HM, Perkins SM, Harezlak J, Rose DF. Recurrent seizures and behavior problems in children with first recognized seizures: a prospective study. Epilepsia 2002; 43(12): 1564-73.
  16. Austin J, Perkins S, Johnson C, Fastenau P, Byars A, Dunn D. Behavior problems in children at time of first recognized seizure and changes over the following 3 years. Epilepsy Behav 2011; 21(4): 373-81.
  17. Clancy MJ, Clarke MC, Connor DJ, Cannon M, Cotter DR. The prevalence of psychosis in epilepsy; a systematic review and meta-analysis. BMC Psychiatry 2014; 14(1): 75.
  18. Bahrenian A, Karamad A. [Generalized anxiety disorder prevalence rate in patients with epilepsy referred to neurology clinic of Emam Hossein Hospital affiliated Iranian epilepsy society]. Research in medicine 2005; 29(3): 230-8. (Persian)
  19. Zahiroddin A, Ghoreishi F. [A survey of depressive symptoms in patients]. Research in medicine 2006; 30 (4): 305-8. (Persian)
  20. Plioplys S. Depression in children and adolescents with epilepsy. Epilepsy Behav 2003; 4: 39-45.
  21. Saylor CF, Finch A, Spirito A, Bennett B. The children's depression inventory: A systematic evaluation of psychometric properties. J Consult Clin Psychol 1984; 52(6): 955.
  22. Smucker MR, Craighead WE, Craighead LW, Green BJ. Normative and reliability data for the Children's Depression Inventory. J Abnorm Child Psychol 1986; 14(1): 25-39.
  23. Dehshiri G, Najafi M, Shikhi M, Habibi Askarabd M. Investigating primary psychometric properties of children’s depression inventory (CDI). J Fam Res 2009; 5(2): 159-77.
  24. Habibi M, Kholghi H, Parija HA, Parandvar Z, Etesami MS. [The psychometric properties of hopelessness scale among children]. Journal of research and health 2017; 7(3): 788-95. (Persian)
  25. Tehrani-Doost M, Shahrivar Z, Pakbaz B, Rezaie A, Ahmadi F. [Normative data and psychometric properties of the child behavior checklist and teacher rating form in an Iranian community sample]. Iranian journal of pediatrics 2011; 21(3): 331. (Persian)
  26. Achenbach T. Integrative guide for the 1991 Child Behavior Checklist/4-18. Burlington, VT: University of Vermont, Department of Psychiatry; 1991.
  27. Shahrivar Z, Shirazi E, Bagheri Yazdi A, Alghband-rad J. Validity of the Child Behavior Checklist-Persian version in a community sample of Iranian youths. Iranian journal of psychiatry and behavioral sciences 2011; 5(1): 45-9.
  28. Williams J. Learning and behavior in children with epilepsy. Epilepsy Behav 2003; 4(2): 107-11.
  29. Ettinger AB, Weisbrot DM, Nolan EE, Gadow KD, Vitale SA, Andriola MR, et al. Symptoms of depression and anxiety in pediatric epilepsy patients. Epilepsia 1998; 39(6): 595-9.
  30. Mustapha A, Odu O, Akande O. Knowledge, attitudes and perceptions of epilepsy among secondary school teachers in Osogbo South-West Nigeria: a community based study. Nigerian J Clin Pract 2013; 16(1): 8-12.
  31. Williams J, Steel C, Sharp GB, DelosReyes E, Phillips T, Bates S, et al. Anxiety in children with epilepsy. Epilepsy Behav 2003; 4(6): 729-32.
  32. Alwash RH, Hussein MJ, Matloub FF. Symptoms of anxiety and depression among adolescents with seizures in Irbid, Northern Jordan. Seizure-Eur J Epilepsy 2000; 9(6): 412-6.
  33. Berl MM, Terwilliger V, Scheller A, Sepeta L, Walkowiak J, Gaillard WD. Speed and complexity characterize attention problems in children with localization-related epilepsy. Epilepsia 2015; 56(6): 833-40.
  34. Ettinger AB, Kanner AM. Psychiatric issues in epilepsy: a practical guide to diagnosis and treatment. Philaelphia: Lippincott Williams and Wilkins; 2007.