Abstracts

Health-related quality of life (HRQOL) after temporal lobectomy is dependent on a complex interaction of variables (demographics, clinical epilepsy characteristics, degree of seizure-freedom, psychological variables). It is now recognized that HRQOL is influenced by factors previously thought to be of little consequence (e.g., depression and anxiety). Depression is commonly seen in 30-50% of temporal lobe cases, and recent studies report clear links between quality of life and these mood states. Personality could also potentially influence HRQOL. Neuroticism, a personality dimension characterized by chronic negative emotions and behaviors) has been related to poorer QOL. This study investigated the separate and combined contributions of depression and neuroticism to HRQOL. Subjects were 57 patients (26 males) with carefully documented temporal lobe epilepsy as reported in Wiebe et al. (2001), who randomized patients to the surgical or medical arm of an RCT. In the present study, measures were collected at baseline, during inpatient epilepsy unit monitoring, and six months later. Wiebe et al. report characteristics of the sample and procedural details. Dependent measures in the present study include the QOLIE-89, and a measure of depression (CES-D). Neuroticism was evaluated with the negative affect scale of the PANAS. Analyses included product-moment correlations among variables at each assessment time. Multiple regression analyses were performed, with depression and neuroticism as individual and combined predictors of follow-up QOLIE-89. The CES-D and PANAS were significantly correlated (r=.77, p=.0001). Although sharing a large degree of variance (approximately 50%), they appeared sufficiently independent. Depression was significantly correlated with overall QOLIE-89 at baseline ([underline]r[/underline]=-.45, [underline]p[/underline][lt].01), suggesting greater pre-operative depression is associated with poorer QOL. The correlation between depression and overall QOL at follow-up remained significant, but the association was not as strong ([underline]r[/underline]=-.38, [underline]p[/underline]=.05). Comparisons of Neuroticism with the QOLIE-89 overall scores were also significant, both at baseline ([underline]r[/underline]=-.41, [underline]p[/underline]=.001) and to a lesser extent at the 6-month follow-up ([underline]r[/underline]=-.18, [underline]p[/underline]=.05). Step-wise linear regression analyses suggested depression and neuroticism contribute significant but unique variance to 6-month HRQOL outcomes. This study sought to advance our understanding of the complex interaction of factors comprising HRQOL ratings. It is clear depression and neuroticism are related, but retain sufficient independence to be considered different. In addition to seizure frequency, there are important factors beyond depression that affect quality of life for these patients. Neuroticism has an important influence on quality of life and on depression.