Association of antiseizure medication adherence with illness perceptions in adults with epilepsy

Hyunmi Choi; John B Wetmore; Itzel A Camarillo; Sylwia Misiewicz; Karolynn Siegel; Wendy K Chung; Cheng-Shiun Leu; Jo C Phelan; Lawrence H Yang; Ruth Ottman

doi:10.1016/j.yebeh.2023.109289

Association of antiseizure medication adherence with illness perceptions in adults with epilepsy

Epilepsy Behav. 2023 Aug:145:109289. doi: 10.1016/j.yebeh.2023.109289. Epub 2023 Jun 12.

Authors

Affiliations

¹ Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. Electronic address: hc323@cumc.columbia.edu.
² Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. Electronic address: jbw2167@cumc.columbia.edu.
³ Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA. Electronic address: iac2112@cumc.columbia.edu.
⁴ Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA. Electronic address: sn2315@cumc.columbia.edu.
⁵ Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA. Electronic address: ks420@cumc.columbia.edu.
⁶ Departments of Pediatrics and Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. Electronic address: wkc15@cumc.columbia.edu.
⁷ Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA. Electronic address: cl94@cumc.columbia.edu.
⁸ Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA. Electronic address: jcp13@cumc.columbia.edu.
⁹ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; School of Global Public Health, New York University, New York, NY, USA. Electronic address: ly1067@nyu.edu.
¹⁰ Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; Division of Translational Epidemiology and Mental Health Equity, New York State Psychiatric Institute, New York, NY, USA. Electronic address: ro6@columbia.edu.

Abstract

Objective: We assessed the relationship of epilepsy illness perceptions to antiseizure medication (ASM) adherence.

Methods: Surveys were completed by 644 adult patients with epilepsy of unknown cause. We used the Morisky Medication Adherence Scale-8 (MMAS-8) to define "high" adherence (score = 8) and "low-medium" adherence (score < 8). We evaluated epilepsy illness perceptions using seven items from the Brief Illness Perception Questionnaire (BIPQ), each scored from 0-10, measuring participants' views of the overall effect of epilepsy on their lives, how long it would last, how much control they had over their epilepsy, the effectiveness of their treatment, level of concern about epilepsy, level of understanding of epilepsy, and emotional impact of epilepsy. We investigated the association of each BIPQ item with medication adherence using logistic regression models that controlled for potential confounders (age, race/ethnicity, income, and time since the last seizure).

Results: One hundred forty-nine patients (23%) gave responses indicating high adherence. In the adjusted models, for each 1-unit increase in participants' BIPQ item scores, the odds of high adherence increased by 17% for understanding of their epilepsy (OR = 1.17, 95% CI 1.07-1.27, p < 0.001), decreased by 11% for overall life impact of epilepsy (OR = 0.89, 95% CI 0.82-0.97, p = 0.01) and decreased by 6% for emotional impact of epilepsy (OR = 0.94, 95% CI 0.86-0.99, p = 0.03). No other illness perception was associated with high adherence. Depression, anxiety, and stigma mediated the inverse relationships of high adherence to the overall life impact of epilepsy and the emotional impact of epilepsy. These measures did not mediate the relationship of high adherence to the perceived understanding of epilepsy.

Conclusion: These results indicate that a greater perceived understanding of epilepsy is independently associated with high ASM adherence. Programs aimed at improving patients' understanding of their epilepsy may help improve medication adherence.

Keywords: Adherence; Antiseizure medication, epidemiology; Illness perception.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Anxiety
Emotions
Epilepsy* / psychology
Humans
Medication Adherence / psychology
Surveys and Questionnaires

Abstract

Publication types

MeSH terms

Grants and funding