Risk factors for poor health-related quality of life in adolescents with epilepsy

Purpose: To examine potential risk factors for poor health-related quality of life (HRQOL) among adolescents with epilepsy by using the newly develope d QOLIE-AD-48. Risk factors were derived from sociodemographic, social, aca demic, and epilepsy- and health-related domains. Methods: The QOLIE-AD-48 was administered to 197 English-speaking adolescen ts (age 11-17 years from >20 sites in the United States and in Canada). The self-report instrument yields an overall HRQOL score and eight subscale sc ores. Other data were obtained from family interviews, physician reports, a nd health records. Multiple regression analyses were conducted to study ris k factors for impairment of HRQOL. Results: Older adolescents (age 14-17 years), those with more severe epilep sy and more symptoms of neurotoxicity, and those living in households with lower socioeconomic status were more likely to report poor overall HRQOL. R isk factors in the eight HRQOL domains were found as follows: (a) Epilepsy impact. older age in adolescence, more severe epilepsy and neurotoxicity, m ore hospitalizations during the past year, and fewer hours of extracurricul ar activities; (b) Memory and Concentration: longer duration of epilepsy, s pecial education classes, and history of repeating a grade in school; (c) A ttitude Toward illness. older age, female gender, and more severe epilepsy and neurotoxicity; (d) Social Support: younger age, male gender, and fewer hospitalizations in the last year; (e) Stigma: lower socioeconomic status a nd special-education classes; and (f) Health Perceptions: older age, female gender, and lower socioeconomic status. None of the factors examined was s ignificantly associated with HRQOL in (g) Physical Functioning or (h) Schoo l Behavior subscales. Conclusions: We identified several risk factors for poor HRQOL outcomes in adolescents with epilepsy. Age, increased seizure severity, and neurotoxici ty were most consistently associated with poor HRQOL across domains. Older adolescents, independent of epilepsy severity, reported worse overall HRQOL than did their younger counterparts. Older adolescents also were more like ly to perceive a greater negative impact on life and general health, and ha d more negative attitudes toward epilepsy. Adolescent boys and girls may sh ow different sensitivities to various quality-of-life domains.