Introduction
Epilepsy is one of the most common neurological disorders and serious public health problems, which is also the second cause of neurological diseases in the world after stroke [
1]. Epilepsy is a chronic disease, which includes repeated seizure attacks caused by abnormal electrical signals in the brain and involves neurological, cognitive, physiological, and social dimensions [
2]. Epilepsy can occur at any age, race, or social class [
3]. The number of patients with epilepsy in the United States is about two million and in the United Kingdom is 300,000 [
4]. It is reported that 3-5% of the world’s population present seizure attacks during their lifetime and 0.5-1% of the world’s population are affected by active epilepsy [
5].
The incidence of epilepsy in the developed and developing countries is 40-70 and 190 per 100,000 individuals, respectively [
6]. In most of the countries, the prevalence of active epilepsy is 4-10 per 1000 individuals [
1]. Based on a systematic review findings (2014), the prevalence of epilepsy in Iran was 7.87 per 1000 individuals and the number of affected people in 2011 was about 800,000 [
7]. According to research articles finings, 1%-1.5% of Iran current population have epilepsy, which indicates that the proportion of patients with epilepsy is about three times higher than that of Europe [
7].
The increasing trend of affected people in Iran calls for further attention, which should be paid to the problems and treatment challenges and adaptation to this disease [
7]. Patients with epilepsy also have ocular problems, anxiety, depression, and memory impairments. No definitive treatment has been introduced for such patients so far, and about one-third of them have not yet been cured, and also the causes of exacerbation and relief of their disease are not clearly understood [
8].
Perception of social support is defined as a mental sensation of belonging, accepting, being interested, and getting help in the required circumstances [
9]. Some authors indicated social support as a degree of fulfilling emotional needs, satisfaction, belonging, and security to others [
10]. Social support can be provided as psychosocial, emotional, informational, tangible, and interactive support, but the patient’s understanding of the support provided is of great importance. Understanding the benefits of social support can play an important role in the advanced stages of chronic diseases and may protect the individual against the tensions caused by the disease, reduce the negative psychological consequences of physical defects, and ease tolerating the disease throughout enhancing the compatibility [
11].
Social support affects health behaviors, as well as disease and treatment outcomes by changing people’s perceptions of stressful life events, such as epilepsy, and reducing negative psychological responses to these stressor factors. Perceiving the social support can prevent physiological adverse effects of the disease, and remain a beneficial impact on physical-psychological symptoms and functioning, and protect individuals from the adverse effects of life crises [
12]. Physical illnesses, such as epilepsy, can distort perception of social support, as the patient gradually shifts away from family members and other people and avoids social contacts [
13].
Perceived social support is one of the factors that contribute to self-esteem in patients with epilepsy. Patients with epilepsy usually receive little social support, which causes psychological problems, including depression and anxiety and decreased self-esteem [
14]. Self-esteem is known as a stress regulator. Therefore, people with higher self-esteem have a higher sense of self-worthiness in stressful situations, which in turn protects them against stress outcomes [
14].
Reviewing the literature revealed a huge number of researches on the relationship between self-esteem and perceived social support in some diseases; however, most studies in this regard are conducted on adults or young individuals, as well as patients with cancer or multiple sclerosis. Also, there are limited study on the relationship between self-esteem and perceived social support in patients with epilepsy. Therefore, considering the impact of perceived social support on increasing self-esteem, and reducing the psychological consequences of seizure attacks and treatment complications, the current study aimed at evaluating the relationship between the components of self-esteem and perceived social support in patients with epilepsy for the first time in Iran.
Materials and Methods
The current cross sectional, correlational study was conducted on 211 patients with epilepsy referring to the Neurology Department and Comprehensive Epilepsy Center of Kashani Hospital in Isfahan, Iran from 2017 to 2018. Patients were selected through convenience sampling method and inclusion and exclusion criteria were used to enroll eligible subjects. Kashani Hospital in Isfahan was selected as the research setting because of ease of access to the study samples (simple or consecutive sampling). Diagnosis of epilepsy was confirmed by a epilepsy fellowship based on standard criteria [
15] and psychological evaluations were performed by a psychiatric. The inclusion criteria were: having epilepsy and signing the written informed consent; at least six months of definitively being diagnosed with epilepsy and treatment onset; being able to answer the questions; no physical-psychological illnesses.
The exclusion criteria were: incidence of any acute diseases associated with seizure attacks during the data collection; no willingness to participate in the study; being missed to follow-up. The patients were enrolled if they met the inclusion criteria and had the desire for participation. The researchers referred to the study site and introduced themselves, explained the research objectives, provided explanations about the way to complete the questionnaires for patients and obtained the signed written consent forms from the ones who returned completed questionnaires. After obtaining permission from authorities, patients were placed in an appropriate place to complete the questionnaires.
The instrument used in the study was comprised of self-esteem and social support questionnaires and demographic characteristics checklist was also added to the first part. Demographic characteristics included age, gender, marital status, occupational status, educational level, and duration of the disease. The first questionnaire was the Rosenberg self-esteem scale. The content reliability and validity of the Rosenberg self-esteem scale was confirmed based on the comments of the developers and some preliminary studies [
16].
The Rosenberg Self-Esteem Scale contains 10 general items that are scored based on a five-point Likert scale from 0 to 3 as: totally disagree (0), disagree (1), agree (2), and totally agree (3), the maximum score of the self-esteem questionnaire is 30. Scores above 25 indicate high self-esteem, 15-25 moderate self-esteem, and less than 15 indicate low self-esteem [
17].
The second questionnaire was the social support questionnaire designed based on the Northouse Social Support Questionnaire (SSQ). The content reliability and validity of the SSQ was confirmed in another study [
18]. The Northouse SSQ consists of 40 items in five dimensions as spouse, family members, friends, physician, and nurse. Each dimension has eight items that measure the level of social support perceived by patient’s spouse, family members, friends, physician, and nurse. The items are scored based on a five-point Likert scale from 1 to 5 as: totally disagree (1), disagree (2), no idea (3), agree (4), and totally agree (5).
The score of each dimension is separately calculated and the total score, which is calculated by summing the dimensions scores, ranges 40 to 200. The total score of perceived social support is interpreted as follows: low (40-92), moderate (93-146), and high (147-200), and the score of each dimension is also interpreted as: low (8-18), medium (19-29) and high (30-40). It should be noted that items of spouse dimension of are not omitted for single subjects. In addition, the Northouse SSQ has open-ended items to measure the social network of patients that was not applicable to the current study.
In the study, the collected data were analyzed using descriptive and statistical inference with SPSS V. 23. Descriptive statistics including frequency distribution, as well as mean and standard deviation was used to express data. Multiple regression analysis and Pearson Correlation Coefficient were also employed.
Results
In the present study, 211 patients with epilepsy referring to the Neurology Department and Comprehensive Epilepsy Center of Kashani Hospital were studied and all the participants completed questionnaires (100% re
sponse rate). Findings of the demographic variables are summarized in Table 1. The findings showed that 64.92% of the respondents were female and 35.1% male. Regarding the frequency distribution of respondents, in terms of age, the findings indicated that 10.4% of the respondents were within the age range of 20-25 years, 21.3% were 26-30 years, 33.1% were 31-35 years, 22.2% were 36-40 years , and 12.7% were above 41 years (Table 1).
Descriptive indices of the self-esteem score and the perceived social support score in each dimension are shown in Table 2. The findings revealed that the level of perceived social support was high in most of the studied cases and the highest score belonged to the family members’ dimension. The Pearson correlation showed no significant relationship between self-esteem and social support perceived by the spouse, family members, friends, physician, and nurse (P>0.05).
To investigate the prediction of self-esteem variable by perceived social support, the perceived social support components were introduced stepwise to self-esteem variables. Stepwise regression was evaluated and the results are shown on Table 3. All variables significantly retained themselves in five steps. The results of variance analysis showed that social support dimensions including spouse, family members, friends, physician, and nurse had a significant impact on self-esteem. The results of stepwise regression are reported in five steps. As shown in Table 4, the total score of perceived social support and self-esteem had a significant correlation (P<0.001).