Background

Mental health is the crucial aspect of health closely allied with the physical and physiological changing aspects of the human body [1]. A clinically important impairement in a person’s cognition, emotion control, or behavior caused by a failure in the biological, psychological or developmental processes underpinning mental functioning is known as a mental disorder [2]. As well as insomnia, fatigue, irritability, forgetfulness, difficulty concentrating, substantial distress, impairment of social, or occupational activities, and somatic complaints, mental disorders encompass a wide range of mental disorders that do not fit into standard diagnostic criteria [3,4,5].

The World Health Organization reported that mental disorder is the direct risk factor for mortality and morbidity [6, 7]. Psychiatric comorbidities occur in about one-third of patients with epilepsy during the lifespan, and the risk of these comorbidities are much higher in patients with treatment-resistant seizures [8, 9].

Mental disorders have a vital negative impact on the quality of life and living standards of patients with epilepsy. Risk factors for common mental disorders among epileptic patients were being female, young age, marital status, lower-income, unemployment, low educational status, worse QOLIE-89 scores, lack of social support, frequent seizures attacks, side effects of antiepileptic drugs, medication non-adherence, nicotine dependence, alcohol misuse, family history of psychiatric illness, comorbidity of medical condition, duration of illness, and poly-pharmacy [10,11,12,13,14,15,16].

Despite the high burden of common mental disorders among patients with epilepsy, they remain under-investigated and inappropriately treated [18]. Better understanding and treatment of common mental disorders can assist early complication management and better health outcomes for people living with epilepsy. However, the magnitude and determinants of common mental disorders in patients with epilepsy are not determined well in low income countries, including Ethiopia in general and the study area in particular. Therefore, this study aimed to assess the magnitude of common mental disorders and the determinants among patients with epilepsy attending at the Fenote Selam hospital.

Methods

Study design, setting, and period

This institutional-based cross-sectional study was conducted at the Fenote Selam hospital from March 10 to May 15, 2019. The hospital is situated 378 km from Ethiopia’s capital city of Addis Ababa in the Amhara region. It is the only public hospital in Fenote Selam town.

Population

The source population for this study was all patients with epilepsy (N = 521) attending at the Fenote Selam hospital for epilepsy treatment, while the study population was those patients 18 years and older. Those patients who dropped out the treatment, missed the appointment, or transferred out to other health institutions during the data collection period were excluded.

Sample size determination and sampling procedure

The sample size was determined using the single population proportion formula by considering a 95% confidence level, a 5% margin of error, and a 50% proportion of common mental disorders. Taking the 10% non-response rate and the correction formula (N < 10, 000), the final sample size was 202. A simple random sampling technique was applied using their medical record numbers. The patients were interviewed and their medical records reviewed.

Operational definitions

Common Mental disorder

The patient was screened for common mental disorder using the SRQ-20 dichotomous items (Yes = 1, No = 0). The likelihood of a common mental disorder was considered when he/she responded to nine or more positive (yes) answers out of the total. Otherwise, the patient was considered not at risk of common mental disorder [19].

Social support

Patients with Epilepsy who scored mean or above of the social support assessing questions (got counseling, financial aid, and or physical support from family, friends) correctly were considered as getting social support. Otherwise didn’t get social support [20].

Data collection tool

Data were collected using a pre-tested structured questionnaire, adapted from a standardized self-reporting questionnaire (SRQ-20) with a 30-day recall period [21, 22]. The questionnaire comprised social-demographic, somatic, depressive/anxiety, and cognitive [23] and the multidimensional scale of perceived social support [20] assessing characteristics. It was translated into the Amharic (the indigenous) language by the independent translator (Ph.D. in linguistics) and then back to English to check for consistency. The five-day training was given to two enumerators (BSc in nursing) and one supervisor (MSc in psychiatry). The enumerators conducted a role-plays before the actual data collection period. Finally, the data was collected using the Amharic version of the questionnaire. Each questionnaire was examined for completeness and consistency by the supervisor and the principal investigator daily, and appropriate feedback was given to the data collectors.

Data management and analysis

Data entry, cleaning, and coding were performed using Epi-data version 3.1 software, and the analysis was done using R version 4.0 software. Descriptive statistics were computed using frequency, percent, mean, and standard deviation. Bivariate and multivariate logistic regression analyses were employed to assess the association between the exploratory variables and mental disorders. The strength of the association was measured using the adjusted odds ratio (AOR) and 95% confidence interval (CI). A p-value < 0.05 was considered a statistically significant predictor of common mental disorders.

Results

Socio-demographic characteristics of the study participants

A total of 202 patients with epilepsy participated in the study, with a response rate of 91.4%. About 52% and 54% of the patients were males and single. About 20% of the patients were unable to read and write. About one-third of the patients were students. Almost 40% of them were living in rural areas and had a monthly income of fewer than 700 Birrs (Table 1).

Table 1 Socio-demographic characteristics of the respondents of Fenote Selam hospital, northwest Ethiopia, 2019
Full size table

Seizure characteristics of patients with epilepsy

About 52% of the current and ever substance-using patients were at risk of common mental disorders. Of 35.3% of multi-substance users, 72% were at risk of common mental disorders. Of 20.3% of phenytoin drug users, 76% were at risk of common mental disorders. Similarly, out of 20.3% of patients who had a seizure during treatment, 76% were at risk of having a common mental disorders (Table 2).

Table 2 Seizure related characteristics of the respondents at the Fenote Selam hospital, northwest Ethiopia, 2019
Full size table

The magnitude of common mental disorders among patients with epilepsy

The magnitude of common mental disorders among patients with epilepsy was 57.9% (95% CI: 44.56, 71.24).

Factors associated with a diagnosable mental disorder

On bivariate analysis, occupational status, social support, types of substances used, types of anti-epileptic drugs used, and seizures during treatment were factors associated with common mental disorders at 20% of level of significance. Whereas in the multivariable analysis, only social support and types of substances used showed a significant association with common mental disorders.

For those patients who hadn’t received social support, the odds of developing common mental disorders were about four (AOR = 4. 3; 95%CI: 1.5, 11.9) times higher compared to those who had. Similarly, for those patients abused by more than one substance, the odds of common mental disorders were about six (AOR = 5. 7; 95%CI: 1.6, 20.7) times higher compared to those khat chewers (Table 3).

Table 3 Factors associated with common mental disorders at the Fenote Selam hospital, northwest Ethiopia, 2019
Full size table

Discussion

This study identified the magnitude of common mental disorders and the determinants among patients with epilepsy attending the Fenote Selam hospital. The study revealed that 57.9% (95% CI: 44.56, 71.24) of the patients had common mental disorders. This finding was higher than the studies done in northwest Ethiopia (45.2%), Addis Ababa, Ethiopia (27.1%), Mexico (36.6%), Sudan (45.5%), the systematic review (32.71%), Hawassa, Ethiopia (34.2%), and Nigeria (31–37%) [17, 24,25,26,27,28,29], respectively. However, it was lower compared to the studies from Burkina Faso (67.3%) and Nigeria (37%) [30, 31]. The possible reasons for the difference might be due to differences in the study period, study area, and socio-cultural practice.

The present study showed that patients who had no social support were about fourfold more likely to have common mental disorders (AOR = 4. 3; 95%CI: 1.5, 11.9) compared to those who had social support. This finding was consistent with a study done in Ethiopia [27]. This could be explained by the fact that lack of social support might deteriorate the patient’s health and quality of life due to fear of lacking support in the future when he/she gets sick.

The study also identified the use of addiction-inducing substances while on anti-epilepsy treatment was significantly associated with common mental disorders. For patients who used more than one substance, the odds of common mental disorders (AOR = 5. 7; 95%CI: 1.6, 20.7) were 6 times higher compared to those who used chat. This was supported by a study done in central Ethiopia [32]. The possible justification for this typical finding might be that the content of chemicals in more substance users might bring a higher risk of common mental disorders than only chat users when taken along with anti-epileptic drugs.

The findings of this study indicate that common mental disorders are common co-morbidities in patients with epilepsy. Healthcare professionals should assess and treat psychiatric and physical co-morbidities among patients with a history of seizures to improve patient health outcomes. The families of patients with epilepsy should be made aware of the disorders and their related psychological co-morbidities so that the patients can receive sufficient support from their families.

Limitations of the study

The difficulty of distinguishing the temporal relationships. There might also be a potential for recall bias. It is difficult to investigate why the effect of khat chewing is a potential risk factor for common mental disorders. Therefore, a strong evidenced study should be done to ascertain the impact of khat on mental disorders.

Conclusion

The risk of common mental disorders among patients with epilepsy was high. Social support and the type of substances used were the identified factors significantly associated with the risk of common mental disorders.

Recommendations

The authors recommended that the health care workers should give great attention to counseling on the reduction of substance use of the patients with epilepsy. In addition, the study suggests arranging social support and creating awareness about the consquences of taking substances (non medication) are important to reduce the common mental disorders.