In this study, the prevalence rate of depression among epilepsy patients was 43.8% (38.9, 48.8%). It is consistent with the study done at the University of Gondar Hospital (45.2%) [25] and Sudan (45.5%) [26].
This finding was lower than the result from the study conducted at the Jimma University Specialized Hospital (49.3%) [19]. Other studies conducted in Nigeria and Gaza stated that depression had been prevalent among 85.5 and 63% of participants, respectively [9, 27] which are very high compared with the current study, and they were almost three times higher in magnitude than that reported in a study done in Canada [11]. This difference might be due to the sociocultural variation and instrument, since those authors used BDI which has items similar to somatic complaints, and this might have led to overestimating the prevalence.
However, the current study’s finding regarding prevalence rate is higher than the report described in Amanuel Mental Specialized Hospital (33.3%) [28], Kenya (16.5%) [29], Iran (9.5%) [8], Thailand (20%) [30], and Greek (22.5%) [31]. These discrepancies might be due to the difference in study participants, method, culture, time, and settings.
In this study, the researchers found a high prevalence of depression among female compared to male respondents which are consistent with the study done in Gaza [9]. However, the study in Nigeria and Ethiopia [19, 27] revealed that no significant relationship between gender and depression in people with epilepsy. The difference is most likely due to diverse methodological approaches, cultural variation, and different instruments they used to measure depression. In general, females faced difficulty in performing normal activities of daily living, and they might face several risks or hardships with regard to reproductive activity and pregnancy. Furthermore, women with epilepsy face difficulty in decision-making with regard to important major life events such as marriage or bearing children. Thus, these consequences might increase depression among females.
With regard to marital status in this study, those who were married were less likely to be depressed compared to those with single status, and having another marital status. This finding was consistent with the previous study in Jimma Ethiopia [19] but inconsistent with other studies in which the authors found no significant difference among different marital statuses [27, 28]. This might be due to marriage-related change of lifestyles because of some kind of guardian-like protective effect of the marital status where adherence to healthy activities is greatly increased—and behaviors leading to health risks are reduced. Moreover, married people also have higher levels of emotional support.
The study has also shown that patients who were not adherent to their medication had depression compared to those who were adherent. This hypothesis is supported by previous studies [19, 25]. The high rates of poor adherence demonstrated in this study are causing concerns, given the consequences of antiepileptic discontinuation. It might be assumed that patients who discontinue medication will be more likely to relapse and have very poor and less control over the disease than those who continue medications.
Moreover, in this study, stigma was associated with depression which is supported by different studies [19, 28]. The previous study conducted in Ethiopia among epilepsy among patients found perceived stigma to be a common problem among people living with epilepsy [32]. This is because people with epilepsy might be overprotected and restricted from doing many activities by their family members, friends, or teachers. Overprotection arising from stigmatization can have severe consequences. Eventually, this stigma shatters a person’s hope and self-esteem leading to negative outcomes related to recovery including depressive symptoms, social avoidance, and a preference for adopting avoidance of coping strategies.
In this particular study, current substance use has a significant association with depression. This result is supported by Epilepsy Action Australia report [33]. Substance use among people taking antiepileptic medications is likely to be more sensitive to the effects of substances. The substance can interfere with the metabolism of these medications and therefore increase the chance of seizures. Some medications can enhance the toxic effects of alcohol, and people can feel severely intoxicated after drinking only a small amount. Skipping a dose, taking extra medication, or altering the time of taking regular antiepileptic medications before drinking will not alter this reaction but may cause additional adverse effects or seizures [33].
In general, the implication of this finding indicates that people living with epilepsy need strong counseling in terms of adherence, by way of creating awareness in the community and addressing misperception issues attached to epilepsy. Collaborative efforts among different stakeholders and clinicians are recommended to bring effective management strategies to neurologic clinics. In addition, generating additional evidence through further research is required.
A limitation of this study was that it was not possible to clarify the cause–effect relationship between depression and epilepsy due to the cross-sectional nature of the study. A prospective study could help to establish clearly whether epilepsy predisposes to depression or a consequence of depression predispose to epilepsy. Another limitation includes recall bias—regarding the duration of illness and substance-use-related factor—which was not assessed by a standard tool.