Prevalence and Determinants of Depression Among Epilepsy Patients in Addis Ababa, Ethiopia 2024

Prevalence and Determinants of Depression Among Epilepsy Patients in Addis Ababa, Ethiopia 2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Determinants of Depression Among Epilepsy Patients in Addis Ababa, Ethiopia 2024 Bemnet Yacobe Sayid, Abdurehman seid Mohammed, Mustofa Hassen Yesuf, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7067593/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Depression is a common and serious psychiatric comorbidity among individuals living with epilepsy. It is associated with poor treatment outcomes, reduced quality of life, and increased disability. Despite this, depression in people with epilepsy often remains unrecognized, particularly in low-resource settings. This study aimed to assess the prevalence of depression and identify its associated factors among patients with epilepsy in public hospitals in Addis Ababa, Ethiopia. Methods : An institution-based cross-sectional study was conducted from July 1 to 30, 2024, involving 591 individuals with epilepsy attending follow-up clinics at Eka Kotebe General Hospital, St. Paul’s Hospital Millennium Medical College, and Yekatit 12 Hospital Medical College. Participants were selected using systematic random sampling. Descriptive statistics were used to summarize sociodemographic and clinical data. Binary logistic regression analysis was applied to identify independent factors associated with depression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was determined at a p-value of ≤ 0.05. Model fitness was evaluated using the Hosmer–Lemeshow test. Results : The prevalence of depression among people with epilepsy was found to be 42.6%. Depression was significantly associated with urban residence (AOR = 0.26; 95% CI: 0.17–0.39), increased seizure frequency per month (AOR = 2.24; 95% CI: 1.23–4.10), frequency of medication use (AOR = 1.98; 95% CI: 1.19–3.28), and lower levels of social support (AOR = 0.33; 95% CI: 0.21–0.52 for moderate support, and AOR = 0.46; 95% CI: 0.28–0.77 for strong support). Conclusion : Depression is highly prevalent among individuals with epilepsy in Addis Ababa. Patients experiencing frequent seizures, increased medication burden, and limited social support are at significantly higher risk. These findings underscore the urgent need to integrate routine depression screening and mental health support into epilepsy care services in Ethiopia. Depression Epileptic patients Ethiopia Figures Figure 1 Introduction Epilepsy is a chronic, non-communicable neurological disorder characterized by recurrent seizures—brief episodes of involuntary movement that may affect a part of the body or the entire body. These seizures can also be accompanied by loss of consciousness and disruptions in bladder or bowel control. Globally, epilepsy affects an estimated 50 million people, making it one of the most prevalent neurological conditions. Notably, nearly 80% of those affected reside in low- and middle-income countries (1). Depression, on the other hand, is a common mood disorder marked by persistent sadness, diminished interest or pleasure in activities, and a range of cognitive and physical symptoms. Nearly all individuals experiencing depression (about 97%) report reduced energy, impaired concentration, and difficulty completing everyday tasks. Sleep disturbances—such as early morning awakenings or fragmented sleep—are also common. While many patients experience a loss of appetite and weight loss, others may show increased appetite and sleep, often accompanied by feelings of guilt, hopelessness, or recurrent thoughts of death or suicide(2). People living with epilepsy (PWE) are significantly more vulnerable to psychiatric comorbidities, especially depression. Evidence shows that PWE experience psychiatric disorders at a rate approximately 9% higher than the general population(3). While the lifetime prevalence of depression is estimated to be around 10% in the general population, this figure rises to nearly 30% among individuals with epilepsy(4). Of the 50 million people worldwide living with epilepsy, estimates suggest that between 9.5% and 85% may also suffer from depressive disorders (5). Alarmingly, more than 80% of these individuals live in low-resource settings, where mental health issues are often underdiagnosed and undertreated. Regionally, depression among PWE in East Africa has a pooled prevalence of 34.5%, with slightly lower rates reported in Southern and West Africa (29.7%)(6). Individual country estimates vary widely: 11.9% in Nigeria(7), 14.2% in Rwanda(8), 68% in Kenya(9) and 67.3% in Burkina Faso(10). In Ethiopia, a recent systematic review and meta-analysis reported a pooled prevalence of 43.1% among people with epilepsy. Regional estimates included 46.2% in Oromia, 52.1% in the Southern Nations, Nationalities, and Peoples Region (SNNPR), and 36.6% in Central Ethiopia and the Amhara region (11). Institutional studies have also found high rates: 34.8% at Ayder Comprehensive Specialized Hospital, 37% at Mekelle General Hospital, and University of Gondar Comprehensive Specialized Hospital(5, 12). Comorbid depression in epilepsy has profound clinical implications. It is associated with poorer seizure control, greater seizure severity, reduced cognitive function, emotional distress, physical comorbidities, and a lower quality of life(6), Depression has also been linked to an increased risk of drug-resistant epilepsy (4), worse surgical outcomes, heightened sensitivity to antiepileptic drugs (AEDs), and an elevated risk of suicide(13). Compared to individuals without depression, people with epilepsy who are also depressed tend to utilize healthcare services more frequently, reflecting the compounded burden of both conditions(14). The relationship between epilepsy and depression is complex and possibly bidirectional, suggesting a potential overlap in neurobiological pathways(15). Multiple studies have identified various risk factors for depression among PWE, including demographic factors (female gender, older age), psychosocial stressors (unemployment, lack of social support, stigma), and epilepsy-specific features (high seizure frequency, drug resistance) (16). Although several studies have examined the prevalence of depression in people with epilepsy globally and across Africa, there remains a scarcity of literature in the Ethiopian context. Notably, prior studies in Ethiopia have not examined whether seizure type or electroencephalogram (EEG) findings are linked to depression. These unexplored factors represent important knowledge gaps. Therefore, this study seeks to address these gaps by assessing the prevalence and associated factors of depression among people living with epilepsy in Addis Ababa, with particular attention to seizure type and EEG characteristics. Methods Study design, period, and area An institution-based cross-sectional study was conducted over the course of one month, from July 1 to 30, 2024, in Addis Ababa, the capital city of Ethiopia. Addis Ababa is home to a range of public health facilities and serves as a major referral center for neurological care in the country. The study was carried out in three selected public hospitals: Eka Kotebe General Hospital St. Paul’s Hospital Millennium Medical College Yekatit 12 Hospital Medical College These hospitals were chosen based on their high patient volume and well-established neurology clinics, providing routine follow-up care for people living with epilepsy. Study population The study population consisted of adult epilepsy patients attending regular follow-up visits at the neurology outpatient departments of the three selected hospitals during the study period. Patients were eligible for inclusion if they: Were 18 years or older Had a confirmed diagnosis of epilepsy Had been receiving antiepileptic treatment for at least six months Patients were excluded if they were critically ill or unable to communicate at the time of data collection, as these conditions would hinder participation in the structured interviews and assessments.. Sample size determination The sample size was calculated using the single population proportion formula, assuming a: 95% confidence level Proportion (p) = 37%, based on a previous study conducted at the University of Gondar Comprehensive Specialized Hospital(5), 5% margin of error (d) 10% non-response rate Design effect of 1.5 to account for variability due to multi-center sampling Applying these parameters, the final sample size was determined to be 591 participants. Sampling procedure Out of the 12 public hospitals in Addis Ababa, three hospitals were randomly selected using a simple random sampling (lottery) method. These included Eka Kotebe General Hospital, St. Paul’s Hospital Millennium Medical College, and Yekatit 12 Hospital Medical College. Before data collection began, the total number of epilepsy patients who had visited each hospital’s outpatient department over the previous 12 months was obtained from patient records. From this, the average monthly attendance was estimated. Based on these figures, the total sample size (n = 591) was proportionally allocated to each hospital according to their average patient volume. Patients were then enrolled consecutively during their scheduled follow-up visits until the required sample size for each hospital was met. Proportional to the size allocation formula: n x Ni N Where n is the number of epilepsy patients in the follow-up unit of each hospital in one month Ni final sample size of the study N: Total number of epilepsy patients in the follow-up unit of Eka Kotebe General Hospital, St. Paul Hospital Millennium Medical College, and Yekatit 12 Hospital Medical College over one month Table 1: shows Total number of epilepsy patients in the follow-up unit in different hospital Study area n Number of epilepsy patients in the follow-up unit of each hospital in one month Ni: Final sample size of the study Eka Kotebe General Hospital 400 189 St. Paul Hospital Millennium Medical College 600 284 Yekatit 12 Hospital Medical College 250 118 Total 1250 591 To recruit study participants from the three selected hospitals, a systematic random sampling method was employed. The sampling interval (k) was determined by dividing the total number of epilepsy patients who attended follow-up clinics during the month prior to data collection (N = 1250) by the final sample size (n = 591). This yielded a sampling interval of approximately k = 2 (i.e., every second patient was selected).At each hospital, the first participant was chosen by lottery method from the initial two patients scheduled for follow-up on the first day of data collection. Subsequently, every 2nd patient presenting for follow-up at the outpatient neurology clinics was recruited into the study until the allocated sample size for each hospital was reached. This approach ensured a fair and representative selection of participants, minimizing selection bias and enhancing the generalizability of the findings. Operational definitions Depression was assessed by the Patient Health Questionnaire-9, which has been validated and extensively used in Ethiopia(17). In this study, a PHQ-9 total score of ≥10 was considered as having depression. Substance use was measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), a structured interview developed by the World Health Organization ((WHO) (18). Perceived stigma was assessed by the Kilifi Stigma Scale (KSS), which was developed and validated in Kilifi, Kenya, and adopted in Ethiopia(19). A score above the 66th percentile of the data measured by the Kilifi stigma scale of epilepsy indicates the presence of perceived stigma(20). Social support was measured with the Oslo-3 items social support scale (Oslo SSS). A score of 3–8 is considered “poor social support”, a score of 9–11 is considered “moderate social support”, and a score of 12–14 is considered “strong social support(21). Data collection procedures and quality assurance The Data were collected using a combination of interviewer-administered structured questionnaires and a data abstraction tool designed to retrieve clinical information from patient records. The structured questionnaire comprised four sections: Sociodemographic characteristics Clinical and substance use factors Psychosocial factors The Patient Health Questionnaire-9 (PHQ-9) for assessing depression Additionally, a data abstraction form was used to extract relevant electroencephalogram (EEG) findings from patient charts.Prior to the main data collection, both tools were pretested on 5% of the final sample size, using randomly selected patients and medical records at the same study hospitals. These pretest participants were excluded from the final analysis. Based on the pilot findings, necessary adjustments were made to ensure clarity, cultural relevance, and data quality. To facilitate understanding, the questionnaire and abstraction tool were translated into Amharic and then back-translated into English to ensure consistency and accuracy. The internal consistency of the tools used in this study was confirmed by Cronbach’s alpha: PHQ-9: α = 0.857 Kilifi Stigma Scale: α = 0.774 Oslo 3-Item Social Support Scale: α = 0.934 To ensure quality and uniformity in data collection, four trained psychiatric nurses and three supervisors were recruited. They received one day of intensive training on June 29, 2024, led by the principal investigator, which covered the objectives of the study, ethical considerations, interviewing techniques, and tool administration. Data collection was carried out between July 1 and July 30, 2024. Supervisors conducted daily reviews of the completed questionnaires and abstraction forms to check for completeness, accuracy, and internal consistency throughout the study period. Data management and data analysis Collected data were coded and entered into Epi Info, cleaned, and then exported to SPSS version 27.0 for statistical analysis. Descriptive statistics, including frequencies, proportions, means, and standard deviations, were used to summarize the data. For numerical variables that did not follow a normal distribution, medians and interquartile ranges were reported. To examine the association between depression and independent variables, a binary logistic regression model was employed. First, a univariate analysis was conducted, and variables with a p-value ≤ 0.25 were included in the multivariable logistic regression model. Adjusted odds ratios (AORs) with 95% confidence intervals were computed. A p-value ≤ 0.05 was considered statistically significant. The final model's goodness of fit was evaluated using the Hosmer-Lemeshow test, with a result indicating acceptable model fit (Pearson χ² = 13.997, p = 0.082). Ethics approval and consent to participate Ethical approval for the study was obtained from the Ethical Review Board of Gamby Medical and Business College, as well as from Eka Kotebe General Hospital, St. Paul’s Hospital Millennium Medical College, and the Addis Ababa Health Bureau. The study adhered to the principles of the Declaration of Helsinki (1964) and its subsequent amendments. Written informed consent was obtained from all participants prior to their enrollment. They were clearly informed about the study’s aims, procedures, potential risks and benefits, and their right to withdraw at any time without consequences. Confidentiality and anonymity were strictly maintained throughout the research process, and all data collected were used solely for academic purposes. Results Sociodemographic characteristics of the respondents A total of 591 participants were enrolled in the study, yielding a response rate of 100%. The median age of the respondents was 38 years with an interquartile range (IQR) of 28.0 to 49.0 years. The largest proportion of participants (24.2%) fell within the 35–44 age group. The study sample was predominantly male (53.3%), and nearly two-thirds (60.9%) of the participants resided in urban areas. Regarding marital status, 42.3% of participants were single, while others were married, divorced, or widowed. In terms of educational background, the most common level attained was primary education (27.4%). When asked about employment status, 26.2% of participants reported being self-employed. Concerning income, the most frequently reported monthly income bracket was 1,401–2,500 Ethiopian Birr (ETB), accounting for 28.1% of the respondents. Table 2: Sociodemographic characteristics of patients with epilepsy at public hospitals in Addis Ababa, 2024 (n=591) Variable Categories Frequency Percent% Age 18–24 years 96 16.2 25–34 years 126 21.3 35–44 years 143 24.2 45–54 years 120 20.3 ≥ 55 years 106 17.9 Sex Male 315 53.3 Female 276 46.7 Marital status Single 250 42.3 Married 226 38.2 Divorced 79 13.4 Widowed 36 6.1 Residence Rural 231 39.1 Urban 360 60.9 Educational Status Unable to read and write 119 20.1 Read and write 129 21.8 Primary education 162 27.4 Secondary education 117 19.8 Diploma and above 64 10.8 Occupation Unemployed 62 10.5 Government Employee 115 19.5 Non-governmental employee 153 25.9 Self-employed 155 26.2 Student 106 17.9 Monthly Income ≤ 600 160 27.1 601-1400 112 19.0 1401-2500 166 28.1 2501-3500 112 19.0 3501-5000 41 6.9 Description of respondents by clinical and substance-related factors As shown in Table 3, over half of the participants (54.0%) reported epilepsy onset at age 18 or older, and 58.9% had lived with the condition for 11 years or more. Generalized seizures were the most common type (58.5%), with 50.4% experiencing 1–3 seizures per month. Regarding treatment, 58.2% were on monotherapy, 37.2% took medication twice daily, and 88.7% reported no adverse effects from antiepileptic drugs. Most participants (86.3%) had no comorbidities, and 87.0% had no family history of mental illness. In terms of substance use, 60.1% had no lifetime use, while 27.4% reported current use. EEG findings were normal in 39.1% of participants. Table 3: Clinical and substance-related factors among patients with epilepsy at public hospitals in Addis Ababa, 2024 (n=591) Variable Categories Frequency Percent% Age of onset of epilepsy ≤ 5 years 68 11.5 6–11 years 147 24.9 12–17 years 57 9.6 ≥ 18 years 319 54.0 Duration of illness ≤ 5 years 110 18.6 6–10 years 133 22.5 ≥ 11 years 348 58.9 Type of seizure Generalized 346 58.5 Focal 245 41.5 Seizure frequency per month 0 79 13.4 1–3 298 50.4 4 and above 214 36.2 Number of drugs Monotherapy 344 58.2 Polytherapy 247 41.8 Frequency of drug Once a day 208 35.2 Twice a day 220 37.2 More than twice 163 27.6 Medication-related side effects Yes 67 11.3 No 524 88.7 Co-morbidity Yes 81 13.7 No 510 86.3 Type of Co-morbidity Hypertension 33 5.6 Diabetes Mellitus 38 6.4 Asthma 10 1.7 Family history of mental illness Yes 77 13.0 No 514 87.0 Lifetime substance use Yes 236 39.9 No 355 60.1 Current substance use Yes 162 27.4 No 74 12.5 EEG report Generalized pattern 163 27.6 Focal pattern 197 33.3 Normal 231 39.1 Description of respondents by psychosocial factors As presented in Table 4, 34.0% of the participants reported experiencing perceived stigma related to their illness. In terms of social support, the majority of respondents (40.8%) reported having moderate social support, while the rest fell into either poor or strong support categories. Table 4: Psychosocial characteristics of patients with epilepsy at public hospitals in Addis Ababa, 2024 (n=591) Variable Categories Frequency Percent% Perceived stigma Present 201 34.0 Absent 390 66.0 Social support Poor 212 35.9 Moderate 241 40.8 Strong 138 23.4 Prevalence of depression among epileptic patients Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with total scores ranging from 0 to 27. A score of 10 or above was used to indicate the presence of clinically significant depression. As illustrated in Figure 1, the overall prevalence of depression among the study participants was 42.6% with a 95% confidence interval of 38.6% to 46.7%.. Factors associated with depression The factors associated with depression among people with epilepsy are summarized in Table 5, based on both univariate and multivariate binary logistic regression analyses. In the univariate analysis, several variables—including residence, educational status, seizure frequency per month, frequency of drug use, comorbidity, family history of mental illness, and social support—showed a statistically significant association with depression at a 25% level of significance. However, after adjusting for potential confounders in the multivariate model, only four variables remained significantly associated with depression at the 5% significance level: residence, seizure frequency per month, frequency of drug use, and social support. Participants residing in urban areas were found to be 74% less likely to develop depression compared to those living in rural areas (AOR = 0.26; 95% CI: 0.17–0.39), suggesting a potential protective role of urban living—possibly due to better access to healthcare and social support services. Conversely, participants who experienced four or more seizures per month had 2.24 times higher odds of being depressed compared to those with no seizures in the preceding month (AOR = 2.24; 95% CI: 1.23–4.10), indicating the psychological toll of frequent seizure episodes. Similarly, individuals who were prescribed antiepileptic medications more than twice daily were nearly twice as likely to experience depression compared to those on once-daily regimens (AOR = 1.98; 95% CI: 1.19–3.28). This may reflect more complex disease severity or the psychological burden of intensive treatment. Social support was found to be a strong protective factor. Compared to participants with poor social support, those with moderate and strong social support were 67% and 54% less likely, respectively, to have depression: Moderate social support: AOR = 0.33; 95% CI: 0.21–0.52 Strong social support: AOR = 0.46; 95% CI: 0.28–0.77 These findings underscore the importance of psychosocial interventions and community-based support in the mental health care of people living with epilepsy Table 5: Univariate and multivariate analysis to identify factors associated with depression among patients with epilepsy at public hospitals in Addis Ababa, 2024 (n=591) Variable Categories Depression Crude odds ratio (COR) (95% CI) Adjusted odds ratio (AOR) (95% CI) P-value Depressed Not depressed Residence Rural 155 76 1 1 Urban 97 263 0.18(0.13-0.26) 0.26(0.17-0.39) 0.01* Educational Status Unable to read and write 63 56 1 1 Read and write 52 72 0.64(0.39-1.07) 0.63(0.34-1.16) 0.14 Primary education 62 80 0.69(0.42-1.12) 0.86(0.47-1.55) 0.61 Secondary education 55 87 0.56(0.34-0.92) 0.72(0.39-1.33) 0.30 Diploma and above 20 44 0.40(0.21-0.77) 0.70(0.33-1.46) 0.34 Seizure frequency per month 0 30 49 1 1 1–3 81 217 0.61(0.36-1.03) 0.60(0.33-1.08) 0.09 4 and above 141 73 3.15(1.85-5.39) 2.24(1.23-4.10) 0.009* Frequency of drug Once a day 60 148 1 1 Twice a day 93 127 1.81(1.21-2.70) 1.26(0.80-2.01) 0.32 More than twice 99 64 3.82(2.47-5.89) 1.98(1.19-3.28) 0.008* Co-morbidity Yes 25 56 1 1 No 227 283 1.796(1.09-2.97) 1.66(0.92-3.01) 0.095 Family history of mental illness Yes 23 54 1 1 No 229 285 1.89(1.12-3.17) 1.70(0.93-3.10) 0.09 Social support poor 128 84 1 1 moderate 75 166 0.296(0.20-0.44) 0.33(0.21-0.52) 0.001* strong 49 89 0.36(0.23-0.56) 0.46(0.28-0.77) 0.003* Discussion In this study, the prevalence of depression among people living with epilepsy was found to be 42.6% [95% CI: 38.6%–46.7%]. This finding is comparable to a study conducted in Rajasthan, India (41.2%)(22), suggesting a consistent burden of depression in epileptic populations across different regions.However, the prevalence observed in our study is lower than that reported in several other countries, including Saudi Arabia (76.7%) (23), Kenya(68%)(9), Burkina Faso(67.3%) (10), and China(52.6%) (24). These discrepancies may stem from variations in inclusion criteria, study settings, sample characteristics, and the use of different diagnostic instruments. For instance, the study in Burkina Faso included patients with less than three months of follow-up and used the Hamilton Depression Rating Scale, whereas our study employed the PHQ-9, which may yield different estimates(10). In contrast, our prevalence estimate was higher than those reported in Sri Lanka (22%)(25), Nigeria(26.6%)(26), Himalayan country(31%)(3), and several studies conducted in Ethiopia, including those at Ayder Comprehensive Specialized Hospital and Mekelle General Hospital (34.8%)(12) and University of Gondar Comprehensive Specialized Hospital (37%)(5). These variations may reflect differences in sociocultural factors, urban versus rural residence, types of seizure disorders, or the tools used to assess depression. For example, the Sri Lankan(25), study used the Beck Depression Inventory-II, and the Nigerian study limited participants to ages 18–60, potentially excluding older adults at higher risk of depression(26). Our multivariate logistic regression analysis identified residence, seizure frequency per month, frequency of drug use, and social support as independent predictors of depression among people with epilepsy. Participants residing in urban areas were 74% less likely to experience depression compared to those in rural settings. This aligns with findings from the University of Gondar(5).and may reflect the greater accessibility of healthcare services, mental health resources, and social support systems in urban environments. In contrast, patients in rural areas may face limited access to care, social isolation, and fewer coping resources, increasing their vulnerability to depression. Additionally, participants experiencing four or more seizures per month were over twice as likely to develop depression compared to those without recent seizures. This finding is consistent with previous studies in Gondar(5), Burkina Faso(10), Rajasthan(22), and Sri Lanka(25).Frequent seizures can lead to chronic fear, unpredictability, and social embarrassment, prompting individuals to avoid public spaces and isolate themselves, which in turn exacerbates feelings of hopelessness and depression. Visible symptoms like mouth foaming, involuntary urination, or loss of consciousness may further heighten stigma and self-perceived shame. Furthermore, participants prescribed antiepileptic drugs more than twice daily were nearly twice as likely to report depressive symptoms compared to those on once-daily regimens. This finding mirrors evidence from the Himalayan region(3). The burden of frequent dosing schedules, potential medication side effects, higher treatment costs, and the behavioral effects of certain antiepileptic drugs may all contribute to worsened mental health outcomes (27). Finally, social support emerged as a strong protective factor. Participants with moderate and strong social support were 67% and 54% less likely, respectively, to be depressed compared to those with poor support This is consistent with findings from Gondar(5) and the Himalayan region(3) reinforcing the crucial role that emotional, instrumental, and social support plays in buffering against depression. Those lacking adequate support are more prone to social isolation, while individuals with strong social ties often experience reduced stress, improved coping, and greater resilience in the face of chronic illness.. Strengths and limitations of the study Strengths of the study To minimize interviewer bias, the study employed standardized, validated diagnostic tools and structured questionnaires uniformly across all participants. Conducting the study across multiple hospitals in Addis Ababa improved the generalizability of the findings to other urban settings in Ethiopia. Limitations of the study Social desirability bias may have influenced self-reported data, particularly concerning substance use. Some key variables—such as age at epilepsy onset, duration of illness, and seizure frequency—were based on self-reported medical history, potentially introducing recall bias. The cross-sectional design limits the ability to infer causal relationships between depression and the associated risk factors identified. Conclusions This study revealed a high prevalence of depression (42.6%) among individuals with epilepsy attending public hospitals in Addis Ababa. Depression was significantly associated with residence, seizure frequency, frequency of antiepileptic drug use, and level of social support. These findings highlight the need for an integrated, biopsychosocial approach in the clinical management of epilepsy. Recommendations Healthcare professionals Epilepsy patients with frequent seizures, complex drug regimens, and poor social support should be considered high-risk groups for depression and prioritized for screening and psychosocial support. Where clinically appropriate, consider switching to once-daily antiepileptic medications to minimize pill burden and improve mental well-being. Minister of Health Integrate routine depression screening into national epilepsy care guidelines. Develop and implement training programs for healthcare providers on the mental health needs of people with epilepsy, with particular focus on modifiable risk factors such as seizure control, treatment burden, and social support. Researcher: Future studies should consider using cohort or longitudinal designs to assess temporal relationships and causal pathways between epilepsy-related factors and depression. Further research is needed to explore additional determinants—including cultural, biological, and environmental influences—that were beyond the scope of this study. Abbreviations AOR- Adjusted odds ratio EEG- Electroencephalogram OPDs- Outpatient departments PHQ-9- Patient Health Questionnaire-9 PWE- People with epilepsy Declarations Ethical Approval and Consent to Participate Ethical approval for this study was obtained from the Institutional Review Board of St. Peter Specialized Hospital, Addis Ababa, Ethiopia (Ref. No. V11/10/06/2024). All study procedures were conducted in full compliance with the Declaration of Helsinki and the applicable national and institutional ethical guidelines. Prior to participation, all individuals received clear information about the study's objectives, risks, and benefits, and provided informed consent. For participants who were unable to read or write, verbal consent was obtained in the presence of an impartial witness, as approved by the ethics committee.Participants’ privacy and confidentiality were carefully protected throughout the research process. No personally identifiable information was collected, and all data were securely stored and used solely for academic and research purposes. Funding Statement This research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors. Disclosure statement The authors declare that there are no conflicts of interest. Availability of data and materials The data and materials used in this study are available upon reasonable request. Owing to privacy concerns and institutional policies, the data cannot be made publicly accessible. Interested parties may contact [email protected] to request access to the data and materials. Clinical trial number : Not applicable Author Contributions: Bemnet Yacobe Sayid served as the principal investigator and corresponding author. she led the study design, oversaw data collection and analysis, and was responsible for drafting, revising, and finalizing the manuscript. she also managed overall research coordination and ensured the integrity of the study. Abdurehman Seid Mohammed made significant contributions to the design, data interpretation, and critical revision of the manuscript. He played a key role in refining the scientific content and enhancing the overall quality of the paper reviewed the manuscript, and approved the final version for submission. Mustofa Hassen Yesuf supported data analysis and interpretation and contributed to reviewing and improving the final draft. Haileleul Mekonnen Tilinty participated in data collection and provided input on the interpretation of results, along with valuable feedback during manuscript revision. Abel Melese Teka was involved in data collection and helped interpret the findings. He also contributed to reviewing the manuscript. Bemnet Fekre Butta assisted with data collection, contributed to result interpretation, and provided helpful comments during the review process. Kidist Abomsa Bedane supported data collection, contributed to interpreting findings, and participated in reviewing the draft manuscript. Nahom Zewdu Yemane took part in both data collection and analysis and contributed to the manuscript review and refinement. Matiyas Yesma Bekele, Robel Bayou Tilahun, and Getachew Mekete Diress provided technical and academic input, reviewed the manuscript, and approved the final version for submission. All authors have read and approved the final manuscript and agreed to take responsibility for its content References WHO. Epilepsy 2024 [Available from: https://www.who.int/news-room/fact-sheets/detail/epilepsy. Sadock B, Sadock V, Ruiz P, Kaplan H. Depressive Disorders. 2022. 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Prevalence and associated factors of depression among people with epilepsy in Ethiopia: a cross-sectional study. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2022;58(1):105. Sylla M, Vogel AC, Bah AK, Tassiou NR, Barry SD, Djibo BA, et al. Prevalence, severity, and associations of depression in people with epilepsy in Guinea: A single-center study. Epilepsy Behav. 2020;113:107475. Siarava E, Hyphantis T, Katsanos AH, Pelidou SH, Kyritsis AP, Markoula S. Depression and quality of life in patients with epilepsy in Northwest Greece. Seizure. 2019;66:93-8. Coppola G, Operto FF, Matricardi S, Verrotti A. Monitoring And Managing Depression In Adolescents With Epilepsy: Current Perspectives. Neuropsychiatr Dis Treat. 2019;15:2773-80. Yang Y, Yang M, Shi Q, Wang T, Jiang M. Risk factors for depression in patients with epilepsy: A meta-analysis. Epilepsy Behav. 2020;106:107030. Gelaye B, Williams MA, Lemma S, Deyessa N, Bahretibeb Y, Shibre T, et al. Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res. 2013;210(2):653-61. Kumar PC, Cleland CM, Gourevitch MN, Rotrosen J, Strauss S, Russell L, et al. Accuracy of the Audio Computer Assisted Self-Interview version of the Alcohol, Smoking and Substance Involvement Screening Test (ACASI ASSIST) for identifying unhealthy substance use and substance use disorders in primary care patients. Drug and alcohol dependence. 2016;165:38-44. Tiki T, Birhanu A, Mamo K. Assessment of the prevalence and factors associated with perceived stigma among epileptic patients who are on follow-up at hospitals in West Shewa Zone, Central Ethiopia, institutional-based cross-sectional study, 2017. J Neurol Neurobiol. 2018;4(2). Mbuba CK, Abubakar A, Odermatt P, Newton CR, Carter JA. Development and validation of the Kilifi Stigma Scale for Epilepsy in Kenya. Epilepsy Behav. 2012;24(1):81-5. Dalgard OS, Dowrick C, Lehtinen V, Vazquez-Barquero JL, Casey P, Wilkinson G, et al. Negative life events, social support, and gender differences in depression: a multinational community survey with data from the ODIN study. Soc Psychiatry Psychiatr Epidemiol. 2006;41(6):444-51. Baniya GC, Verma K. Prevalence of depression, risk factors, and quality of life in patients with epilepsy in a remote area of western Rajasthan. Epilepsy Behav. 2022;127:108488. Mubaraki AA, Sibyani AK, Alkhawtani RA, Alqahtani BG, Abu Alaynayn FK. Prevalence of depression among epileptic patients in Taif City, Saudi Arabia. Neurosciences (Riyadh). 2021;26(4):366-71. Wang HJ, Tan G, Deng Y, He J, He YJ, Zhou D, et al. Prevalence and risk factors of depression and anxiety among patients with convulsive epilepsy in rural West China. Acta Neurol Scand. 2018;138(6):541-7. De Silva S, Isuru A, Rodrigo A, Kuruppuarachchi L. Prevalence and correlates of depression in patients with epilepsy in Sri Lanka. Ceylon Med J. 2021;66(3):138-43. Madandola NO, Sale S, Adebisi AS, Obembe A, Salihu AS, Bakare AT, et al. Sociodemographic and Clinical Variables of Depression among Patients with Epilepsy in a Neuropsychiatric Hospital in Nigeria. Depress Res Treat. 2020;2020:2953074. Mula M, Sander JW. Negative effects of antiepileptic drugs on mood in patients with epilepsy. Drug Saf. 2007;30(7):555-67. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7067593","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":486911065,"identity":"6c9b27b4-6b7d-421d-af41-fa3b9d318062","order_by":0,"name":"Bemnet Yacobe Sayid","email":"","orcid":"","institution":"Eka Kotebe General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bemnet","middleName":"Yacobe","lastName":"Sayid","suffix":""},{"id":486911066,"identity":"18d11126-844d-44f3-9e30-6ed165d6915b","order_by":1,"name":"Abdurehman seid 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University","correspondingAuthor":false,"prefix":"","firstName":"Matiyas","middleName":"Yesma","lastName":"Bekele","suffix":""},{"id":486911074,"identity":"c6c3cfd1-c10b-49b0-a864-e307317f7262","order_by":9,"name":"Robel Bayou Tilahun","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Robel","middleName":"Bayou","lastName":"Tilahun","suffix":""},{"id":486911075,"identity":"4a35f51e-e30d-4812-b773-e8eaf6f6184d","order_by":10,"name":"Getachew Mekete Diress","email":"","orcid":"","institution":"Debre Tabor University","correspondingAuthor":false,"prefix":"","firstName":"Getachew","middleName":"Mekete","lastName":"Diress","suffix":""}],"badges":[],"createdAt":"2025-07-07 16:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7067593/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7067593/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89994834,"identity":"be5fc4df-2878-4b4c-bb18-1ceddf07da8f","added_by":"auto","created_at":"2025-08-27 07:52:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":73336,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of depression among patients with epilepsy at public hospitals in Addis Ababa, 2024 (n=591)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7067593/v1/00dd125ca8e7bc01651c3a0d.png"},{"id":89995818,"identity":"c4d2f637-33e2-4b99-b3a2-0734db68f29b","added_by":"auto","created_at":"2025-08-27 08:00:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1560414,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7067593/v1/163b0fba-cc37-4436-91bb-6f32ca0fe331.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Determinants of Depression Among Epilepsy Patients in Addis Ababa, Ethiopia 2024","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEpilepsy is a chronic, non-communicable neurological disorder characterized by recurrent seizures\u0026mdash;brief episodes of involuntary movement that may affect a part of the body or the entire body. These seizures can also be accompanied by loss of consciousness and disruptions in bladder or bowel control. Globally, epilepsy affects an estimated 50 million people, making it one of the most prevalent neurological conditions. Notably, nearly 80% of those affected reside in low- and middle-income countries (1).\u003c/p\u003e\n\u003cp\u003eDepression, on the other hand, is a common mood disorder marked by persistent sadness, diminished interest or pleasure in activities, and a range of cognitive and physical symptoms. Nearly all individuals experiencing depression (about 97%) report reduced energy, impaired concentration, and difficulty completing everyday tasks. Sleep disturbances\u0026mdash;such as early morning awakenings or fragmented sleep\u0026mdash;are also common. While many patients experience a loss of appetite and weight loss, others may show increased appetite and sleep, often accompanied by feelings of guilt, hopelessness, or recurrent thoughts of death or suicide(2).\u003c/p\u003e\n\u003cp\u003ePeople living with epilepsy (PWE) are significantly more vulnerable to psychiatric comorbidities, especially depression. Evidence shows that PWE experience psychiatric disorders at a rate approximately 9% higher than the general population(3).\u0026nbsp;While the lifetime prevalence of depression is estimated to be around 10% in the general population, this figure rises to nearly 30% among individuals with epilepsy(4).\u0026nbsp;Of the 50 million people worldwide living with epilepsy, estimates suggest that between 9.5% and 85% may also suffer from depressive disorders\u0026nbsp;(5).\u003c/p\u003e\n\u003cp\u003eAlarmingly, more than 80% of these individuals live in low-resource settings, where mental health issues are often underdiagnosed and undertreated.\u003c/p\u003e\n\u003cp\u003eRegionally, depression among PWE in East Africa has a pooled prevalence of 34.5%, with slightly lower rates reported in Southern and West Africa (29.7%)(6).\u0026nbsp;Individual country estimates vary widely: 11.9% in Nigeria(7), 14.2% in Rwanda(8), 68% in Kenya(9)\u0026nbsp;and 67.3% in Burkina Faso(10).\u003c/p\u003e\n\u003cp\u003eIn Ethiopia, a recent systematic review and meta-analysis reported a pooled prevalence of 43.1% among people with epilepsy. Regional estimates included 46.2% in Oromia, 52.1% in the Southern Nations, Nationalities, and Peoples Region (SNNPR), and 36.6% in Central Ethiopia and the Amhara region\u0026nbsp;(11). Institutional studies have also found high rates: 34.8% at Ayder Comprehensive Specialized Hospital, 37% at Mekelle General Hospital, and University of Gondar Comprehensive Specialized Hospital(5, 12).\u003c/p\u003e\n\u003cp\u003eComorbid depression in epilepsy has profound clinical implications. It is associated with poorer seizure control, greater seizure severity, reduced cognitive function, emotional distress, physical comorbidities, and a lower quality of life(6), Depression has also been linked to an increased risk of drug-resistant epilepsy (4), worse surgical outcomes, heightened sensitivity to antiepileptic drugs (AEDs), and an elevated risk of suicide(13). Compared to individuals without depression, people with epilepsy who are also depressed tend to utilize healthcare services more frequently, reflecting the compounded burden of both conditions(14).\u003c/p\u003e\n\u003cp\u003eThe relationship between epilepsy and depression is complex and possibly bidirectional, suggesting a potential overlap in neurobiological pathways(15).\u0026nbsp;Multiple studies have identified various risk factors for depression among PWE, including demographic factors (female gender, older age), psychosocial stressors (unemployment, lack of social support, stigma), and epilepsy-specific features (high seizure frequency, drug resistance)\u0026nbsp;(16).\u003c/p\u003e\n\u003cp\u003eAlthough several studies have examined the prevalence of depression in people with epilepsy globally and across Africa, there remains a scarcity of literature in the Ethiopian context. Notably, prior studies in Ethiopia have not examined whether seizure type or electroencephalogram (EEG) findings are linked to depression. These unexplored factors represent important knowledge gaps. Therefore, this study seeks to address these gaps by assessing the prevalence and associated factors of depression among people living with epilepsy in Addis Ababa, with particular attention to seizure type and EEG characteristics.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design, period, and area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn institution-based cross-sectional study was conducted over the course of one month, from July 1 to 30, 2024, in Addis Ababa, the capital city of Ethiopia. Addis Ababa is home to a range of public health facilities and serves as a major referral center for neurological care in the country. The study was carried out in three selected public hospitals:\u003c/p\u003e\n\u003cp\u003eEka Kotebe General Hospital\u003c/p\u003e\n\u003cp\u003eSt. Paul\u0026rsquo;s Hospital Millennium Medical College\u003c/p\u003e\n\u003cp\u003eYekatit 12 Hospital Medical College\u003c/p\u003e\n\u003cp\u003eThese hospitals were chosen based on their high patient volume and well-established neurology clinics, providing routine follow-up care for people living with epilepsy.\u003c/p\u003e\n\u003cp id=\"_Toc155401416\"\u003eStudy population\u003c/p\u003e\n\u003cp\u003eThe study population consisted of adult epilepsy patients attending regular follow-up visits at the neurology outpatient departments of the three selected hospitals during the study period. Patients were eligible for inclusion if they:\u003c/p\u003e\n\u003cp\u003eWere 18 years or older\u003c/p\u003e\n\u003cp\u003eHad a confirmed diagnosis of epilepsy\u003c/p\u003e\n\u003cp\u003eHad been receiving antiepileptic treatment for at least six months\u003c/p\u003e\n\u003cp\u003ePatients were excluded if they were critically ill or unable to communicate at the time of data collection, as these conditions would hinder participation in the structured interviews and assessments..\u003c/p\u003e\n\u003cp id=\"_Toc155401417\"\u003eSample size determination\u003c/p\u003e\n\u003cp\u003eThe \u0026nbsp;sample size was calculated using the single population proportion formula, assuming a:\u003c/p\u003e\n\u003cp\u003e95% confidence level\u003c/p\u003e\n\u003cp\u003eProportion (p) = 37%, based on a previous study conducted at the University of Gondar Comprehensive Specialized Hospital(5), 5% margin of error (d) \u0026nbsp;10% non-response rate\u003c/p\u003e\n\u003cp\u003eDesign effect of 1.5 to account for variability due to multi-center sampling\u003c/p\u003e\n\u003cp\u003eApplying these parameters, the final sample size was determined to be 591 participants.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc155401418\"\u003eSampling procedure\u003c/p\u003e\n\u003cp\u003eOut of the 12 public hospitals in Addis Ababa, three hospitals were randomly selected using a simple random sampling (lottery) method. These included Eka Kotebe General Hospital, St. Paul\u0026rsquo;s Hospital Millennium Medical College, and Yekatit 12 Hospital Medical College.\u003c/p\u003e\n\u003cp\u003eBefore data collection began, the total number of epilepsy patients who had visited each hospital\u0026rsquo;s outpatient department over the previous 12 months was obtained from patient records. From this, the average monthly attendance was estimated. Based on these figures, the total sample size (n = 591) was proportionally allocated to each hospital according to their average patient volume. Patients were then enrolled consecutively during their scheduled follow-up visits until the required sample size for each hospital was met.\u003c/p\u003e\n\u003cp\u003eProportional to the size allocation formula: \u003cu\u003en x Ni\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; N\u003c/p\u003e\n\u003cp\u003eWhere n is the number of epilepsy patients in the follow-up unit of each hospital in one month\u003c/p\u003e\n\u003cp\u003eNi final sample size of the study\u003c/p\u003e\n\u003cp\u003eN: Total number of epilepsy patients in the follow-up unit of Eka Kotebe General Hospital, St. Paul Hospital Millennium Medical College, and Yekatit 12 Hospital Medical College over one month\u003c/p\u003e\n\u003cp\u003eTable 1: shows Total number of epilepsy patients in the follow-up unit in different hospital\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4405%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2797%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en Number of epilepsy patients in the follow-up unit of each hospital in one month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2797%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNi: Final sample size of the study\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4405%;\"\u003e\n \u003cp\u003eEka Kotebe General Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2797%;\"\u003e\n \u003cp\u003e400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2797%;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4405%;\"\u003e\n \u003cp\u003eSt. Paul Hospital Millennium Medical College\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2797%;\"\u003e\n \u003cp\u003e600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2797%;\"\u003e\n \u003cp\u003e284\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4405%;\"\u003e\n \u003cp\u003eYekatit 12 Hospital Medical College\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2797%;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2797%;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4405%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2797%;\"\u003e\n \u003cp\u003e1250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2797%;\"\u003e\n \u003cp\u003e591\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc155401421\"\u003eTo recruit study participants from the three selected hospitals, a systematic random sampling method was employed. The sampling interval (k) was determined by dividing the total number of epilepsy patients who attended follow-up clinics during the month prior to data collection (N = 1250) by the final sample size (n = 591). This yielded a sampling interval of approximately k = 2 (i.e., every second patient was selected).At each hospital, the first participant was chosen by lottery method from the initial two patients scheduled for follow-up on the first day of data collection. Subsequently, every 2nd patient presenting for follow-up at the outpatient neurology clinics was recruited into the study until the allocated sample size for each hospital was reached. This approach ensured a fair and representative selection of participants, minimizing selection bias and enhancing the generalizability of the findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepression\u0026nbsp;\u003c/strong\u003ewas assessed by the Patient Health Questionnaire-9, which has been validated and extensively used in Ethiopia(17). In this study, a PHQ-9 total score of \u0026ge;10 was considered as having depression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubstance use\u003c/strong\u003e was measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), a structured interview developed by the World Health Organization ((WHO) (18).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived stigma\u0026nbsp;\u003c/strong\u003ewas assessed by the Kilifi Stigma Scale (KSS), which was developed and validated in Kilifi, Kenya, and adopted in Ethiopia(19).\u0026nbsp;A score above the 66th percentile of the data measured by the Kilifi stigma scale of epilepsy indicates the presence of perceived stigma(20).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial support\u0026nbsp;\u003c/strong\u003ewas\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003emeasured with the Oslo-3 items social support scale (Oslo SSS). A score of 3\u0026ndash;8 is considered \u0026ldquo;poor social support\u0026rdquo;, a score of 9\u0026ndash;11 is considered \u0026ldquo;moderate social support\u0026rdquo;, and a score of 12\u0026ndash;14 is considered \u0026ldquo;strong social support(21).\u003c/p\u003e\n\u003cp id=\"_Toc155401422\"\u003e\u003cstrong\u003eData collection procedures and quality assurance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Data were collected using a combination of interviewer-administered structured questionnaires and a data abstraction tool designed to retrieve clinical information from patient records. The structured questionnaire comprised four sections:\u003c/p\u003e\n\u003cp\u003eSociodemographic characteristics\u003c/p\u003e\n\u003cp\u003eClinical and substance use factors\u003c/p\u003e\n\u003cp\u003ePsychosocial factors\u003c/p\u003e\n\u003cp\u003eThe Patient Health Questionnaire-9 (PHQ-9) for assessing depression\u003c/p\u003e\n\u003cp\u003eAdditionally, a data abstraction form was used to extract relevant electroencephalogram (EEG) findings from patient charts.Prior to the main data collection, both tools were pretested on 5% of the final sample size, using randomly selected patients and medical records at the same study hospitals. These pretest participants were excluded from the final analysis. Based on the pilot findings, necessary adjustments were made to ensure clarity, cultural relevance, and data quality. To facilitate understanding, the questionnaire and abstraction tool were translated into Amharic and then back-translated into English to ensure consistency and accuracy.\u003c/p\u003e\n\u003cp\u003eThe internal consistency of the tools used in this study was confirmed by Cronbach\u0026rsquo;s alpha:\u003c/p\u003e\n\u003cp\u003ePHQ-9: \u0026alpha; = 0.857\u003c/p\u003e\n\u003cp\u003eKilifi Stigma Scale: \u0026alpha; = 0.774\u003c/p\u003e\n\u003cp\u003eOslo 3-Item Social Support Scale: \u0026alpha; = 0.934\u003c/p\u003e\n\u003cp\u003eTo ensure quality and uniformity in data collection, four trained psychiatric nurses and three supervisors were recruited. They received one day of intensive training on June 29, 2024, led by the principal investigator, which covered the objectives of the study, ethical considerations, interviewing techniques, and tool administration. Data collection was carried out between July 1 and July 30, 2024. Supervisors conducted daily reviews of the completed questionnaires and abstraction forms to check for completeness, accuracy, and internal consistency throughout the study period.\u003c/p\u003e\n\u003cp id=\"_Toc155401423\"\u003e\u0026nbsp;\u003cstrong\u003eData management and data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCollected data were coded and entered into Epi Info, cleaned, and then exported to SPSS version 27.0 for statistical analysis. Descriptive statistics, including frequencies, proportions, means, and standard deviations, were used to summarize the data. For numerical variables that did not follow a normal distribution, medians and interquartile ranges were reported.\u003c/p\u003e\n\u003cp\u003eTo examine the association between depression and independent variables, a binary logistic regression model was employed. First, a univariate analysis was conducted, and variables with a p-value \u0026le; 0.25 were included in the multivariable logistic regression model. Adjusted odds ratios (AORs) with 95% confidence intervals were computed. A p-value \u0026le; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eThe final model\u0026apos;s goodness of fit was evaluated using the Hosmer-Lemeshow test, with a result indicating acceptable model fit (Pearson \u0026chi;\u0026sup2; = 13.997, p = 0.082).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was obtained from the Ethical Review Board of Gamby Medical and Business College, as well as from Eka Kotebe General Hospital, St. Paul\u0026rsquo;s Hospital Millennium Medical College, and the Addis Ababa Health Bureau.\u003c/p\u003e\n\u003cp\u003eThe study adhered to the principles of the Declaration of Helsinki (1964) and its subsequent amendments. Written informed consent was obtained from all participants prior to their enrollment. They were clearly informed about the study\u0026rsquo;s aims, procedures, potential risks and benefits, and their right to withdraw at any time without consequences. Confidentiality and anonymity were strictly maintained throughout the research process, and all data collected were used solely for academic purposes.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003eSociodemographic characteristics of the respondents\u003c/h3\u003e\n\u003cp id=\"_Toc155401427\"\u003eA total of 591 participants were enrolled in the study, yielding a response rate of 100%. The median age of the respondents was 38 years with an interquartile range (IQR) of 28.0 to 49.0 years. The largest proportion of participants (24.2%) fell within the 35\u0026ndash;44 age group. The study sample was predominantly male (53.3%), and nearly two-thirds (60.9%) of the participants resided in urban areas. Regarding marital status, 42.3% of participants were single, while others were married, divorced, or widowed.\u003c/p\u003e\n\u003cp\u003eIn terms of educational background, the most common level attained was primary education (27.4%). When asked about employment status, 26.2% of participants reported being self-employed. Concerning income, the most frequently reported monthly income bracket was 1,401\u0026ndash;2,500 Ethiopian Birr (ETB), accounting for 28.1% of the respondents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Sociodemographic characteristics of patients with epilepsy at public hospitals in Addis Ababa, 2024 (n=591)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e18\u0026ndash;24 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e21.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e35\u0026ndash;44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e45\u0026ndash;54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;55 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e53.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e38.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e39.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e60.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eUnable to read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e20.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eRead and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003ePrimary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eDiploma and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eGovernment Employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNon-governmental employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly Income\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e601-1400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e1401-2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e2501-3500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e3501-5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch3 id=\"_Toc155401429\"\u003eDescription of respondents by clinical \u0026nbsp;and substance-related factors\u003c/h3\u003e\n\u003cp id=\"_Toc155401430\"\u003eAs shown in Table 3, over half of the participants (54.0%) reported epilepsy onset at age 18 or older, and 58.9% had lived with the condition for 11 years or more. Generalized seizures were the most common type (58.5%), with 50.4% experiencing 1\u0026ndash;3 seizures per month. Regarding treatment, 58.2% were on monotherapy, 37.2% took medication twice daily, and 88.7% reported no adverse effects from antiepileptic drugs. Most participants (86.3%) had no comorbidities, and 87.0% had no family history of mental illness. In terms of substance use, 60.1% had no lifetime use, while 27.4% reported current use. EEG findings were normal in 39.1% of participants.\u003c/p\u003e\n\u003cp\u003eTable 3: Clinical and substance-related factors among patients with epilepsy at public hospitals in Addis Ababa, 2024 (n=591)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of onset of epilepsy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e6\u0026ndash;11 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e12\u0026ndash;17 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;18 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of illness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;11 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e58.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of seizure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eGeneralized\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e58.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eFocal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeizure frequency per month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e1\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e50.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e4 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of drugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eMonotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e58.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003ePolytherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e41.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of drug\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eOnce a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e35.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eTwice a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e37.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eMore than twice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e27.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedication-related side effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e88.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCo-morbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e86.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Co-morbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eAsthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history of mental illness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e87.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLifetime substance use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e60.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent substance use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEEG report\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eGeneralized pattern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e27.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eFocal pattern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e39.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescription of respondents by psychosocial factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc155401431\"\u003eAs presented in Table 4, 34.0% of the participants reported experiencing perceived stigma related to their illness. In terms of social support, the majority of respondents (40.8%) reported having moderate social support, while the rest fell into either poor or strong support categories.\u003c/p\u003e\n\u003cp\u003eTable 4: Psychosocial characteristics of patients with epilepsy at public hospitals in Addis Ababa, 2024 (n=591)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived stigma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e34.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e390\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e66.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e35.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e40.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eStrong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch3 id=\"_Toc155401432\"\u003ePrevalence of depression among epileptic patients\u003c/h3\u003e\n\u003cp\u003eDepression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with total scores ranging from 0 to 27. A score of 10 or above was used to indicate the presence of clinically significant depression. As illustrated in Figure 1, the overall prevalence of depression among the study participants was 42.6% with a 95% confidence interval of 38.6% to 46.7%..\u003c/p\u003e\n\u003cp id=\"_Toc155401476\"\u003e\u003cstrong\u003eFactors associated with depression \u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc155401483\"\u003eThe factors associated with depression among people with epilepsy are summarized in Table 5, based on both univariate and multivariate binary logistic regression analyses. In the univariate analysis, several variables\u0026mdash;including residence, educational status, seizure frequency per month, frequency of drug use, comorbidity, family history of mental illness, and social support\u0026mdash;showed a statistically significant association with depression at a 25% level of significance.\u003c/p\u003e\n\u003cp\u003eHowever, after adjusting for potential confounders in the multivariate model, only four variables remained significantly associated with depression at the 5% significance level: residence, seizure frequency per month, frequency of drug use, and social support.\u003c/p\u003e\n\u003cp\u003eParticipants residing in urban areas were found to be 74% less likely to develop depression compared to those living in rural areas (AOR = 0.26; 95% CI: 0.17\u0026ndash;0.39), suggesting a potential protective role of urban living\u0026mdash;possibly due to better access to healthcare and social support services.\u003c/p\u003e\n\u003cp\u003eConversely, participants who experienced four or more seizures per month had 2.24 times higher odds of being depressed compared to those with no seizures in the preceding month (AOR = 2.24; 95% CI: 1.23\u0026ndash;4.10), indicating the psychological toll of frequent seizure episodes.\u003c/p\u003e\n\u003cp\u003eSimilarly, individuals who were prescribed antiepileptic medications more than twice daily were nearly twice as likely to experience depression compared to those on once-daily regimens (AOR = 1.98; 95% CI: 1.19\u0026ndash;3.28). This may reflect more complex disease severity or the psychological burden of intensive treatment.\u003c/p\u003e\n\u003cp\u003eSocial support was found to be a strong protective factor. Compared to participants with poor social support, those with moderate and strong social support were 67% and 54% less likely, respectively, to have depression:\u003c/p\u003e\n\u003cp\u003eModerate social support: AOR = 0.33; 95% CI: 0.21\u0026ndash;0.52\u003c/p\u003e\n\u003cp\u003eStrong social support: AOR = 0.46; 95% CI: 0.28\u0026ndash;0.77\u003c/p\u003e\n\u003cp\u003eThese findings underscore the importance of psychosocial interventions and community-based support in the mental health care of people living with epilepsy\u003c/p\u003e\n\u003cp\u003eTable 5: Univariate and multivariate analysis to identify factors associated with depression among patients with epilepsy at public hospitals in Addis Ababa, 2024 (n=591)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"762\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude odds ratio\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(COR) \u0026nbsp; \u0026nbsp; (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted odds ratio (AOR) (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepressed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot depressed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.18(0.13-0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.26(0.17-0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eUnable to read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eRead and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.64(0.39-1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.63(0.34-1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePrimary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.69(0.42-1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.86(0.47-1.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.56(0.34-0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.72(0.39-1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDiploma and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.40(0.21-0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.70(0.33-1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeizure frequency per month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.61(0.36-1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.60(0.33-1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3.15(1.85-5.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e2.24(1.23-4.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of drug\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eOnce a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTwice a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1.81(1.21-2.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1.26(0.80-2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMore than twice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3.82(2.47-5.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1.98(1.19-3.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCo-morbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1.796(1.09-2.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1.66(0.92-3.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history of mental illness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1.89(1.12-3.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1.70(0.93-3.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003epoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003emoderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.296(0.20-0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.33(0.21-0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003estrong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.36(0.23-0.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.46(0.28-0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, the prevalence of depression among people living with epilepsy was found to be 42.6% [95% CI: 38.6%\u0026ndash;46.7%]. This finding is comparable to a study conducted in Rajasthan, India (41.2%)(22),\u0026nbsp;suggesting a consistent burden of depression in epileptic populations across different regions.However, the prevalence observed in our study is lower than that reported in several other countries, including Saudi Arabia (76.7%)\u0026nbsp;(23),\u0026nbsp;Kenya(68%)(9), Burkina Faso(67.3%)\u0026nbsp;(10), and\u0026nbsp;China(52.6%)\u0026nbsp;(24). These discrepancies may stem from variations in inclusion criteria, study settings, sample characteristics, and the use of different diagnostic instruments. For instance, the study in Burkina Faso included patients with less than three months of follow-up and used the Hamilton Depression Rating Scale, whereas our study employed the PHQ-9, which may yield different estimates(10).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn contrast, our prevalence estimate was higher than those reported in Sri Lanka (22%)(25), Nigeria(26.6%)(26),\u0026nbsp;Himalayan country(31%)(3),\u0026nbsp;and several studies conducted in Ethiopia, including those at Ayder Comprehensive Specialized Hospital and Mekelle General Hospital (34.8%)(12)\u0026nbsp;and University of Gondar Comprehensive Specialized Hospital (37%)(5). These variations may reflect differences in sociocultural factors, urban versus rural residence, types of seizure disorders, or the tools used to assess depression. For example, the Sri Lankan(25),\u0026nbsp;study \u0026nbsp;used the Beck Depression Inventory-II, and the Nigerian study limited participants to ages 18\u0026ndash;60, potentially excluding older adults at higher risk of depression(26).\u003c/p\u003e\n\u003cp id=\"_Toc155401484\"\u003eOur multivariate logistic regression analysis identified residence, seizure frequency per month, frequency of drug use, and social support as independent predictors of depression among people with epilepsy. Participants residing in urban areas were 74% less likely to experience depression compared to those in rural settings. This aligns with findings from the University of Gondar(5).and may reflect the greater accessibility of healthcare services, mental health resources, and social support systems in urban environments. In contrast, patients in rural areas may face limited access to care, social isolation, and fewer coping resources, increasing their vulnerability to depression.\u003c/p\u003e\n\u003cp\u003eAdditionally, participants experiencing four or more seizures per month were over twice as likely to develop depression compared to those without recent seizures. This finding is consistent with previous studies in Gondar(5), Burkina Faso(10),\u0026nbsp;Rajasthan(22), and\u0026nbsp;Sri Lanka(25).Frequent seizures can lead to chronic fear, unpredictability, and social embarrassment, prompting individuals to avoid public spaces and isolate themselves, which in turn exacerbates feelings of hopelessness and depression. Visible symptoms like mouth foaming, involuntary urination, or loss of consciousness may further heighten stigma and self-perceived shame.\u003c/p\u003e\n\u003cp\u003eFurthermore, participants prescribed antiepileptic drugs more than twice daily were nearly twice as likely to report depressive symptoms compared to those on once-daily regimens. This finding mirrors evidence from the Himalayan region(3). The burden of frequent dosing schedules, potential medication side effects, higher treatment costs, and the behavioral effects of certain antiepileptic drugs may all contribute to worsened mental health outcomes\u0026nbsp;(27). Finally, social support emerged as a strong protective factor. Participants with moderate and strong social support were 67% and 54% less likely, respectively, to be depressed compared to those with poor support This is consistent with findings from Gondar(5) and the Himalayan region(3) reinforcing the crucial role that emotional, instrumental, and social support plays in buffering against depression. Those lacking adequate support are more prone to social isolation, while individuals with strong social ties often experience reduced stress, improved coping, and greater resilience in the face of chronic illness..\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTo minimize interviewer bias, the study employed standardized, validated diagnostic tools and structured questionnaires uniformly across all participants.\u003c/li\u003e\n \u003cli\u003eConducting the study across multiple hospitals in Addis Ababa improved the generalizability of the findings to other urban settings in Ethiopia.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eSocial desirability bias may have influenced self-reported data, particularly concerning substance use.\u003c/li\u003e\n \u003cli\u003eSome key variables\u0026mdash;such as age at epilepsy onset, duration of illness, and seizure frequency\u0026mdash;were based on self-reported medical history, potentially introducing recall bias.\u003c/li\u003e\n \u003cli\u003eThe cross-sectional design limits the ability to infer causal relationships between depression and the associated risk factors identified.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study revealed a high prevalence of depression (42.6%) among individuals with epilepsy attending public hospitals in Addis Ababa. Depression was significantly associated with residence, seizure frequency, frequency of antiepileptic drug use, and level of social support. These findings highlight the need for an integrated, biopsychosocial approach in the clinical management of epilepsy.\u003c/p\u003e"},{"header":"Recommendations","content":"\u003cp\u003e\u003cstrong\u003eHealthcare professionals\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEpilepsy patients with frequent seizures, complex drug regimens, and poor social support should be considered high-risk groups for depression and prioritized for screening and psychosocial support. Where clinically appropriate, consider switching to once-daily antiepileptic medications to minimize pill burden and improve mental well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMinister of Health\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntegrate routine depression screening into national epilepsy care guidelines. Develop and implement training programs for healthcare providers on the mental health needs of people with epilepsy, with particular focus on modifiable risk factors such as seizure control, treatment burden, and social support.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearcher:\u0026nbsp;\u003c/strong\u003eFuture studies should consider using cohort or longitudinal designs to assess temporal relationships and causal pathways between epilepsy-related factors and depression. Further research is needed to explore additional determinants\u0026mdash;including cultural, biological, and environmental influences\u0026mdash;that were beyond the scope of this study.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAOR- Adjusted odds ratio\u003c/p\u003e\n\u003cp\u003eEEG- Electroencephalogram\u003c/p\u003e\n\u003cp\u003eOPDs- Outpatient departments\u003c/p\u003e\n\u003cp\u003ePHQ-9- Patient Health Questionnaire-9\u003c/p\u003e\n\u003cp\u003ePWE- People with epilepsy\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Institutional Review Board of St. Peter Specialized Hospital, Addis Ababa, Ethiopia (Ref. No. V11/10/06/2024). All study procedures were conducted in full compliance with the Declaration of Helsinki and the applicable national and institutional ethical guidelines.\u003c/p\u003e\n\u003cp\u003ePrior to participation, all individuals received clear information about the study\u0026apos;s objectives, risks, and benefits, and provided informed consent. For participants who were unable to read or write, verbal consent was obtained in the presence of an impartial witness, as approved by the ethics committee.Participants\u0026rsquo; privacy and confidentiality were carefully protected throughout the research process. No personally identifiable information was collected, and all data were securely stored and used solely for academic and research purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and materials used in this study are available upon reasonable request. Owing to privacy concerns and institutional policies, the data cannot be made publicly accessible. Interested parties may contact [email protected] to request access to the data and materials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBemnet Yacobe Sayid served as the principal investigator and corresponding author. she led the study design, oversaw data collection and analysis, and was responsible for drafting, revising, and finalizing the manuscript. she also managed overall research coordination and ensured the integrity of the study.\u003c/p\u003e\n\u003cp\u003eAbdurehman Seid Mohammed made significant contributions to the design, data interpretation, and critical revision of the manuscript. He played a key role in refining the scientific content and enhancing the overall quality of the paper reviewed the manuscript, and approved the final version for submission.\u003c/p\u003e\n\u003cp\u003eMustofa Hassen Yesuf supported data analysis and interpretation and contributed to reviewing and improving the final draft.\u003c/p\u003e\n\u003cp\u003eHaileleul Mekonnen Tilinty participated in data collection and provided input on the interpretation of results, along with valuable feedback during manuscript revision.\u003c/p\u003e\n\u003cp\u003eAbel Melese Teka was involved in data collection and helped interpret the findings. He also contributed to reviewing the manuscript.\u003c/p\u003e\n\u003cp\u003eBemnet Fekre Butta assisted with data collection, contributed to result interpretation, and provided helpful comments during the review process.\u003c/p\u003e\n\u003cp\u003eKidist Abomsa Bedane supported data collection, contributed to interpreting findings, and participated in reviewing the draft manuscript.\u003c/p\u003e\n\u003cp\u003eNahom Zewdu Yemane took part in both data collection and analysis and contributed to the manuscript review and refinement.\u003c/p\u003e\n\u003cp\u003eMatiyas Yesma Bekele, Robel Bayou Tilahun, and Getachew Mekete Diress provided technical and academic input, reviewed the manuscript, and approved the final version for submission.\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript and agreed to take responsibility for its content\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. Epilepsy 2024 [Available from: https://www.who.int/news-room/fact-sheets/detail/epilepsy.\u003c/li\u003e\n\u003cli\u003eSadock B, Sadock V, Ruiz P, Kaplan H. Depressive Disorders. 2022. In: Kaplan \u0026amp; Sadock\u0026rsquo;s synopsis of psychiatry [Internet]. Philadelphia: Wolters Kluwer. 12th. [1215-7].\u003c/li\u003e\n\u003cli\u003eSah SK, Rai N, Sah MK, Timalsena M, Oli G, Katuwal N, et al. Comorbid depression and its associated factors in patients with epilepsy treated with single and multiple drug therapy: A cross-sectional study from the Himalayan country. Epilepsy Behav. 2020;112:107455.\u003c/li\u003e\n\u003cli\u003eLi Q, Chen D, Zhu LN, Wang HJ, Xu D, Tan G, et al. Depression in people with epilepsy in West China: Status, risk factors, and treatment gap. Seizure. 2019;66:86-92.\u003c/li\u003e\n\u003cli\u003eAddis B, Wolde M, Minyihun A, Aschalew AY. Prevalence of depression and associated factors among patients with epilepsy at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019. PLoS One. 2021;16(10):e0257942.\u003c/li\u003e\n\u003cli\u003eDessie G, Mulugeta H, Leshargie CT, Wagnew F, Burrowes S. Depression among epileptic patients and its association with drug therapy in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One. 2019;14(3):e0202613.\u003c/li\u003e\n\u003cli\u003eOgundare T, Adebowale TO, Borba CPC, Henderson DC. Correlates of depression and quality of life among patients with epilepsy in Nigeria. Epilepsy Res. 2020;164:106344.\u003c/li\u003e\n\u003cli\u003eSebera F, Dedeken P, Garrez I, Umwiringirwa J, Leers T, Ndacyayisenga JP, et al. Association of depression and epilepsy in Rwanda: A prospective longitudinal study. Epilepsy Behav. 2024;138:108993.\u003c/li\u003e\n\u003cli\u003eHodan CJ. Prevalence of Depression and Associated Factors Among Patients With Epilepsy at Kenyatta National Hospital, Kenya: University of Nairobi; 2022.\u003c/li\u003e\n\u003cli\u003eDabilgou AA, Nanema D, Drav\u0026eacute; A, Sawadogo S, Kyelem JMA, Napon C, et al. Symptoms of depression and associated risk factors in patients with epilepsy in Burkina Faso. Open Journal of Depression. 2019;8(1):29-40.\u003c/li\u003e\n\u003cli\u003eBelete A. The Magnitude of Depression and Factors Associated with it among Epileptic Patients in Ethiopia: A Systematic Review and Meta-Analysis. 2021.\u003c/li\u003e\n\u003cli\u003eSeid J, Mebrahtu K. Prevalence and associated factors of depression among people with epilepsy in Ethiopia: a cross-sectional study. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2022;58(1):105.\u003c/li\u003e\n\u003cli\u003eSylla M, Vogel AC, Bah AK, Tassiou NR, Barry SD, Djibo BA, et al. Prevalence, severity, and associations of depression in people with epilepsy in Guinea: A single-center study. Epilepsy Behav. 2020;113:107475.\u003c/li\u003e\n\u003cli\u003eSiarava E, Hyphantis T, Katsanos AH, Pelidou SH, Kyritsis AP, Markoula S. Depression and quality of life in patients with epilepsy in Northwest Greece. Seizure. 2019;66:93-8.\u003c/li\u003e\n\u003cli\u003eCoppola G, Operto FF, Matricardi S, Verrotti A. Monitoring And Managing Depression In Adolescents With Epilepsy: Current Perspectives. Neuropsychiatr Dis Treat. 2019;15:2773-80.\u003c/li\u003e\n\u003cli\u003eYang Y, Yang M, Shi Q, Wang T, Jiang M. Risk factors for depression in patients with epilepsy: A meta-analysis. Epilepsy Behav. 2020;106:107030.\u003c/li\u003e\n\u003cli\u003eGelaye B, Williams MA, Lemma S, Deyessa N, Bahretibeb Y, Shibre T, et al. Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res. 2013;210(2):653-61.\u003c/li\u003e\n\u003cli\u003eKumar PC, Cleland CM, Gourevitch MN, Rotrosen J, Strauss S, Russell L, et al. Accuracy of the Audio Computer Assisted Self-Interview version of the Alcohol, Smoking and Substance Involvement Screening Test (ACASI ASSIST) for identifying unhealthy substance use and substance use disorders in primary care patients. Drug and alcohol dependence. 2016;165:38-44.\u003c/li\u003e\n\u003cli\u003eTiki T, Birhanu A, Mamo K. Assessment of the prevalence and factors associated with perceived stigma among epileptic patients who are on follow-up at hospitals in West Shewa Zone, Central Ethiopia, institutional-based cross-sectional study, 2017. J Neurol Neurobiol. 2018;4(2).\u003c/li\u003e\n\u003cli\u003eMbuba CK, Abubakar A, Odermatt P, Newton CR, Carter JA. Development and validation of the Kilifi Stigma Scale for Epilepsy in Kenya. Epilepsy Behav. 2012;24(1):81-5.\u003c/li\u003e\n\u003cli\u003eDalgard OS, Dowrick C, Lehtinen V, Vazquez-Barquero JL, Casey P, Wilkinson G, et al. Negative life events, social support, and gender differences in depression: a multinational community survey with data from the ODIN study. Soc Psychiatry Psychiatr Epidemiol. 2006;41(6):444-51.\u003c/li\u003e\n\u003cli\u003eBaniya GC, Verma K. Prevalence of depression, risk factors, and quality of life in patients with epilepsy in a remote area of western Rajasthan. Epilepsy Behav. 2022;127:108488.\u003c/li\u003e\n\u003cli\u003eMubaraki AA, Sibyani AK, Alkhawtani RA, Alqahtani BG, Abu Alaynayn FK. Prevalence of depression among epileptic patients in Taif City, Saudi Arabia. Neurosciences (Riyadh). 2021;26(4):366-71.\u003c/li\u003e\n\u003cli\u003eWang HJ, Tan G, Deng Y, He J, He YJ, Zhou D, et al. Prevalence and risk factors of depression and anxiety among patients with convulsive epilepsy in rural West China. Acta Neurol Scand. 2018;138(6):541-7.\u003c/li\u003e\n\u003cli\u003eDe Silva S, Isuru A, Rodrigo A, Kuruppuarachchi L. Prevalence and correlates of depression in patients with epilepsy in Sri Lanka. Ceylon Med J. 2021;66(3):138-43.\u003c/li\u003e\n\u003cli\u003eMadandola NO, Sale S, Adebisi AS, Obembe A, Salihu AS, Bakare AT, et al. Sociodemographic and Clinical Variables of Depression among Patients with Epilepsy in a Neuropsychiatric Hospital in Nigeria. Depress Res Treat. 2020;2020:2953074.\u003c/li\u003e\n\u003cli\u003eMula M, Sander JW. Negative effects of antiepileptic drugs on mood in patients with epilepsy. Drug Saf. 2007;30(7):555-67.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Depression, Epileptic patients, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-7067593/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7067593/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eDepression is a common and serious psychiatric comorbidity among individuals living with epilepsy. It is associated with poor treatment outcomes, reduced quality of life, and increased disability. Despite this, depression in people with epilepsy often remains unrecognized, particularly in low-resource settings. This study aimed to assess the prevalence of depression and identify its associated factors among patients with epilepsy in public hospitals in Addis Ababa, Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: An institution-based cross-sectional study was conducted from July 1 to 30, 2024, involving 591 individuals with epilepsy attending follow-up clinics at Eka Kotebe General Hospital, St. Paul’s Hospital Millennium Medical College, and Yekatit 12 Hospital Medical College. Participants were selected using systematic random sampling. Descriptive statistics were used to summarize sociodemographic and clinical data. Binary logistic regression analysis was applied to identify independent factors associated with depression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was determined at a p-value of ≤ 0.05. Model fitness was evaluated using the Hosmer–Lemeshow test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The prevalence of depression among people with epilepsy was found to be 42.6%. Depression was significantly associated with urban residence (AOR = 0.26; 95% CI: 0.17–0.39), increased seizure frequency per month (AOR = 2.24; 95% CI: 1.23–4.10), frequency of medication use (AOR = 1.98; 95% CI: 1.19–3.28), and lower levels of social support (AOR = 0.33; 95% CI: 0.21–0.52 for moderate support, and AOR = 0.46; 95% CI: 0.28–0.77 for strong support).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Depression is highly prevalent among individuals with epilepsy in Addis Ababa. Patients experiencing frequent seizures, increased medication burden, and limited social support are at significantly higher risk. These findings underscore the urgent need to integrate routine depression screening and mental health support into epilepsy care services in Ethiopia.\u003c/p\u003e","manuscriptTitle":"Prevalence and Determinants of Depression Among Epilepsy Patients in Addis Ababa, Ethiopia 2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 07:52:29","doi":"10.21203/rs.3.rs-7067593/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"51ae8298-33ae-4f82-bb8f-00b1e6cf8a6f","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-27T07:52:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 07:52:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7067593","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7067593","identity":"rs-7067593","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}