The 'make or break' impact of family dynamics on psychological outcomes in focal epilepsy.

Abstract

Living with epilepsy can shape the dynamics of the whole family unit. The first objective of this study was to establish the reliability and validity of our purpose-built online family mapping tool, 'Living with Epilepsy'. Our second objective was to identify distinct patterns of emotional closeness between family members (family typologies), and explore (i) whether family typologies are shaped by epilepsy-related factors, and (ii) which typologies confer optimal psychological outcomes to people with epilepsy. 91 adults with chronic epilepsy and their caregivers (n=56) participated and 70 similarly-aged healthy controls and 36 caregiver controls (N=253). Purpose-built software assessed a range of epilepsy-specific psychosocial issues, including family mapping. Questionnaires validated for epilepsy evaluated mood and quality of life (QOL). The reliability and validity of the family mapping tool was established. Family maps revealed three typologies varying in emotional closeness, each with distinct patterns of healthy versus maladaptive family behaviour: Extremely Close (32%), Close (54%), and Fractured (14%). There was no difference in the frequency of typology between epilepsy and control families (P>.05). Within the epilepsy cohort, however, patients with seizure onset in childhood largely belonged to the extreme typologies; Extremely Close (47%) or Fractured (42%). In comparison, those with adolescent or adult onset commonly belonged to the moderate, Close typology (53%). People with epilepsy from Extremely Close families reported significantly higher QOL (P=.013) and lower mood symptoms (P=.008) relative to other typologies; no such association was found for controls or caregivers (P>.05). These findings suggest that adults whose epilepsy commenced in childhood are likely to have extreme family dynamics characterised by either being brought closer together or driven apart. Extremely close families appear highly adaptive for people with epilepsy, bringing benefits for mood and QOL not seen in their caregivers nor controls. The results provide strong empirical support for the value of an emotionally supportive family when living with epilepsy, and suggest that fostering healthy connections within epilepsy families can optimise long-term patient wellbeing.