Individual and family factors associated with self-esteem in young people with epilepsy: A multiple mediation analysis

Objective As young people experience added demands from living with epilepsy, which may lead to poor psychosocial adjustment, it is essential to examine mechanisms of change to provide practitioners with knowledge to develop effective interventions. The aim of this study was to examine individual and family-level factors – stress and illness perceptions, coping behaviors and family resilience – that promote or maintain young people's self-esteem. Methods From November 2013 to August 2014, young people attending a neurology clinic in KK Women's and Children's Hospital, Singapore, participated in a cross-sectional survey (n = 152; 13–16 years old). Multiple mediation analyses were conducted to evaluate whether these variables mediated the relationship between illness severity (i.e., low, moderate, high) and self-esteem. Results Multiple mediation analyses demonstrated that illness severity had a direct effect on young people's self-esteem. Compared to those with moderate illness severity (reference group), young people with low severity had significantly higher self-esteem (c = 3.42, p < 0.05); while those with high severity had a more negative view of themselves (c = − 3.93, p < 0.001). Illness severity also had an indirect influence on self-esteem through its effects on mediators, such as perceived stress, illness perceptions and family resilience (D₁: Total ab = 3.46, 95% CI 1.13, 5.71; D₂: Total ab = − 2.80, 95% CI − 4.35, − 1.30). However, young people's coping levels did not predict their self-esteem, when accounting for the effects of other variables. Significance The continued presence of seizure occurrences is likely to place greater demands on young people and their families: in turn, increased stress and negative illness perceptions negatively affected family processes that promote resilience. As the mediating effect of these modifiable factors were above and beyond the contributions of illness characteristics and young people's levels of coping, this has implications for developing individual and family interventions aimed to support young people living with epilepsy.