Electronic Thesis and Dissertation Repository

Degree

Doctor of Philosophy

Program

Epidemiology and Biostatistics

Supervisor

Dr. Kathy Nixon Speechley

Abstract

Having a child diagnosed with a chronic illness such as epilepsy is a major source of stress for caregivers. Up to half of mothers of children with epilepsy are at increased risk for clinical depression and symptoms of maternal depression are associated with poorer health outcomes in these children. The purpose of this study was to: 1) estimate the prevalence and course of depressive symptoms over 24 months among mothers of children with new-onset epilepsy; 2) identify subgroups of mothers that share similar trajectories of depressive symptoms; and, 3) assess the family factors involved in the causal pathway between maternal depressive symptoms and child health-related quality of life.

The data for this study originated from the Health-related Quality of Life of Children with Epilepsy Study (HERQULES), a national prospective cohort study designed to examine the determinants of health-related quality of life in children with epilepsy during the first 24 months after diagnosis. A total of 339 mothers participated in the study. Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale and health-related quality of life was measured with the Quality of Life in Childhood Epilepsy. Maternal, child, and family factors were measured using valid and reliable measures with a proven track record of use in this population. Multiple regression was utilized to test whether depressive symptoms affected mothers’ reports of child outcomes. Latent class growth modeling and multinomial logistic regression were used to identify trajectories of depressive symptoms and predictors of trajectory group membership, respectively. Individual growth curve modeling was used to examine the impact of maternal depressive symptoms on child health-related quality of life, including the moderating and mediating effects of the family environment.

Depressive symptoms were not observed to affect mothers’ reports of child health-related quality life in this sample. Four distinct trajectories of depressive symptoms were observed: low stable, borderline, moderate increasing, and high decreasing. A unique set of predictors was found for membership in each trajectory group. Maternal depressive symptoms were found to have a negative impact on child health-related quality of life during the 24 month follow-up. This relationship was moderated by family resources and the magnitude of moderation varied over time. The relationship between depressive symptoms and health-related quality of life was mediated by family functioning and family demands.

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