EPILEPSY self-management improved as depression eased and self-efficacy rose during the evidence-based SMART intervention.
A randomized controlled trial of 160 people with epilepsy found that improvements in depressive symptoms and epilepsy self-efficacy partly explained gains in epilepsy self-management after participation in SMART, an evidence-based self-management program.
The analysis evaluated whether three factors, depressive symptom severity, epilepsy self-efficacy, and perceived stigma, mediated the association between SMART and improved epilepsy self-management. These potential mediators were measured at baseline, 13 weeks, and 6 months, with multivariable linear regression used to estimate direct and indirect effects.
Mood and Self-Efficacy Were Key Pathways
Improvement in depressive symptoms from baseline to 6 months significantly mediated the effect of SMART on Epilepsy Self-Management Scale improvement. The average causal mediation effect was 0.83, with a p value of 0.0089. This pathway accounted for 23.2% of the total effect, with a 95% CI of 4.4–41.9% and a p value of 0.015.
Self-efficacy also emerged as a significant mediator. Increases in epilepsy self-efficacy from baseline to 6 months were associated with improved self-management, with an average causal mediation effect of 0.155 and a p value of 0.0095. This pathway accounted for 4.6% of the total effect, with a 95% CI of 2.0–7.3% and a p value of 0.00063.
Together, the findings suggest that epilepsy self-management interventions may work not only by teaching practical skills, but also by improving mood and strengthening patients’ confidence in their ability to manage seizures and related challenges.
Stigma Did Not Significantly Mediate Outcomes
Changes in perceived stigma did not significantly mediate the relationship between SMART and self-management improvement. This does not rule out stigma as a clinically important concern in epilepsy care, but in this analysis, it did not explain the observed improvement in epilepsy self-management.
The larger mediating role of depressive symptom improvement highlights mood as a potentially important target for clinicians supporting people with epilepsy. The findings also reinforce the relevance of self-efficacy in epilepsy care, particularly when designing programs intended to improve long-term self-management competency.
For healthcare professionals, the study supports a broader view of epilepsy self-management, one that integrates seizure-related skills with attention to depression, patient confidence, and psychosocial barriers.
Reference
Armah L et al. Mediating effects of depression, stigma, and self-efficacy on self-management improvement in an evidence-based epilepsy self-management program. Epilepsy Behav. 2026;182:111117.
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