Abstracts

Rationale: Childhood epilepsy is prevalent with a high risk of impaired quality of life (QOL). Understanding the causes and mechanisms of QOL in children with epilepsy to date has been based in conceptual work, small studies or cross-sectional regression models. The objective of this study was to test a previously published regression's existing direct pathways against a nested indirect paths model to demonstrate relationships among biomedical, comorbidity, child and family factors of QOL through the use a of structural equation modelling (SEM). Methods: Comprehensive demographic, seizure information, and chid and parent reports of health and health-related outcomes were collected from 502 patients with varying seizure types and severity across seven clinical epilepsy and neurology programs within Canada as part of a longitudinal study of QOL. The measurement structure of latent constructs included biomedical, comorbidity, child, and family factors which were tested with confirmatory factor analysis. An a priori regression model of QOL was compared to a model which included the same constructs but with added indirect pathways using path analysis using the Chi square goodness of fit test. Results: The results supported the direct influence of child and family psychosocial factors on QOL. However, the model that included both direct and indirect pathways among the constructs of biomedical, comorbidity, child and family factors as predictors of QOL demonstrated stronger fit using Chi square statistics than the model that included only direct effects. Conclusions: The SEM approach provided enhanced understanding of the mechanisms contributing to QOL by including both direct and indirect relationships among constructs. While prior regression approaches and the current SEM approach highlighted the importance of child and family factors to QOL in children with epilepsy, SEM that includes the changes in these variables longitudinally will provide information about the extent to which these constructs are merely related to or cause the QOL difficulties experienced by children with epilepsy.