Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Accounting for comorbidity in assessing the burden of epilepsy among US adults: results from the National Comorbidity Survey Replication (NCS-R)

Molecular Psychiatry volume 17, pages 748–758 (2012)Cite this article

Abstract

Although epilepsy is associated with substantial role impairment, it is also highly comorbid with other physical and mental disorders, making unclear the extent to which impairments associated with epilepsy are actually due to comorbidities. This issue was explored in the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of 5692 US adults. Medically recognized epilepsy was ascertained with self-report, comorbid physical disorders with a chronic conditions checklist, and comorbid DSM-IV mental disorders with the Composite International Diagnostic Interview. Lifetime epilepsy prevalence was estimated at 1.8%. Epilepsy was comorbid with numerous neurological and general medical conditions and with a sporadic cluster of mental comorbidities (panic, PTSD, conduct disorder and substance use disorders). Although comorbid disorders explain part of the significant gross associations of epilepsy with impairment, epilepsy remains significantly associated with work disability, cognitive impairment and days of role impairment after controlling comorbidities. The net association of epilepsy with days of role impairment after controlling for comorbidities is equivalent to an annualized 89.4 million excess role impairment days among US adults with epilepsy, arguing that role impairment is a major component of the societal costs of epilepsy per se rather than merely due to disorders comorbid with epilepsy. This estimated burden is likely conservative as some parts of the effects of epilepsy are presumably mediated by secondary comorbid disorders.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Banerjee PN, Filippi D, Allen-Hauser W . The descriptive epidemiology of epilepsy-a review. Epilepsy Res 2009; 85: 31–45.

    Article  Google Scholar 

  2. Leonardi M, Ustun TB . The global burden of epilepsy. Epilepsia 2002; 43 (Suppl 6): 21–25.

    Article  Google Scholar 

  3. Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R . How common are the ‘common’ neurologic disorders? Neurology 2007; 68: 326–337.

    Article  CAS  Google Scholar 

  4. de Boer HM, Mula M, Sander JW . The global burden and stigma of epilepsy. Epilepsy Behav 2008; 12: 540–546.

    Article  Google Scholar 

  5. Bazil CW . Comprehensive care of the epilepsy patient—control, comorbidity, and cost. Epilepsia 2004; 45 (Suppl 6): 3–12.

    Article  Google Scholar 

  6. Strzelczyk A, Reese JP, Dodel R, Hamer HM . Cost of epilepsy: a systematic review. Pharmacoeconomics 2008; 26: 463–476.

    Article  Google Scholar 

  7. Ivanova JI, Birnbaum HG, Kidolezi Y, Qiu Y, Mallett D, Caleo S . Direct and indirect costs associated with epileptic partial onset seizures among the privately insured in the United States. Epilepsia 2010; 51: 838–844.

    Article  Google Scholar 

  8. Ottman R, Lipton RB, Ettinger AB, Cramer JA, Reed ML, Morrison A et al. Comorbidities of epilepsy: results from the Epilepsy Comorbidities and Health (EPIC) survey. Epilepsia 2011; 52: 308–315.

    PubMed  Google Scholar 

  9. Tellez-Zenteno JF, Matijevic S, Wiebe S . Somatic comorbidity of epilepsy in the general population in Canada. Epilepsia 2005; 46: 1955–1962.

    Article  Google Scholar 

  10. Zaccara G . Neurological comorbidity and epilepsy: implications for treatment. Acta Neurol Scand 2009; 120: 1–15.

    Article  CAS  Google Scholar 

  11. Kessler RC, Merikangas KR . The National Comorbidity Survey Replication (NCS-R): background and aims. Int J Methods Psychiatr Res 2004; 13: 60–68.

    Article  Google Scholar 

  12. Kessler RC, Berglund P, Chiu WT, Demler O, Heeringa S, Hiripi E et al. The US National Comorbidity Survey Replication (NCS-R): design and field procedures. Int J Methods Psychiatr Res 2004; 13: 69–92.

    Article  Google Scholar 

  13. Kessler RC, stün TB . The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004; 13: 93–121.

    Article  Google Scholar 

  14. Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R et al. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 2006; 15: 167–180.

    Article  Google Scholar 

  15. Elliott JO, Lu B, Shneker B, Charyton C, Layne Moore J . Comorbidity, health screening, and quality of life among persons with a history of epilepsy. Epilepsy Behav 2009; 14: 125–129.

    Article  Google Scholar 

  16. Layne Moore J, Elliott JO, Lu B, Klatte ET, Charyton C . Serious psychological distress among persons with epilepsy based on the 2005 California Health Interview Survey. Epilepsia 2009; 50: 1077–1084.

    Article  CAS  Google Scholar 

  17. Strine TW, Kobau R, Chapman DP, Thurman DJ, Price P, Balluz LS . Psychological distress, comorbidities, and health behaviors among U.S. adults with seizures: results from the 2002 National Health Interview Survey. Epilepsia 2005; 46: 1133–1139.

    Article  Google Scholar 

  18. Tellez-Zenteno JF, Patten SB, Jette N, Williams J, Wiebe S . Psychiatric comorbidity in epilepsy: a population-based analysis. Epilepsia 2007; 48: 2336–2344.

    PubMed  Google Scholar 

  19. Kelvin EA, Hesdorffer DC, Bagiella E, Andrews H, Pedley TA, Shih TT et al. Prevalence of self-reported epilepsy in a multiracial and multiethnic community in New York City. Epilepsy Res 2007; 77: 141–150.

    Article  Google Scholar 

  20. Ottman R, Barker-Cummings C, Leibson CL, Vasoli VM, Hauser WA, Buchhalter JR . Validation of a brief screening instrument for the ascertainment of epilepsy. Epilepsia 2010; 51: 191–197.

    Article  Google Scholar 

  21. Merikangas KR, Ames M, Cui L, Stang PE, Ustun TB, Von Korff M et al. The impact of comorbidity of mental and physical conditions on role disability in the US adult household population. Arch Gen Psychiatry 2007; 64: 1180–1188.

    Article  Google Scholar 

  22. Schoenborn CA, Adams PF, Schiller JS . Summary health statistics for the U.S. population: National Health Interview Survey, 2000. Vital Health Stat 10 2003; 214: 1–83.

    Google Scholar 

  23. Knight M, Stewart-Brown S, Fletcher L . Estimating health needs: the impact of a checklist of conditions and quality of life measurement on health information derived from community surveys. J Public Health Med 2001; 23: 179–186.

    Article  CAS  Google Scholar 

  24. Garin O, Ayuso-Mateos JL, Almansa J, Nieto M, Chatterji S, Vilagut G et al. Validation of the ‘World Health Organization Disability Assessment Schedule, WHODAS-2’ in patients with chronic diseases. Health Qual Life Outcomes 2010; 8: 51.

    Article  Google Scholar 

  25. Wallesch CW, Schlote A . WHODAS II - practical and theoretical issues. Disabil Rehabil 2010; 32: 685–686.

    Article  Google Scholar 

  26. Scott KM . The joint association of mental and physical conditions with disability. In: Von Korff MR, Scott KM, Gureje O (eds). Global Perspectives on Mental–Physical Comorbidity in the WHO World Mental Health Surveys. Cambridge University Press: New York, 2009.

    Google Scholar 

  27. Kessler RC, Ames M, Hymel PA, Loeppke R, McKenas DK, Richling DE et al. Using the World Health Organization Health and Work Performance Questionnaire (HPQ) to evaluate the indirect workplace costs of illness. J Occup Environ Med 2004; 46: S23–S37.

    Article  Google Scholar 

  28. Wolter KM . Introduction to Variance Estimation. Springer-Verlag: New York, 1985.

    Google Scholar 

  29. Research Triangle Institute. SUDAAN: Professional Software for Survey Data Analysis, Computer program, 8.0.1 Version. Research Triangle Institute: Research Triangle Park, NC, 2002.

  30. Ferguson PL, Chiprich J, Smith G, Dong B, Wannamaker BB, Kobau R et al. Prevalence of self-reported epilepsy, health care access, and health behaviors among adults in South Carolina. Epilepsy Behav 2008; 13: 529–534.

    Article  Google Scholar 

  31. Kobau R, DiIorio CA, Price PH, Thurman DJ, Martin LM, Ridings DL et al. Prevalence of epilepsy and health status of adults with epilepsy in Georgia and Tennessee: Behavioral Risk Factor Surveillance System, 2002. Epilepsy Behav 2004; 5: 358–366.

    Article  Google Scholar 

  32. Kobau R, Zahran H, Grant D, Thurman DJ, Price PH, Zack MM . Prevalence of active epilepsy and health-related quality of life among adults with self-reported epilepsy in California: California Health Interview Survey, 2003. Epilepsia 2007; 48: 1904–1913.

    Article  Google Scholar 

  33. Kobau R, Zahran H, Thurman DJ, Zack MM, Henry TR, Schachter SC et al. Epilepsy surveillance among adults—19 States, Behavioral Risk Factor Surveillance System, 2005. MMWR Surveill Summ 2008; 57: 1–20.

    PubMed  Google Scholar 

  34. Theodore WH, Spencer SS, Wiebe S, Langfitt JT, Ali A, Shafer PO et al. Epilepsy in North America: a report prepared under the auspices of the global campaign against epilepsy, the International Bureau for Epilepsy, the International League Against Epilepsy, and the World Health Organization. Epilepsia 2006; 47: 1700–1722.

    Article  Google Scholar 

  35. Tellez-Zenteno JF, Pondal-Sordo M, Matijevic S, Wiebe S . National and regional prevalence of self-reported epilepsy in Canada. Epilepsia 2004; 45: 1623–1629.

    Article  Google Scholar 

  36. Baker GA . The psychosocial burden of epilepsy. Epilepsia 2002; 43 (Suppl 6): 26–30.

    Article  Google Scholar 

  37. Krishnamoorthy ES, Gilliam F . Best clinical and research practice in adult epileptology. Epilepsy Behav 2009; 15 (Suppl 1): S55–S59.

    Article  Google Scholar 

  38. Gaitatzis A, Carroll K, Majeed A, Sander JW . The epidemiology of the comorbidity of epilepsy in the general population. Epilepsia 2004; 45: 1613–1622.

    Article  Google Scholar 

  39. Gaitatzis A, Trimble MR, Sander JW . The psychiatric comorbidity of epilepsy. Acta Neurol Scand 2004; 110: 207–220.

    Article  CAS  Google Scholar 

  40. Kanner AM . Postictal phenomena in epilepsy. In: Schachter SC, Holmes GL, Kastleijn-Nolst Trenite DGA (eds). Behavioral Aspects of Epilepsy. Demos Medical Publishing: New York, 2008 pp, 105–116.

    Google Scholar 

  41. Sandstrom SA, Bowman ES, Johnson CS, Salanova V . Interictal mood disorder and quality of life in active epilepsy. Epilepsy Behav 2010; 17: 199–204.

    Article  Google Scholar 

  42. Trinka E, Kienpointner G, Unterberger I, Luef G, Bauer G, Doering LB et al. Psychiatric comorbidity in juvenile myoclonic epilepsy. Epilepsia 2006; 47: 2086–2091.

    Article  Google Scholar 

  43. Forsgren L . Prevalence of epilepsy in adults in northern Sweden. Epilepsia 1992; 33: 450–458.

    Article  CAS  Google Scholar 

  44. Krishnamoorthy ES, Trimble MR, Blumer D . The classification of neuropsychiatric disorders in epilepsy: a proposal by the ILAE Commission on Psychobiology of Epilepsy. Epilepsy Behav 2007; 10: 349–353.

    Article  CAS  Google Scholar 

  45. Mula M, Jauch R, Cavanna A, Gaus V, Kretz R, Collimedaglia L et al. Interictal dysphoric disorder and periictal dysphoric symptoms in patients with epilepsy. Epilepsia 2010; 51: 1139–1145.

    Article  Google Scholar 

  46. Mula M, Schmitz B, Jauch R, Cavanna A, Cantello R, Monaco F et al. On the prevalence of bipolar disorder in epilepsy. Epilepsy Behav 2008; 13: 658–661.

    Article  Google Scholar 

  47. Samokhvalov AV, Irving H, Mohapatra S, Rehm J . Alcohol consumption, unprovoked seizures, and epilepsy: a systematic review and meta-analysis. Epilepsia 2010; 51: 1177–1184.

    Article  Google Scholar 

  48. Holland P, Lane S, Whitehead M, Marson AG, Jacoby A . Labor market participation following onset of seizure and early epilepsy: findings from A UK cohort. Epilepsia 2009; 50: 1030–1039.

    Article  Google Scholar 

  49. Smeets VM, van Lierop BA, Vanhoutvin JP, Aldenkamp AP, Nijhuis FJ . Epilepsy and employment: literature review. Epilepsy Behav 2007; 10: 354–362.

    Article  Google Scholar 

  50. Baker GA, Taylor J, Hermann B . How can cognitive status predispose to psychological impairment? Epilepsy Behav 2009; 15 (Suppl 1): S31–S35.

    Article  Google Scholar 

  51. Long L, Reeves AL, Moore JL, Roach J, Pickering CT . An assessment of epilepsy patients’ knowledge of their disorder. Epilepsia 2000; 41: 727–731.

    Article  CAS  Google Scholar 

  52. Reynders HJ . Social and emotional information processing. In: Schacter SC, Holmes GL, Trenite K-N (eds). Behavioral Aspects of Epilepsy Principles & Practice. Demos: New York, 2008 pp, 181–186.

    Google Scholar 

  53. Swinkels WA, van Emde Boas W, Kuyk J, van Dyck R, Spinhoven P . Interictal depression, anxiety, personality traits, and psychological dissociation in patients with temporal lobe epilepsy (TLE) and extra-TLE. Epilepsia 2006; 47: 2092–2103.

    Article  Google Scholar 

Download references

Acknowledgements

The National Comorbidity Survey Replication (NCS-R) is supported by the US National Institute of Mental Health (U01-MH60220) with supplemental support from the National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708) and the John W Alden Trust. Kessler had full access to all of the data in the current report and takes responsibility for the integrity of the data and the accuracy of the data analysis. The views and opinions expressed in the report are ours and should not be construed to represent the views of any of the sponsoring organizations, agencies or US Government. A complete list of NCS publications, the full text of all NCS-R instruments and a public use version of the entire individual level NCS-R data set can be found at http://www.hcp.med.harvard.edu/ncs. The NCS-R is carried out in conjunction with the World Health Organization (WHO) and World Mental Health (WMH) Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork and consultation on data analysis. These activities were supported by the National Institute of Mental Health (R01 MH070884), the John D and Catherine T MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R01-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline and Bristol-Myers Squibb. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.

Author information

Authors and Affiliations

  1. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    R C Kessler, M C Lane & V Shahly

  2. Johnson & Johnson Pharmaceutical Research & Development, LLC, Titusville, NJ, USA

    P E Stang

Authors
  1. R C Kessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M C Lane
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V Shahly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P E Stang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R C Kessler.

Ethics declarations

Competing interests

Preparation of this report was supported, in part, by Ortho-McNeil Janssen Scientific Affairs, LLC. Dr Kessler has served as a paid consultant for GlaxoSmithKline, Kaiser Permanente, Pfizer, Sanofi-Aventis, Shire Pharmaceuticals and Wyeth-Ayerst; has served on advisory boards for Eli Lilly & Company and Wyeth-Ayerst; and has had research support for his epidemiological studies from Bristol-Myers Squibb, Eli Lilly & Company, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho-McNeil Pharmaceuticals, Pfizer Inc and Sanofi-Aventis. Dr Stang is an employee of Johnson & Johnson Pharmaceuticals Research and Development, who has a product for epilepsy. Mr Lane and Dr Shahly report no disclosures. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kessler, R., Lane, M., Shahly, V. et al. Accounting for comorbidity in assessing the burden of epilepsy among US adults: results from the National Comorbidity Survey Replication (NCS-R). Mol Psychiatry 17, 748–758 (2012). https://doi.org/10.1038/mp.2011.56

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/mp.2011.56

Keywords

This article is cited by

Search

Advanced search

Quick links