This study aimed to estimate the prevalence and risk factors of CMDs using SRQ-20 in PWEs in Goma (DRC). The results indicate that CMDs were prevalent in 39.1% of PWEs in the study. The presence of medical co-morbidity and a high number of seizures (≥ 5) were identified as determinants of CMDs. These findings suggest the need for medical and psychological care to be provided specifically for CMDs when treating PWEs. Therefore, establishing a link between psychiatric and neurological services for PWEs is crucial. The presence of CMDs may negatively impact the outcome of the management of PWEs. As epilepsy is the most common neurological problem with an organic origin that is not always recognized due to mistaken beliefs, assessing the extent of CMDs and their determinants is essential in developing countries such as the DRC [19].
Several previous studies have reported comparable prevalences to that found in this study, such as 35-35.8% in Ethiopia [16, 20], 35.5% in Iceland [21], 36.5% in the United States [12], and 37% in Europe [22]. However, some studies found significantly higher prevalence rates ranging from 45–80% [15, 23–30], while other studies reported lower prevalences ranging from 5.9–29% [11, 31–33]. Differences in sample size, assessment instruments used, and epilepsy patterns may explain the variation in prevalence across studies. Unlike other studies that focused only on temporal lobe epilepsy, which has a higher risk of CMD [25], this study assessed all types of epilepsy.
Numerous studies have unanimously shown that the most CMDs in PWEs are anxiety and depression [4, 34–36]. The prevalence of these disorders differs from study to study. This could be explained by methodological differences, mainly concerning the choice of measuring instruments used and the scores used to assess the severity of anxiety and depression symptoms. However, results of this study showed that the prevalence of CMDs was nearly three times that of the World Health Organization report on the global burden of CMDs (14%) in the general population [37], indicating that the burden of CMDs in PWEs in the eastern DRC is higher than in the general population. This would be the result of problems faced by PWEs, including the state of epileptic seizures, the financial burden of treatment, side effects of medicines, and community discrimination related to an epileptic seizure.
The study confirms that the development of CMDs in PWEs is associated with the presence of co-morbid medical conditions (aOR = 3.1; 95% CI: 1.5–6.4). This finding is consistent with a similar Ethiopian study, which reported that PWEs with medical co-morbidities were three times more likely to experience CMDs than those without medical co-morbidities (aOR = 2.99; 95% CI: 1.95–9.39) [16]. This could be attributed to the negative impact of medical conditions on the quality of life of PWEs, as suggested by other studies [38].
Participants with 5 or more seizures were nearly four times more likely to develop a CMD compared to those with fewer than 5 seizures in the month prior to the survey (aOR = 3.8; 95% CI: 1.7–8.3). Consistent with our study, Mekuriaw et al. [39] reported in a recent Ethiopian study that PWEs who had uncontrolled seizures in the year prior to the survey were more likely to have CMDs than their counterparts (aOR = 1.96; 95% CI: 1.21–3.18). This association could be explained by the fact that people with uncontrolled epileptic seizures usually become desperate and may lack confidence in drug therapies [40].
The persistence of seizures, often due to poor adherence, can lead PWEs to develop additional physical conditions or co-morbidities, as well as feelings of desperation due to the incurability of the disease and medication fatigue [39]. Non-compliance with medication can result in reduced seizure control, decreased quality of life, decreased productivity, or even job loss due to seizures, as stated by Mekuriaw et al. [39]. Recurrent epileptic seizures that complicate CMDs establish a bidirectional interaction between epilepsy and CMD.
This study has several limitations. The findings may not be applicable to the entire Congolese population as the research was conducted in only one city. Self-reported questionnaires used to assess mental health issues may be influenced by a positivist bias, overestimating actual mental health values and recall bias. Additionally, due to the cross-sectional nature of the study design, it is difficult to establish causality between CMDs and its associated risk factors.