The biopsychosocial model and quality of life in persons with active epilepsy

Background: Despite a long recognized need in the field of the importance of the psychological and social factors in persons with epilepsy (PWE), the medical community has continued to focus primarily on seizures and their treatment (the biological-biomedical model). From the biopsychosocial perspective, a person's lived experience needs to be incorporated into the understanding of quality of life. While the biopsychosocial model has gained prominence over the years, it has not been studied much in epilepsy. Methods: The study sample included 1720 PWE from the 2003 and the 2005 Canadian Community Health Survey (CCHS). Data were analyzed using set correlation, as it allows for the examination of the relative contribution of sets of independent variables (biological, psychological, and social domains) and a set of dependent variables (quality of life) of interest, defined as self-rated health status, self-rated mental health status, and life satisfaction. Results: Results provide strong evidence that the full biopsychosocial model explained a significantly larger amount of variance in quality of life (R-2 = 55.0%) compared with the biological-biomedical model alone (R-2 = 24.8%). When the individual domains of the biopsychosocial model were controlled for, the psychological (R-2 = 24.6%) and social (R-2 = 18.5%) domains still explained a greater amount of the variance in quality of life compared with the biological-biomedical model (R-2 = 14.3%). Conclusions: While seizure freedom will continue to be an important treatment goal in epilepsy, the psychological and social domains are an important consideration for both interventional programs and clinical research designed to improve quality of life in PWE. Better integration of social workers and psychologists into routine care may help address these disparities. (C) 2014 Elsevier Inc. All rights reserved.