Clinical relevance of seizure self-efficacy in pediatric epilepsy: Its associations with depression and anxiety.
BACKGROUND Although seizure self-efficacy is recognized as an important factor in epilepsy management, its relationship with psychological outcomes such as depression and anxiety in pediatric populations remains underexplored. This study aimed to evaluate seizure self-efficacy in children and adolescents with epilepsy and to examine its associations with depression, anxiety, and relevant clinical and psychosocial factors. METHODS This cross-sectional observational study included 121 patients aged 9-17 years with epilepsy. Seizure self-efficacy was assessed using the Seizure Self-Efficacy Scale for Children (SSES-C), while depressive symptoms and anxiety levels were measured using the Children's Depression Inventory (CDI) and the State-Trait Anxiety Inventory for Children (STAIC). Associations were analyzed using correlation and group comparison tests, and multivariable logistic regression was performed to identify independent predictors of depression. RESULTS The median age was 14 years (IQR: 12-15), and 53.7% were male. The median self-efficacy score was 3.80 (IQR: 3.20-4.40). Seizure self-efficacy was significantly and inversely correlated with depression (r = - 0.546), state anxiety (r = - 0.437), and trait anxiety (r = - 0.348) (all p < 0.001). Depression showed strong positive correlations with both anxiety measures. Patients with lower self-efficacy had higher depression and anxiety scores, with a clear gradient across levels. In multivariable analysis, lower self-efficacy remained independently associated with depression (OR: 0.35, p = 0.001). Lower income and lack of family support were also independent risk factors. CONCLUSION Seizure self-efficacy is closely associated with psychological outcomes in pediatric epilepsy and may represent a modifiable risk factor for depression. These findings support routine assessment and targeted interventions, although they should be interpreted in light of the study's single-center, cross-sectional design and reliance on self-reported measures, which may limit generalizability and preclude causal inferences.