Self‐esteem mediates mental health outcomes in young people with epilepsy

OBJECTIVE: To evaluate the extent to which self-esteem mediates the impacts of epilepsy-specific and environmental factors on mental health outcomes in young people with epilepsy. METHODS: A prospective cohort of 480 young people with epilepsy and their families participated in five visits over 28 months. We collected data on clinical seizure burden, cognitive comorbidity, peer and parental support, self-esteem, and self-reported mental health symptoms. We used structural equation modeling to specify and test relationships among these constructs simultaneously. Direct, indirect, and total effects were estimated with confidence intervals constructed through bias-corrected bootstrapping. RESULTS: Self-esteem mediated the effects of clinical seizure burden ( $\beta$  = 0.23, 95% confidence interval [0.05, 0.42]) and peer support ( $\beta$  = -0.15, 95% CI [-0.28, -0.03]) on mental health. There were no mediating effects of parental support ( $\beta$  = -0.07, 95% CI [-0.14, 0.00]) or cognitive comorbidity ( $\beta$  = -0.01, 95% CI [-0.02, 0.01]) on mental health. SIGNIFICANCE: We found evidence that self-esteem mediates the impact that both clinical seizure burden and peer support have on mental health outcomes, indicating that assessment of and interventions targeting self-esteem may be appropriate for young people with epilepsy. Supporting self-esteem could mitigate negative influences on mental health, whether from resistant epilepsy or low peer support.