Relationships between Personality, Executive Functions, Perceived Stigma, and Epilepsy- Related Social Well-being in Socioeconomically Disadvantaged and Racially/Ethnically Diverse Adults with Medically Refractory Epilepsy

Abstract

Background: Perceived epilepsy stigma and reduced social well-being are prevalent sources of distress among people with epilepsy. Yet, research on patient-level correlates of these difficulties is lacking, especially among underserved groups.;Methods: Socioeconomically disadvantaged and racially/ethnically diverse adults with intractable seizures (N=60, 62% female; 79% Black, 20% Hispanic/Latino, 8% White) were recruited and completed validated measures of personality (NEO-FFI-3), executive functioning (Controlled Oral Word Association, Wisconsin Card Sorting, Color Trails), perceived epilepsy stigma (Epilepsy Stigma Scale), and quality of life (QOLIE-89). Controlling for covariates, ordinary least-squares regression and path analysis evaluated direct and indirect effects of personality (neuroticism and extraversion) on epilepsy-related social well-being (QOLIE-89: Social Functioning and Social Isolation), mediated through perceived epilepsy stigma. Exploratory analyses examined personality factors as potential moderators of each other's effects on stigma and the association between executive functioning and stigma.;Results: In separate models, higher levels of neuroticism and lower levels of extraversion were significantly and independently associated with heightened stigma perception (path a=.71, p =.005 and path a=-1.10,p<.005, respectively), which was in turn significantly and independently associated with poorer social well-being (path b=.23, p<.001 and path b=-.23, p<.001, respectively). Bias-corrected bootstrap confidence intervals showed that neuroticism and extraversion were indirectly associated with social well-being through perceived stigma (path ab=-.16, 95%CI's [-.347,-.044] and path ab=.25, 95%CI's [.076,.493], respectively). Exploratory analyses revealed a significant interaction between executive functioning and neuroticism in predicting perceived stigma (b=1.18, p=.009). At low levels of neuroticism, each standard deviation increase in executive functioning was associated with a corresponding decrease in perceived stigma by 14.61 units (p=.001). At high levels of neuroticism this effect was attenuated: each standard deviation increase in executive functioning corresponded to a non-significant 4.25 unit increase in stigma (p=.408).;Conclusions: Elevated neuroticism and reduced extraversion may have predisposed patients towards feeling stigmatized, which in turn may have led to reduced social well-being. Individuals displaying average or better executive functioning, who also endorsed low vulnerability to distress, were less likely to report stigma. Future research should examine these associations and interactions longitudinally. Intervention studies may benefit from promoting cognitive re-appraisal strategies to reduce perceived stigma.