The relationship between ecological executive function and stigma among patients with epilepsy: The mediating effect of social support

Stigma is a key determinant of mental health among patients with epilepsy (PWE). In prior work, many PWE have been found to exhibit impaired executive function (EF) and to lack sufficient social support. This study was developed to explore factors that may influence stigma in PWE with a focus on the associations among EF, social support, and stigma in this patient population. A questionnaire was administered to 121 patients with primary epilepsy as a means of collecting clinical and demographic details. The severity of EF impairment, social support levels, and stigma were analyzed using the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A), the Social Support Rating Scale, and the Kilifi Stigma Scale for Epilepsy-Chinese (KSSE-C). Descriptive analyses were used to evaluate demographic details, and parameters associated with stigma were identified through multiple linear stepwise analyses. Spearman's correlation analyses and moderated mediation analyses were utilized to examine relationships between impaired EF, social support, and stigma. Significant mediation effects were identified using the SPSS PROCESS macro via a bootstrap approach. Up to 95.9% of the 121 PWE in this study were affected by stigma, with differneces in stigma being associated with long-term residence (urban or rural), family monthly income, disease control status (controlled or uncontrolled), and medication types. Multiple stepwise linear regression analyses revealed that the number of years of education (t = - 4.58, P < 0.001), family monthly income per capita (t = −3.43, P = 0.001), and age of first episode (t = −2.71, P = 0.008) for PWE were negatively correlated with stigma scores, while long-term residence (t = 2.79, P = 0.006), course of disease (t = 3.65, P < 0.001), disease control (t = 2.79, P = 0.006), and types of medication (t = 2.73, P = 0.007) were positively correlated with stigma scores. Impaired EF was found to be significantly associated with stigma (β = 0.64, P < 0.001), and social support was able to mediate the association between stigma and impaired EF (β = 0.64, P < 0.001). Non-parametric bootstrap analysis results revealed the indirect impact of EF through social support (95% bootstrap CI = 0.11, 0.22), with the indirect influence of social support accounting for 44.3% of the overall effect of stigma. These results offer new insight into the interactive mechanisms that underlie stigma and EF, in addition to clarifying the ability of social support to mediate this relationship. These data thus highlight valuable theoretical and methodological approaches to preventing stigma in PWE, suggesting that stigma in PWE can be effectively reduced by bolstering EF, and social support plays a mediating effect in this context.