Psychological resilience as a key pathway between depression and executive functioning in epilepsy.

INTRODUCTION

In epilepsy, the burden of depression extends beyond mood, often accompanying difficulties in executive functioning. However, the psychological factors shaping this relationship remain largely unexplored. This study examines whether psychological resilience serves as a bridge between emotional distress and cognitive functioning in focal epilepsy.

METHODS

In this cross-sectional study, 71 patients with focal epilepsy underwent assessment of depressive symptoms (Depression Anxiety Stress Scales-42), resilience (Connor-Davidson Resilience Scale-10), and executive functioning using a composite neuropsychological score. A mediation analysis using Hayes' PROCESS macro (Model 4) with 5000 bootstrap samples examined whether resilience mediated the association between depressive symptoms and executive functioning.

RESULTS

Among 31 patients with frontal lobe epilepsy (FLE) and 40 with mesial temporal lobe epilepsy (mTLE), resilience emerged as a key psychological pathway connecting depressive symptoms and executive functioning. Mediation analysis showed that resilience partially mediated the relationship between depressive symptoms and executive functioning after controlling for education and seizure frequency. The indirect effect was significant (effect = -0.095, BootSE = 0.047, 95 % bootstrap CI [-0.199, -0.011]), indicating that reduced resilience partly explained the association between depressive symptoms and executive dysfunction. Education and seizure frequency also emerged as independent predictors of executive functioning.

CONCLUSION

Beyond clinical factors, psychological strength matters: resilience may be associated with cognitive outcomes in focal epilepsy and may attenuate the influence of depressive symptoms on executive functioning. These findings underscore the importance of integrating psychological assessment and interventions into comprehensive epilepsy care to support cognitive and emotional well-being.