Psychiatric comorbidities in pediatric epilepsy: a single-center retrospective study highlighting the burden of depressive symptoms

Abstract

Epilepsy in the pediatric population is frequently associated with psychiatric comorbidities. Depression is of particular clinical significance given its elevated incidence and substantial impact on quality of life, treatment adherence, and psychosocial functioning. The prevalence of depression in children with epilepsy ranges from 7% to 14%, considerably higher than the 1–5% reported in the general pediatric population. The relationship between epilepsy and depression appears bidirectional: epilepsy predisposes to depressive disorders, and depression may increase seizure risk, suggesting shared neurobiological pathways. This study aimed to assess the prevalence of psychiatric symptoms in pediatric patients with epilepsy, with particular focus on depressive symptomatology, and to examine associations with etiological and clinical variables. This retrospective study included 240 pediatric patients (aged 2–18 years) diagnosed with epilepsy between 2013 and 2024. Psychiatric symptoms were ascertained retrospectively from clinical records. Patients were categorized into two groups: those with an identified genetic and/or structural abnormality (G1, n = 60) and those without (G2, n = 180). Statistical analysis employed the chi-squared test and Student’s t -test ( p < 0.05). Psychiatric symptoms were identified in 30% of patients (72/240, 95% CI 24.2–35.8%). The most prevalent disorder was attention-deficit/hyperactivity disorder (ADHD; n = 30), followed by sleep disturbance/asthenia ( n = 19), aggression/temper tantrums ( n = 13), depressive/mood symptoms ( n = 11), anxiety symptoms ( n = 10), autism spectrum disorder ( n = 6), eating behavior alterations ( n = 4), self-harm ( n = 4), adjustment/self-esteem features ( n = 3), obsessive-compulsive disorder (OCD; n = 3), panic attacks ( n = 2), and suicide attempts ( n = 2). Psychiatric symptoms were significantly more prevalent in G1 (42%, 95% CI 29.2–54.1%) than in G2 (26%, 95% CI 19.7–32.5%; p = 0.03), corresponding to an odds ratio of 2.02 (95% CI 1.10–3.72). No significant associations were found between psychiatric symptoms and age, sex, family history, or treatment regimen. Psychiatric comorbidities, including depressive symptomatology, are common in pediatric epilepsy and likely associated with underlying neurobiological factors. These findings support integrating neuropsychiatric screening, using validated instruments such as the Children’s Depression Inventory-2 (CDI-2) and the Neurological Disorders Depression Inventory for Epilepsy–Youth version (NDDI-E-Y), into routine epilepsy care.