{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T09:06:00Z","timestamp":1780304760863,"version":"3.54.0"},"reference-count":50,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Epilepsy significantly impacts various aspects of a patient\u2019s life, extending beyond seizure control to encompass their overall well-being and quality of life. Understanding the complex interplay of direct factors, such as seizure frequency and medication side effects, alongside indirect factors like psychological distress and social support, is crucial for developing comprehensive interventions aimed at improving the lives of individuals living with epilepsy. This study aimed to determine the direct and indirect effects of anxiety, depression, and seizure frequency on the quality of life of patients with epilepsy using path analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was an observational analytic study with a cross-sectional design. A total of 32 patients with primary epilepsy were recruited from the Neurology Clinic at Universitas Sebelas Maret Hospital. The mean age of the participants was 35.43 \u00b1 14.00 years. Quality of life was assessed using the Indonesian Quality of Life in Epilepsy Inventory-10 (QOLIE-10). Anxiety and depression were measured with the Generalized Anxiety Disorder 7-item (GAD-7) and the Hamilton Depression Rating Scale (HDRS), respectively. Blood samples were used to measure cortisol and brain-derived neurotrophic factor (BDNF) levels. Path analysis was conducted in Stata 13.0 for Windows to model the hypothesized direct and indirect relationships among variables. Model fit was evaluated using Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and absolute fit indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Path analysis revealed a significant negative direct association between BDNF levels and QOLIE-10 scores (B = \u22120.072,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.017), indicating that higher BDNF levels are associated with improved quality of life, as reflected in lower distress scores. Conversely, seizure frequency (B = 0.23,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.039) and GAD-7 scores (B = 0.70,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) were positively associated with QOLIE-10, indicating that increased seizures and anxiety are linked to poorer quality of life. Indirect effects were also identified, with seizure frequency positively influencing both GAD-7 (B = 0.56,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) and HDRS scores (B = 0.39,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002), which, in turn, are significant contributors to a reduced quality of life. The model demonstrated a good fit, with an AIC of 1,272.185 and a BIC of 1,315.064.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Managing seizures is not only critical for reducing the direct burden of epilepsy but also essential for mitigating anxiety and depression, which are significant contributors to a reduced quality of life. Our findings underscore the importance of a holistic care approach that addresses seizure control and psychological well-being.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.21309","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T08:26:02Z","timestamp":1780302362000},"page":"e21309","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with quality of life in patients with epilepsy: a preliminary path analysis of psychological and neurobiological determinants"],"prefix":"10.7717","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0558-5680","authenticated-orcid":true,"given":"Diah Kurnia","family":"Mirawati","sequence":"first","affiliation":[{"name":"Department of Neurology, Sebelas Maret Teaching Hospital, Sebelas Maret University, Sukoharjo, Central Java, Indonesia"},{"name":"Department of Neurology, Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, 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