Metacognitive Beliefs in Epilepsy: What is Their Contribution to Quality of Life in the Context of Anxiety, Depression and Cognitive Functioning?

Background: Beliefs about one's own thinking process - metacognition - are thought to influence a person's susceptibility to anxiety and depression. We aimed to explore the association between metacognitive beliefs, psychological symptomatology, objective cognitive functioning and quality of life (QoL) among people with epilepsy.

Methods: We performed a cross-sectional study including adults with epilepsy who attended an outpatient clinic. Participants provided sociodemographic data, information about their seizures and were then asked to complete the metacognitions questionnaire-30 (MCQ-30), the patient-weighted inventory on quality of life in epilepsy (QOLIE-31-P), the Neurological Disorders Depression Inventory in Epilepsy (NDDI-E), the Generalized Anxiety Disorder Scale-7 (GAD-7), and provide a self-rated assessment of cognitive functioning by rating their memory, attention and reaction speed on single-item scales from 0 to 10. They then underwent neuropsychological assessment targeting executive functioning, attention and reaction speed. The associations between metacognitive beliefs, psychological symptoms and QoL as well as self-rated and objective cognitive assessment were explored through correlation calculations. Statistically significant relationships were then used for analysis of path models with QoL as the dependent variable.

Results: The PWE sample consisted of 54 PWE (32, 59.3 % female), most having focal epilepsy (38, 70.4 %) and receiving ASM polytherapy (36, 66.7 %). There were no substantial differences in metacognitive beliefs based on demographic or epilepsy-related variables (p > 0.05). Symptoms of anxiety and depression were found to mediate the association between negative metacognitive beliefs about the uncontrollability and danger of perseverative thinking and QoL. Cognitive confidence and self-rated assessment of memory, attention and reaction speed contributed to overlapping psychometric constructs with the cognitive subscale of QOLIE-31-P. Correlations between objective cognitive measures and self-rated attention, but not metacognitive domains were seen.

Conclusion: Metacognitive beliefs may be associated with QoL in epilepsy by exerting effect through psychological symptomatology. Based on our findings, negative metacognitive beliefs may be investigated as relevant targets for future therapies aiming to improve QoL among PWE. Self-rated cognitive ability assessment and cognitive confidence are largely independent of objective cognitive performance and overlap with the cognitive domain of QOLIE-31-P.