Striving for balance: Coping with epilepsy in Iranian patients Nazafarin Hosseini a , Farkhondeh Sharif b, ⁎, Fazlollah Ahmadi c , Mohammad Zare d a Nursing and Midwifery School, Isfahan University of Medical Science, Isfahan, Iran b Psychiatric Nursing Department, Faculty of Nursing, Shiraz University of Medical Sciences, Shiraz, Iran c Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran d Neurology Department, Faculty of Medicine, Isfahan University of Medical Science, Isfahan, Iran abstract article info Article history: Received 2 February 2010 Received in revised form 15 March 2010 Accepted 31 May 2010 Keywords: Epilepsy Seizure Coping Coping behaviors Coping skills Qualitative study Iran Patients with epilepsy are subject to a wide range of distinctive psychosocial consequences, which can be more harmful than the seizures themselves and other medical difficulties accompanying them. This qualitative study was aimed at identifying coping strategies employed by 21 Iranian adults with epilepsy. The study participants were chosen by purposeful sampling from hospitals, neurologists’ clinics, rural health care facilities, and epilepsy associations. Data were collected through semistructured interviews. A qualitative content analysis method was used to analyze the gathered data. The analysis resulted in the emergence of six themes and seven subthemes: confronting the disease using religious sentiment, seeking support, fighting the disease, defending oneself against the disease, concealing the disease, and expressing emotions. The findings showed that the participants used an emotion-focused approach more often than a problem-focused approach as a coping strategy. The results will improve health care professionals’ knowledge of how Iranian patients cope with epilepsy and help them to design nursing care models to promote successful coping strategies for patients. © 2010 Elsevier Inc. All rights reserved. 1. Introduction Epilepsy is one of the most neurological disorders, with mean prevalences of about 0.52% in Europe, 0.68% in the United States, and a peak of 1.5% in developing countries [1]. In Iran, the prevalence rate is about 1.8% [2]. Historically, epilepsy has been described as a kind of witchcraft, insanity, supernatural force [3], hysteria, madness, or possession by the devil, which has led to stigmatization of individuals with epilepsy [4]. Epilepsy has psychosocial consequences such as a higher rate of psychiatric disorders, mood disturbances, suicide, social isolation [5], perception of shame and guilt [6], low self-esteem, anxiety, and a pessimistic feeling about life [7]. It also imposes restrictions and problems on family life, employment, education, and marital status [8]. As a result, epilepsy lays a foundation for poorer quality of life and even suicide [5]. Depression and suicide are four to five times more common in patients with epilepsy than in the general population [9]. The prevalence of psychiatric disorders among Iranian adolescents with epilepsy was recently estimated to be 68.3%. The most frequent diagnoses were major depression (36.7% vs 18.3% in the control group) and obsessive–compulsive disorders (21.7% vs 18.3% in the control group) [10]. Sometimes, psychosocial conse- quences are more debilitating and damaging than the seizures and related physical problems [11]. Such problems and challenges cause patients to resort to coping strategies. Coping strategies are commonly defined as ‘“efforts to manage environmental and internal demands and conflicts among them, which can tax or exceed a person's resources” [12]. In adjusting to this chronic circumstance, the method of coping with epilepsy seems to be a significant determinant of the self-perceived severity of seizures [13]. In addition, studies have shown that coping strategies have a marked influence on the psychosocial adjustment and well-being of patients with epilepsy [14]. Adjustment resources and coping strategies can play a mediating role between stressors and the illness. In fact, these mediators can either decrease the effect of stressors, causing the patient to move toward positive psychological adjustment, or increase the effects of stressors, causing the patient to resort to negative psychological adjustment [15]. Lazarus recognized two main coping categories: problem focused, based on specific strategies to find a direct resolution for the situation, and emotion focused, which deals chiefly with the emotional responses to stressors [16]. Among the more specific coping strategies, patients with epilepsy who adopted problem-focused and cognitive restructuring coping modes were reported to have better psychosocial outcomes, including better mental health, increased psychological well-being, decreased psy- chological distress, and lower levels of reported depression and anxiety [17]. Many quantitative studies have presented a variety of results on coping strategies employed by patients with epilepsy in countries other than Iran. Some reported that the patients applied effective Epilepsy & Behavior 18 (2010) 466–471 ⁎ Corresponding author. Psychiatric Nursing Department, Faculty of Nursing, Shiraz University of Medical Sciences, 4th floor, No. 4, Shiraz, Fars7184983916, Iran. Fax: + 98 711 6474252. E-mail address: fsharif@sums.ac.ir (F. Sharif). 1525-5050/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2010.05.022 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh