Relationship and sexual satisfaction are associated with better disease self-management in persons with epilepsy

Abstract

Prior research has demonstrated that PWEs view intimate interpersonal relationships as personally important and as a substantive challenge in their lives. This is significant as high-quality intimate relationships have been linked with greater well-being and better healthcare self-management in other disease contexts. For persons with epilepsy (PWEs), self-management is critical for seizure control, lower mortality, and better quality of life. In the current study, we conducted the first known investigation into the quality of PWEs’ intimate relationships and their self-management abilities. In a sample of 88 PWEs, using the Adult Epilepsy Self-Management Instrument, results demonstrate links between greater relationship satisfaction and sexual satisfaction with better self-management on seven of the eleven subscales: health communication, coping skills, social support, seizure tracking, seizure response, stress management, and wellness; satisfaction was unrelated to the treatment, safety, medical adherence, and proactivity subscales. Importantly, these results held while controlling for age, gender, social support, and presence of comorbidities. These findings provide some evidence of the importance of intimate relationships in understanding PWEs’ healthcare management abilities. Given that intimate relationship dynamics have been shown to be highly amenable to intervention, this is an area of potential interest for improving self-management in PWEs.

1. Introduction

Epilepsy is a neurological condition affecting approximately 1.1% of adults—around 3.4 million people in the United States and 50 million people worldwide [1,2]. The U.S. National Academy of Sciences’ Institute of Medicine (3) has noted that the most critical aspect of successful epilepsy management and care is self-management, generally defined as a combination of the personal actions taken to control one’s seizures and active participation in one’s own medical care [4,5]. In the context of epilepsy, self-management includes the patient’s ability to manage their symptoms, treatment, physical and psychosocial consequences, and lifestyle modifications needed to control their epilepsy. Consistent and effective epilepsy self-management has been linked with better seizure control, higher quality of life, and more effective healthcare resource utilization [3]. Further, self-management among persons with epilepsy (PWEs) is a critical factor in controlling seizures, the frequency of which is the number one risk factor for Sudden Unexpected Death in Epilepsy (SUDEP) [6,7]. It is crucial to identify and better understand factors that help or hinder PWE’s ability to engage in effective self-management.

Sizable barriers to epilepsy self-management have been documented. PWEs navigate many structural barriers, including average lower income and education levels, lower quality health insurance, more instances of disability, and lower ratings of one’s own physical health (e.g., [5,8]). A sizable literature has also shown that PWEs are at high risk of a range of negative psychosocial outcomes including poorer psychological well-being (e.g., [9]), worsened quality of life (e.g., [10,11]), greater likelihood of experiencing symptoms of depression (e.g., [12]), feelings of stigmatization and/or of oneself as a burden on others (e.g., [13,14]), and less satisfaction with their lives (e.g., [15]).

In addition to the aforementioned struggles, PWEs also report hardships with social connection, which is a critical factor in well-being and quality of life [16,17]. Multiple studies have demonstrated poorer psychosocial functioning in PWEs. For instance, across three large Finnish population-based surveys of children 4 to 16 years of age, 98% of children in the healthy control condition were found to have appropriate social skills needed for managing daily activities, compared to 20–33% of children with epilepsy. Children with epilepsy also had fewer friends than healthy controls, and between 21%-31% of children with epilepsy experienced marked or moderate difficulties making friends [18]. This pattern is also found in adults with epilepsy. In a nationally representative study of over 5400 American adults, PWEs were between two and three times more likely than people without epilepsy to express dissatisfaction and frustration with their family life, friendships, and social life [8]. Relatedly, PWEs are significantly more likely to report rarely or never receiving the emotional support they need when compared to people without epilepsy, and are more likely to report dissatisfaction with their lives in general [19]. PWEs experience more loneliness, have trouble maintaining relationships, are consistently found to be less likely to ever marry, and report poorer social outcomes across the lifespan, including at 35-year follow-ups (e.g., [15,20]). With these findings amassed, it is clear that PWEs are often leading lives in which their social and interpersonal needs are unmet.

Social relationships, and intimate relationships in particular (such as committed romantic relationships characterized by emotional bonding and support), have been shown to significantly impact mental and physical well-being both in healthy samples and in those with disease or illness (e.g., [21]). The positive effects of romantic relationships on health and longevity have been repeatedly documented, with satisfying and high-quality relationships promoting fewer instances of mental illness, faster recovery from physical illness and injury, better adherence to medical advice and treatment, and lower risk of mortality years and even decades after critical health events [22–27]. The influence of intimate relationships on health and health outcomes also extends to the self-management of chronic diseases [28]. For instance, in a study of hypertension, researchers found that higher levels of ‘marital adjustment’ (e.g., cohesion, satisfaction, and affectional expression) were associated with less obesity, better adherence to medications, and decreased cessation of prescribed medications [29]. Similarly, in a recent study, researchers examined 52 romantic couples to determine whether facets of intimate relationship quality influenced self-management of type 2 diabetes [30]. These researchers assessed partner support, partner investment, and relationship satisfaction as markers of relationship quality. Their results suggested that higher quality relationships were associated with better self-efficacy for diabetes management in the patient, which was subsequently associated with testing their blood glucose levels more often, exercising, and adhering to a healthy diet [30].

While high-quality intimate relationships are associated with positive health outcomes, negative aspects of intimate relationships that contribute to low relationship quality are often detrimental to self-management of chronic disease. For instance, in a study of 7547 coupled adults who had one or more chronic health problems, researchers found significant correlations between conflict with a romantic partner, psychological distress, and poorer self-management of their disease(s) [31]. Additionally, a study of disease self-management in people with type 2 diabetes demonstrated a link between relationship issues, communication about their disease, and effective self-management [32]. Specifically, participants who reported concerns about the state of their relationship and whether it would be long-lasting, and/or who reported that their partner often became an obstacle to their health goals (e.g., impeding a low sugar diet), also felt that talking about their type 2 diabetes with their partner would likely lead to a negative outcome for their relationship. Many feared that their partner would wish to leave the relationship due to the burden, and/or anticipated feeling shame around their condition. Participants who felt that communicating about their health with their partner posed a threat of some sort were significantly less effective at adhering to prescribed treatment and medication [32]. These findings highlight the importance of examining indicators of relationship quality in people with chronic disease who are in need of effective and consistent self-management, as in the context of PWEs.

Although the beneficial impacts of romantic relationships have been observed in the context of a number of conditions and disorders, this line of research has not been applied to the study of epilepsy. However, it is clear that such an application is needed, based on the documented struggles of PWEs. In a recent study on thousands of message board posts generated by patients with epilepsy and their caretakers, researchers found that PWEs view romantic and sexual relationships as a specific point of struggle in their lives [33]. Epilepsy-based judgments from (potential) partners, inability to maintain relationships, and sexual issues were some of the most common concerns. These message board posts from PWEs and PWE caretakers demonstrate an information gap and unmet need around maintaining satisfying and successful romantic and sexual relationships while living with epilepsy. In the current cross-sectional study, we examined whether PWEs’ romantic and sexual satisfaction predicted more effective self-management of their epilepsy.

Relationship satisfaction and sexual satisfaction are distinct, but related constructs that are robustly correlated across intimate relationship contexts and outcomes (i.e., [34–36]). Definitions of sexual satisfaction are similar to relationship satisfaction in that both include a combination of affective and evaluation aspects. Satisfaction with either is determined by weighing the positives and negatives in the (sexual) relationship against a person’s expectations, and by a person’s subjective feelings of contentment in the (sexual) relationship [35,37]. As with relationship satisfaction, sexual satisfaction is uniquely associated with greater well-being, including fewer reports of depression and higher reported quality of life [38–41]. Given the importance of both forms of satisfaction on well-being, and PWEs identifying both romantic and sexual issues as points of concern [33], both relationship and sexual satisfaction should be considered in promoting positive health behavior in this population.

In the current study, we assess relationship satisfaction and sexual satisfaction as indicators of intimate relationship quality. Additionally, we included two covariates in our models. Previous work has shown that comorbidities provide an additional burden on relationship satisfaction [42] and on health more generally [43,44]. In fact, data from 41,658 participants demonstrated a 43% higher chance of self-reporting poor health with each added comorbidity [43]. Thus, we include the presence of comorbidities (dichotomous yes/no) as a controlled variable in our models. Other programs of research have identified the beneficial effects of social support within intimate relationships. Social support includes tangible and emotional resources that help the recipient cope with stress [45]. Social support from romantic partners has been linked to better physical and psychological well-being in the context of stressful life circumstances [46–49]. Thus, to ensure that we are reporting findings specific to relationship satisfaction and sexual satisfaction, rather than the effects of received social support, we include an assessment of partner social support in our models as a covariate.

2. Methods

2.1. Participants

Participants (N = 88) were recruited for a self-directed online survey via advertisements that were shared by the Epilepsy Foundation of Indiana (EFI) social media accounts and further shared by other accounts. EFI was not involved in the survey but agreed to disseminate the advertisement. Participants were eligible for the study if they had a medical diagnosis of epilepsy, were prescribed medication to control their seizures, could speak and read English, had reliable Internet access, were at least 18 years of age, and were in a committed romantic relationship at the time of the study. All study procedures were approved by the institutional review board at Indiana University. Informed consent was waived in favor of a study information sheet to prevent the collection of any identifying information.

The sample was made up of 57 men, 30 women, and one gender-unspecified participant, with an age range from 20 to 53 years (M = 32.09, SD = 7.20). Most (83%) identified as White/Caucasian; 7% as Hispanic or Latino; 6% as Black or African-American; 3% as Native American, American Indian, or Alaskan Native; and 2% as Asian. Average household income was between $60,000 and $74,999 USD per year, with most (77%) reporting that their income was enough to make ends meet and 23% reporting that it was barely enough or not enough. Half (53%) of the sample held a college degree, 24% had some college experience but no degree, 16% held a high school diploma or GED, and 7% did not hold a high school diploma. Regarding insurance coverage, 33% had Medicaid, 39% had Medicare, and 28% had private insurance. Last, according to the Liverpool Seizure Severity Scale (described below), participants on average reported moderate perceptions of control over their seizures (M = 17.40, SD = 2.25) and reported mild-to-moderately severe seizures in the last six weeks (M = 30.41, SD = 6.54).

2.2. Measures

Participants first completed a demographic questionnaire assessing age, gender, education level, race and ethnicity, insurance coverage, household income, and whether they felt their income was “enough to make ends meet” (not enough, barely enough, enough, more than enough).

2.2.1. Epilepsy Self-Management

Epilepsy self-management refers to the behaviors in which PWEs engage to manage the symptoms, treatments, physical and psychosocial consequences, and lifestyle modifications accompanying epilepsy. We used the 65-item Adult Epilepsy Self-Management Instrument [50] to assess self-management behaviors across 11 domains: Healthcare Communication, Treatment, Coping, Social Support, Seizure Tracking, Wellness, Seizure Response, Safety, Medication Adherence, Stress Management, and Proactivity. In accordance with the scale scoring instruction, responses were summed to create subscale variables.

2.2.2. Relationship satisfaction and sexual satisfaction

We used the Global Measure of Relationship Satisfaction (GMREL) [35] to assess overall relationship satisfaction. The GMREL has participants rate their relationship satisfaction on five 7-point dimensions: good–bad, pleasant–unpleasant, positive–negative, satisfying–unsatisfying, valuable–worthless. Ratings are averaged, with higher scores indicating greater satisfaction. Additionally, we used the Global Measure of Sexual Satisfaction (GMSEX) [35] to assess sexual satisfaction. The rating scale was identical to the GMREL, except that participants were instructed to answer regarding their sexual relationship with their partner rather than their overall relationship.

2.2.3. Comorbidities

We asked, “Have you ever been told by a doctor or other healthcare professional that you have any of the following conditions? Check all that apply.” The conditions were: depression, anxiety, attention deficit hyperactivity disorder, attention deficit disorder, insomnia, migraines, or ‘other’. If they selected ‘other’, they were asked to specify their condition in an open textbox. We recoded this variable into a binary measure of the presence or absence of any comorbidities.

2.2.4. Social support

We used the 10-item Sources of Social Support Scale (SSSS) [51] to assess social support from one’s partner, modified to be specific to support around epilepsy (e.g., “how much does your partner give you advice or information about your epilepsy?” and “how often does your partner withdraw from discussions about your epilepsy or try to change the topic away from your epilepsy?”). Responses were made on a scale from 1 (not at all) to 5 (a lot). Scores were created by averaging the 10 items.

2.2.5. Seizure severity

We used the Liverpool Seizure Severity Scale to measure participants’ self-reported seizure severity [52]. This instrument consists of two subscales: percept of control (8 items) and ictal/postictal severity (12 items). We eliminated one of the items from the percept of control subscale “When you have had seizures, how often have they occurred together in clusters, with quite long periods between each cluster?” because there are both high severity (seizure clusters) and low severity (long periods of time between clusters) concepts within the same item. Items were scored on a four- or five-point Likert response scale. Summed scores for the precept of control subscale range from 7 to 28 and the ictal/postictal severity subscale ranges from 12 to 50 with higher scores indicating greater seizure severity. Items were reversed scored as appropriate.

2.3. Analyses

Zero-order correlations and descriptive statistics for each variable included in the analyses are presented in Table 1. We conducted linear multiple regression analyses to determine whether relationship and sexual satisfaction were significantly associated with epilepsy self-management. In each regression model, we included either romantic or sexual satisfaction as predictor variables, as well as age (mean-centered), gender (coded as 0 = women, 1 = men), the presence of any comorbidities (coded as 0 = no comorbidities, 1 = any comorbidities), and social support (mean-centered) as covariates.

Table 1.

Inter-item correlations and descriptive statistics for all variables included in the regression models.

	1	2	3	4	5	6	7	8	9
1. Age	–
2. Gender	−0.12	–
3. Comorbidities	−0.30*	0.22	–
4. Social support	0.21	−0.29*	−0.42*	–
5. Relationship satisfaction	0.07	−0.23	−0.46*	0.71*	–
6. Sexual satisfaction	−0.01	−0.19	−0.40*	0.55*	0.84*	–
Self-Management subscales
7. Health Communication	0.16	0.15	0.15	0.19	0.26	0.30*	–
8. Treatment	−0.05	−0.02	0.002	0.34*	0.37*	0.12	0.07	–
9. Coping	−0.03	0.21	0.16	0.15	0.28*	0.31*	0.34*	0.18	–
10. Social Support	0.07	0.08	0.07	0.31*	0.36*	0.38*	0.49*	0.16	0.47*
11. Seizure Tracking	−0.08	0.21	0.13	0.27	0.38*	0.30*	0.54*	0.19	0.29*
12. Wellness	−0.30*	0.01	−0.08	0.20	0.47*	0.51*	0.40*	0.06	0.27*
13. Seizure Response	−0.19	0.06	0.08	0.18	0.44*	0.55*	0.48*	0.08	0.36*
14. Safety	0.04	0.18	0.09	−0.05	−0.07	0.14	0.25	−0.11	0.11
15. Medical Adherence	0.07	0.04	−0.02	0.25	0.30*	0.22	0.44*	0.26	0.42*
16. Stress Management	−0.18	0.22	0.09	−0.05	0.26	0.37*	0.50*	−0.12	0.30*
17. Proactivity	0.08	0.23	0.30*	0.04	0.07	0.04	0.62*	0.17	0.31*
Descriptive Statistics
M	32.05	–a	–b	3.39	5.14	4.96	49.81	35.30	34.51
SD	7.17	–	–	0.61	1.19	1.21	8.24	6.51	5.26
	10	11	12	13	14		15	16	17
10. Social Support	–
11. Seizure Tracking	.42*	–
12. Wellness	.49*	.52*	–
13. Seizure Response	.40*	.39*	.50*	–
14. Safety	.12	.07	.18	.24	–
15. Medical Adherence	.42*	.39*	.35*	.29*	.08		–
16. Stress Management	.37*	.44*	.54*	.59*	.23		.34*	–
17. Proactivity	.50*	.55*	.30*	.39*	.22		.52*	.50*	–
Descriptive Statistics
M	25.09	10.84	10.79	10.94	13.17		14.54	10.36	10.69
SD	3.71	2.39	1.93	1.99	1.82		2.43	2.20	2.35

^aGender was coded as 0 = women, 1 = men.

^bThe presence of comorbidities was coded as 0 = no comorbidities, 1 = any comorbidities.

^*p < .001.

Note that we analyzed separate models for relationship satisfaction and sexual satisfaction to avoid multicollinearity, as these variables were highly intercorrelated (r = 0.84), as has been reported in prior studies (e.g., [53,54]) We did initially conduct our analyses with both entered simultaneously, however, the associated variance inflation factors neared 5.0 (a standard according to some sources (VIF = 4.71) [55–57]. Thus, we examined each in individual models to avoid inflated effects. Additionally, because we conducted a large number of tests, we used a Bonferroni correction to find an acceptable alpha level. Because of this, we only consider effects to be significant if p ≤ 0.001. All regression coefficients for relationship satisfaction are presented in Table 2, and for sexual satisfaction in Table 3.

Table 2.

Regression coefficients for relationship satisfaction predicting self-management.

	Self-management subscales
	Health communication	Coping	Social support	Seizure Tracking	Wellness	Seizure Response	Stress Management	Treatment	Safety	Medical Adherence	Proactivity
Predictor variables
Age
b	0.36	0.04	0.13	−0.02	−0.06	−0.04	−0.04	−0.001	0.03	0.02	0.06
t	3.33†	0.56	2.51	−0.48	−2.26	−1.34	−1.22	−0.01	1.17	0.52	1.69
rp	0.35	0.06	0.27	−0.05	−0.24	−0.15	−0.14	−0.001	0.13	0.06	0.18
Gender
b	2.36	1.28	0.77	1.18	0.29	0.16	0.70	0.44	0.46	0.11	0.61
t	1.39	1.12	0.99	2.36	0.71	0.38	1.46	0.29	1.01	0.20	1.18
rp	0.15	0.12	0.11	0.25	0.08	0.04	0.16	0.03	0.11	0.02	0.13
Comorbidities
b	10.62	6.15	4.04	2.12	0.22	1.51	1.09	2.69	0.91	1.48	3.23
t	4.75*	4.06*	3.90*	3.21	0.41	2.74	1.73	1.34	1.53	1.96	4.76*
rp	0.47	0.41	0.40	0.34	0.05	0.29	0.19	0.15	0.17	0.21	0.47
Social support
b	0.77	0.25	0.67	0.47	−0.58	−0.50	−1.08	2.12	0.12	0.53	0.21
t	0.43	0.21	0.82	0.90	−1.36	−1.15	−2.15	1.33	0.25	0.89	0.39
rp	0.05	0.02	0.09	0.10	−0.15	−0.13	−0.23	0.15	0.03	0.10	0.04
Relationship satisfaction
b	3.15	2.13	1.58	1.06	1.09	1.17	1.05	1.78	0.02	0.60	0.57
t	3.39†	3.38†	3.67*	3.87*	4.87*	5.09*	4.02*	2.13	0.07	1.90	2.02
rp	0.35	0.35	0.38	0.40	0.48	0.49	0.41	0.23	0.01	0.21	0.22

Note. Degrees of freedom (df) for each model = 81. b = unstandardized regression coefficient; t = t-statistic coefficient; r_p = partial correlation, interpreted as r_p ≥ 0.20 = small effect size, r_p ≥ 0.50 = medium/moderate effect size, and r_p ≥ 0.80 = large effect size.

^*p < .001,

^†p = .001.

Table 3.

Regression coefficients for sexual satisfaction predicting self-management.

	Self-management subscales
	Health commun.	Coping	Social Support	Seizure Tracking	Wellness	Seizure Response	Stress Management	Treatment	Safety	Medical Adherence	Proactivity
Predictor variables
Age
b	0.39	0.05	0.14	−0.02	−0.06	−0.03	−0.03	−0.06	0.05	0.02	0.05
t	3.70*	0.73	2.77	−0.58	−2.10	−1.02	−0.95	−0.55	1.78	0.42	1.63
rp	0.38	0.08	0.29	−0.06	−0.23	−0.11	−0.11	−0.06	0.19	0.05	0.18
Gender
b	2.33	1.25	0.75	1.15	0.27	0.15	0.69	0.35	0.47	0.10	0.60
t	1.42	1.11	0.98	2.21	0.67	0.38	1.51	0.23	1.09	0.17	1.15
rp	0.16	0.12	0.11	0.24	0.07	0.04	0.17	0.03	0.12	0.02	0.13
Comorbidities
b	10.92	6.18	4.11	1.89	0.18	1.61	1.19	1.19	1.28	1.33	3.14
t	5.07*	4.14*	4.08*	2.75	0.34	3.16	1.98	0.58	2.25	1.74	4.60*
rp	0.49	0.42	0.41	0.29	0.04	0.33	0.22	0.07	0.24	0.19	0.46
Social support
b	1.68	1.09	1.24	1.20	−0.08	−0.15	−0.77	4.80	−0.35	0.98	0.57
t	1.13	1.06	1.78	2.54	−0.22	−0.44	−1.86	3.40†	−0.90	1.86	1.20
rp	0.13	0.12	0.19	0.27	−0.02	−0.05	−0.20	0.35	−0.10	0.20	0.13
Sexual satisfaction
b	3.16	1.90	1.48	0.62	0.90	1.16	1.05	−0.51	0.52	0.31	0.37
t	4.26*	3.69*	4.25*	2.60	4.84*	6.59*	5.08*	−0.72	2.65	1.19	1.57
rp	0.43	0.38	0.43	0.28	0.47	0.59	0.49	−0.08	0.28	0.13	0.17

Note. Degrees of freedom (df) for each model = 81. b = unstandardized regression coefficient; t = t-statistic coefficient; r_p = partial correlation, interpreted as r_p ≥ 0.20 = small effect size, r_p ≥ 0.50 = medium/moderate effect size, and r_p ≥ 0.80 = large effect size.

^*p < .001,

^†p = .001.

3. Results

3.1. Epilepsy Self-Management and relationship satisfaction

Relationship satisfaction was significantly associated with seven of the eleven self-management subscales. Regression models including relationship satisfaction, along with the control variables, explained between 23% and 34% of the variance in the following self-efficacy subscale measurements: Health Communication, Coping, Social Support, Seizure Tracking, Seizure Response, Wellness, and Stress Management. PWEs reporting more satisfaction with their current relationship also reported better outcomes on these subscales, with moderate/medium effect sizes ranging from r_p = .35 to r_p = .49. Relationship satisfaction was not associated with scores on the Treatment, Safety, Medical Adherence, or Proactivity subscales.

3.2. Epilepsy Self-Management and sexual satisfaction

Sexual satisfaction showed the same pattern of results as did relationship satisfaction, with significant associations on the same seven of eleven subscales, albeit with some stronger associations. Regression models including sexual satisfaction, along with the control variables, explained between 28% and 42% of the variance in these subscales. Effect sizes ranged from small to moderate/medium, r_p = .28 to r_p = .59.

4. Discussion

In this study, we examined the association between essential facets of intimate relationship quality—specifically relationship satisfaction and sexual satisfaction—with self-management among persons with epilepsy (PWEs). Intimate relationship quality has been consistently linked with better mental and physical health outcomes, including better adherence to medical treatments and lower risk of mortality [24,25]. Because PWEs are known to experience difficulties with social relationships [8,18], and recent work has shown that PWEs are especially concerned with issues related to their romantic and sexual relationships [33], the current study provides a foundation for investigating PWEs’ intimate relationships as critical influences on their epilepsy-related health outcomes.

We explored one health outcome in particular among PWEs: self-management. The concept of self-management has been shown to be paramount in controlling one’s seizures and subsequently reducing severe health ramifications, including SUDEP [6]. Controlling for participant age and gender, the presence of comorbidities, and perceptions of social support received from one’s partner, our results showed that satisfaction predicted better self-management on seven of the eleven measured subscales (64% of outcomes measured), and did so with moderate or moderate-to-large effect sizes. Specifically, PWEs who reported more satisfaction with their romantic and sexual lives also reported better health communication, coping skills, social support, seizure tracking, seizure response, stress management, and wellness. The relationship satisfaction and sexual satisfaction measures were highly intercorrelated and had the same pattern of significant associations with each self-management subscale, suggesting that only one measure of satisfaction would suffice for clinical implementation. Satisfaction of either type was found to be unrelated to the treatment, safety, medical adherence, and proactivity subscales. Although our findings were not uniform across all subscales, these results demonstrate the importance of intimate relationship dynamics in PWEs’ ability to effectively manage their condition. As has been shown in other conditions, such as cancer, intimate relationship satisfaction is amenable to intervention [58,59]. This is one potential area of intervention to enhance self-management and related outcomes in PWEs.

Notably, in many of our models, relationship satisfaction and sexual satisfaction impacted self-management as strongly as— and occasionally even more so than—did the presence of comorbidities (i.e., similarly sized statistical effects). Previous literature has shown that the presence of comorbidities complicates self-management and has an effect on persons’ abilities to function optimally [60,61] within the context of a chronic illness such as epilepsy. That intimate relationship characteristics, which are amenable to intervention, can have just as much as or more of an effect on self-management than the presence of comorbidities is a promising finding. This result offers more evidence for the possibility of interventions that target intimate relationship characteristics in PWEs to enhance self-management.

Although this was the first known study to examine intimate relationship factors on self-management in PWE, there are some methodological limitations. First, the sample consisted of 88 PWEs, a sample too small to confidently generalize our findings to the larger population of PWEs. Second, we relied on self-report measures of self-management rather than behavioral measures of medical adherence or seizure frequency. Future researchers should work to garner a more representative sample, and combine the use of objective measures and self-reports of self-management. Third, while relationship and sexual satisfaction are important features of overall intimate relationship quality and function, future work could expand to include a wider variety of intimate relationship factors in PWEs lives. Further, there are a number of individual difference factors that affect relationship dynamics and sexuality, such as attachment style [62] and religiosity [63]. An expanded study would give a clearer understanding of how to best tailor interventions based on personal and relationship characteristics. Fourth, our sample consisted of mostly highly educated (53% with college degrees) males, and were recruited via an advertisement shared by an organization located in Indiana. Thus, findings may have somewhat limited generalizability to PWE without these characteristics. Follow-up studies should include more women, PWEs with lower education and socioeconomic status, and from different regional or cultural backgrounds. Finally, though we did collect data regarding participants’ diagnoses of anxiety and depression, we did not measure current levels of anxiety and/or depressive symptoms. Because these symptoms could be affected by recent seizure activity, and these symptoms could potentially affect perceived intimate relationship characteristics, this is a potential limitation in this study.

5. Conclusions

We investigated the link between intimate relationship satisfaction and epilepsy self-management in PWEs. Our results demonstrated significant associations between both romantic relationship and sexual satisfaction with two-thirds of the epilepsy self-management measures tested. Given that intimate relationship dynamics have been shown to be highly amenable to intervention in the context of other diseases like cancer, this is an area of potential interest for improving self-management in PWEs.