Gender differences in risk factors and psychosocial functioning in children with psychogenic nonepileptic seizures 2022 Yeom et al

[Andy]

Highlights

• Female predominates in childhood-onset psychogenic nonepileptic seizures (PNES).
• Early life trauma, specifically sexual abuse, was common in girls with PNES.
• Learning disability was a significant contributing factor in boys with PNES.
• Girls were more likely to experience suicidal thoughts and suicidal attempts.
• Both sexes experienced emotional problems and bothersome somatic symptoms.

Abstract

Objective
Female predominance is evident in childhood-onset psychogenic nonepileptic seizures (PNES). Understanding gender-specific vulnerability to PNES may provide a unique insight into its cause and management. We aimed to investigate gender differences in demographic characteristics, triggering factors and psychosocial functioning in children and youth with PNES.

Methods
We retrospectively reviewed patients who were evaluated in the PNES clinic at Children’s Healthcare of Atlanta from July 2019 to March 2020 and completed questionnaires to assess adverse life events, psychosocial function (Pediatric Symptom Checklist-17 [PSC-17]), and somatic symptoms (Children’s Somatic Symptom Inventory-8, [CSSI-8]).

Results
Forty-nine consecutive patients (38 girls, 11 boys) with a median age of 15.0 (9–19) years were included in the study. We performed univariate analysis and evaluated significant variables related to PNES according to sex. Majority of both genders experienced daily to weekly PNES, came from dysfunctional families, scored high on PSC-17, were treated for neuropsychiatric illnesses, and experienced bothersome somatic symptoms. The variables significantly different between genders were suicidal thoughts, history of trauma, and learning disability. Suicidal thoughts and trauma, particularly sexual abuse, were significantly more prevalent in girls (p = 0.03) whereas learning disability was more common in boys (p = 0.03).

Conclusion
Females predominated in our PNES clinic (F:M = 3.5:1). Gender differences in predisposing factors were sexual abuse in females and learning disability in males. Our data highlight the gender-specific risk factors and vulnerability to PNES. The awareness of gender difference may guide more targeted intervention for children and youth with PNES.

Paywall, https://www.epilepsybehavior.com/article/S1525-5050(22)00333-X/fulltext

 

[Peter T]

Gender differences in predisposing factors were sexual abuse in females and learning disability in males.

I have not checked this up, but again correlation seems to be being equated with causation without adequate justification. My recollections may very much be woolly or out of date, but isn’t there a higher incidence of learning disabilities in boys and I assume higher levels of sexual abuse with girls.

 

[Hutan]

Yes, the usual problem in these sorts of studies - the abstract doesn't report the percentages and 95% confidence intervals for children who have suffered sexual abuse or learning difficulties, or set the percentage in the context of comparable populations.

There is some research suggesting 1 in 20 children the UK suffer sexual abuse, it's not uncommon, and so it wouldn't be surprising to find 2 or 3 girls suffering from sexual abuse in a sample of 38 girls.

The variables significantly different between genders were suicidal thoughts, history of trauma, and learning disability. Suicidal thoughts and trauma, particularly sexual abuse, were significantly more prevalent in girls (p = 0.03) whereas learning disability was more common in boys (p = 0.03).

Reading that carefully, there were not significant differences between sexual abuse in the girls and sexual abuse in the boys. What they found was that girls in this sample were significantly more likely to have had suicidal thoughts or a history of trauma (including sexual abuse, among other sorts of trauma) than boys. Even then, the p result for the comparisons were not impressive, and with that small sample (only 10 boys), even more doubtful.

It's annoying that peer reviewers allow abstracts like that, because I'm pretty sure most readers who are't looking for problems would come away from the abstract assuming that sexual abuse predisposes girls to have PNES, and learning disabilities predisposes boys to have PNES. The abstract does not present evidence to support that idea.

 

[Snow Leopard]

Yes, the usual problem in these sorts of studies - the abstract doesn't report the percentages and 95% confidence intervals for children who have suffered sexual abuse or learning difficulties, or set the percentage in the context of comparable populations.

Yes, quoting P values but not effect sizes/primary effects in an Abstract is considered a big no-no in research, yet I guess the editor/peer reviewers never got the message.