Advancing Mental Health Equity in Epilepsy: Social Determinants of Health Across the Lifespan.

Abstract

Mental health equity is a critical issue for people with epilepsy (PWE), who bear a disproportionate burden of psychiatric and cognitive comorbidities. Conditions such as depression, anxiety, attention-deficit/hyperactivity disorder, autism spectrum disorder, functional/dissociative seizures, and cognitive impairment occur more frequently in PWE, contributing to elevated morbidity, mortality, and reduced quality of life. Many of these disorders have bidirectional relationships with epilepsy, reflecting overlapping biological, psychological, and social mechanisms. Social Determinants of Health (SDoH), including educational opportunities, access to health care, neighborhood and environmental exposures, social and community context, and economic stability, further shape risk, presentation, and outcomes across the lifespan. Children with epilepsy and neurodevelopmental disorders face academic and service inequities, while adults encounter barriers in mental health access and stigma that may worsen depression and anxiety. Older adults with epilepsy and dementia experience additional disparities driven by socioeconomic status and minority status. This narrative review synthesizes current evidence on the epidemiology, risk factors, and mechanisms linking epilepsy with psychiatric, neurodevelopmental, and neurodegenerative conditions, with an emphasis on how SDoH exacerbates inequities. We identify gaps in mechanistic research and highlight the underrepresentation of vulnerable populations. To advance equity, strategies must include routine SDoH screening, integration of psychosocial and neurologic care, stigma-reduction efforts, and development of culturally competent, patient-centered interventions. Policy initiatives that address structural barriers to care are also essential. Together, these approaches can improve outcomes and promote health equity for PWE.