What is effective treatment of depression in people with epilepsy?

Using Rasch measurement theory to assess three depression scales among adults with epilepsy

People with chronic conditions, such as epilepsy, are at a high risk for depression; however depression is often under-recognized and undertreated. Depression scales, including one specific to people with epilepsy, have been used for screening in this population, although none have been assessed with Rasch measurement theory. This study used Rasch analyses in order to evaluate and compare the psychometric properties of the modified Beck Depression Inventory, the Patient Health Questionnaire, and the Neurological Disorders Depression Inventory for Epilepsy in a sample of people with epilepsy and depression who participated in an intervention designed to reduce depressive symptoms. A secondary purpose was to assess item functioning across time. The sample includes 44 participants in the Project UPLIFT program who completed the assessments before and after taking part in the intervention. Results of the Rasch analysis indicate that the three depression scales functioned as intended. There was good overall targeting between the items and the sample, acceptable model-data fit, and good reliability of separation for persons, items, and time. The participants experienced a significant decrease in depressive symptoms from pretest to posttest. This study illustrates the value of using model-based measurement with the Rasch model to combine items across the three depression scales. It also demonstrates an approach for analyzing and evaluating the results of small scale intervention programs, such as the UPLIFT program.

Long-term outcomes from the PEARLS randomized trial for the treatment of depression in patients with epilepsy

Depression is associated with higher rates of suicide and lower quality of life in individuals with epilepsy. We previously published the 12-month outcome from our randomized clinical trial of PEARLS (Ciechanowski P, Chaytor N, Miller J, et al. Epilepsy Behav. Epub 5 July 2010). The purpose of this study was to determine the long-term effectiveness of PEARLS, a home-based collaborative care intervention consisting of problem-solving treatment, behavioral activation, and psychiatric consultation, in individuals with epilepsy. Patients were randomly assigned to PEARLS (N=40) or usual care (N=40), and assessed at baseline and 6, 12, and 18 months. Patients assigned to PEARLS achieved lower depression severity (P<0.05) (Hopkins Symptoms Checklist-20), lower suicidal ideation (P<0.02), and better emotional well being (QOLIE-31) (P<0.02) over 18 months, compared with patients given the usual care. The PEARLS program significantly reduces depressive symptoms in adults with epilepsy, and this effect is maintained for 18 months after baseline and for more than 1 year after completion of home visits.

Group cognitive-behavioral therapy for patients with epilepsy and comorbid depression and anxiety

Clinical Practice Guidelines for depression and anxiety recommend cognitive-behavioral therapy (CBT) as an equivalent and sometimes more effective treatment than medication. The limited research investigating CBT for anxiety and depression in epilepsy demonstrates mixed results. Described here is a pilot project using an existing group CBT intervention for symptoms of depression and/or anxiety, CBT Basics II, in patients with epilepsy. Eighteen patients with epilepsy, referred by neurologists to address depression and/or anxiety symptoms, completed the 10-week group. Results demonstrated improvements in depression, anxiety, negative automatic thoughts, and cognitive therapy knowledge and skills. The group was generally acceptable to patients as indicated by good attendance rates and only one dropout. This pilot project demonstrates that group CBT is a feasible, acceptable, and promising intervention for patients with epilepsy and comorbid depression and anxiety symptoms.

Formative and process evaluations of a cognitive-behavioral therapy and mindfulness intervention for people with epilepsy and depression

People with chronic diseases are at high risk for depression, resulting in a need for effective and accessible treatment options. Project UPLIFT is a program based on cognitive-behavioral therapy and mindfulness that is aimed at reducing depressive symptoms among people with epilepsy. It is designed to be delivered to small groups of people over the phone or Internet. This study describes the formative and process evaluations of Project UPLIFT; the purpose of these evaluations was to assess the acceptability and feasibility of the program, looking at both the program components and delivery methods. The formative evaluation, conducted prior to program implementation, included nine participants in three focus groups. The process evaluation included qualitative comments and responses to the Client Satisfaction Questionnaire from 38 Project UPLIFT pilot study participants. Overall, the results from both evaluations indicate that participants felt that Project UPLIFT was acceptable and perceived to be beneficial.

PEARLS depression treatment for individuals with epilepsy: a randomized controlled trial

OBJECTIVE

Depression is associated with higher rates of suicide and lower levels of functioning and quality of life in individuals with epilepsy. The objective of this randomized controlled trial was to determine the effectiveness of PEARLS, a home-based program for managing depression in adult individuals with epilepsy and clinically significant acute and chronic depression.

METHODS

Delivered by masters-level counselors, PEARLS is a collaborative care intervention consisting of problem solving treatment, behavioral activation, and psychiatric consultation. Patients were randomly assigned to the PEARLS intervention (N = 40) or usual care (N = 40), and assessed at baseline, 6 months, and 12 months.

RESULTS

Compared with patients who received usual care, patients assigned to the PEARLS intervention achieved lower depression severity (P<0.005) (Hopkins Symptoms Checklist-20) and lower suicidal ideation (P = 0.025) over 12 months.

CONCLUSIONS

The PEARLS program, a community-integrated, home-based treatment for depression, effectively reduces depressive symptoms in adults with epilepsy and comorbid depression.

Chronic physical conditions and their association with first onset of suicidal behavior in the world mental health surveys

OBJECTIVE

To investigate the association of a range of temporally prior physical conditions with the subsequent first onset of suicidal ideation, plans, and attempts in large, general population, cross-national sample. The associations between physical conditions and suicidal behavior remain unclear due to sparse data and varied methodology.

METHODS

Predictive associations between 13 temporally prior physical conditions and first onset of suicidal ideation, plans, and attempts were examined in a 14-country sample (n = 37,915) after controlling for demographic, socioeconomic, and psychosocial covariates, with and without adjustment for mental disorders.

RESULTS

Most physical conditions were associated with suicidal ideation in the total sample; high blood pressure, heart attack/stroke, arthritis, chronic headache, other chronic pain, and respiratory conditions were associated with attempts in the total sample; epilepsy, cancer, and heart attack/stroke were associated with planned attempts. Epilepsy was the physical condition most strongly associated with the suicidal outcomes. Physical conditions were especially predictive of suicidality if they occurred early in life. As the number of physical conditions increased, the risk of suicidal outcomes also increased, however the added risk conferred was generally smaller with each additional condition. Adjustment for mental disorders made little substantive difference to these results. Physical conditions were equally predictive of suicidality in higher and lower income countries.

CONCLUSIONS

The presence of physical conditions is a risk factor for suicidal behavior even in the absence of mental disorder.

Psychological services in a pediatric epilepsy clinic: Referral patterns and feasibility

Referral patterns for on-site psychological services were tracked in a pediatric epilepsy clinic at a university medical center. Results revealed that 84 children treated for seizures were referred to an on-site pediatric psychologist. Behavior problems were the overall most common reason for referral; however, boys were more likely to be referred for disruptive behaviors, and girls were more likely to be referred for internalizing symptoms. Following psychological assessment, brief cognitive-behavioral intervention services were provided on-site in the epilepsy clinic to 39% of children and families. Finally, referral rates for psychological assessment/intervention were likely far below the estimated prevalence rates for psychosocial maladjustment in children with epilepsy. Results, therefore, highlight the necessity of facilitating increased referrals to mental health providers and provide support for the feasibility of on-site mental health services.

Experiences of persons with epilepsy and their families as they look for medical and community care: a focus group study from South Carolina

Epilepsy affects a larger number of individuals than previously thought-up to 2% of the population-and its effects reach further. Yet epilepsy, with its associated lingering stigma and fear, has remained in the background in terms of services and research. Traditional quantitative research often falls short when trying to describe the impact of epilepsy on the lives of individuals and their families. In the present study, focus groups were held throughout South Carolina to discuss individuals' experiences with accessing epilepsy-related services and health care, and what life with epilepsy is like. Following qualitative data analysis, findings included two themes. One theme focuses on the ongoing search for services and help. The second theme concerns the experiences of living life with epilepsy. Also highlighted are recommendations for potential improvements in public awareness and professional training, and helpful interventions.

Quality of life for patients with epilepsy is determined by more than seizure control: the role of psychosocial factors

Antiepileptic drugs remain the cornerstone of epilepsy treatment for minimizing, if not eliminating, seizures. However, many factors other than the degree of seizure control influence the quality of life for patients with epilepsy. This review focuses on psychosocial factors that have been associated with quality of life in this population, especially mood disorders, stigma seizure worry, self-esteem and self-mastery. Irrespective of their level of seizure control from antiepileptic drugs, patients may also benefit from targeted psychosocial interventions that reduce the negative impact of these factors on their quality of life.

Psychosocial intervention in pediatric epilepsy: a critique of the literature

It is well documented that youth with epilepsy are at increased risk for psychopathology. The current literature supports a biopsychosocial model of adjustment to pediatric epilepsy, and implies that interventions focused on changing youths' cognitions and illness appraisals, as well as enhancing their coping skills, may be an effective treatment for psychosocial maladjustment associated with pediatric epilepsy. The purpose of this article is to review and critique the extant literature covering psychological interventions that target psychosocial adjustment in youth with seizures followed by those aimed at reducing seizure frequency. For health care professionals treating epilepsy, establishing evidence-based interventions that target psychiatric difficulties in youth with epilepsy should be paramount in the promotion of optimal epilepsy outcomes. Thus, future recommendations for clinical endeavors and research proposals are also presented.