Annotated Abstracts of Journal Articles
2015, 1st Quarter
Annotation by Audrey Walker, MD, FAPM
Guilfoyle SM, Monahan S, Wesolowski C, Modi AC
Epilepsy Behav 2015 Jan 15; 44C:5-10
ANNOTATION (Audrey Walker)
The Finding: This study evaluated a large number of youth with epilepsy (YWE, N=311) using both a youth self-report instrument (CDI-2nd edition) in combination with a caregiver report (PedsQL parent proxy report) to evaluate depressive symptoms in YWE.
Strengths and Weaknesses: The use of a self-report instrument is unique in the evaluation of depression in youth with epilepsy and adds value to the finding.
This study demonstrates the feasibility and value of proactive depression screening by a behavioral medicine consultation service integrated into a comprehensive pediatric epilepsy center. The important finding is that depressive symptoms and suicidal ideation are common in youth with epilepsy and have a detrimental impact on QOL.
Weaknesses: Only 159 of the participants had follow up evaluations after the initial screening. This smaller subsample limited the ability of the investigators to examine the impact of the behavioral medicine consultation on the depressive symptoms identified in the study group.
The design of the study is retrospective, thereby limiting the findings.
Health-related QOL was assessed by caregivers only.
Relevance: Youth with epilepsy have an increased risk of comorbid psychopathology compared with the general population. The burden of depression in these patients is particularly high; most studies which have documented this finding have relied on proxy caregiver reports only. The current study expands this finding by adding a youth self-report to the assessment.
Only one-third of youth with epilepsy and comorbid depression receive behavioral health interventions. The consequences of untreated depression in these patients is protean and include poor medical adherence, poor medical outcomes, poor health-related quality of life, and increased health care utilization. This study demonstrates that depression screening can be successfully integrated into a comprehensive pediatric epilepsy center and that the presence of depressive symptoms negatively impacts health-related quality of life.
Despite the increased risk and prevalence of depression in youth with epilepsy, only one-third receive mental health services. Untreated depression can contribute to negative outcomes and increased health-care utilization and medical cost. Proactive behavioral medicine screening may facilitate identification of depressive symptoms and necessary interventions in efforts to optimize behavioral health and health-related quality of life (HRQOL). Primary study aims included the examination of 1) rates of self-reported depression in youth with epilepsy, 2) differences in depression by demographic and medical variables, 3) the impact of depression on HRQOL, and 4) changes in depression and suicidal ideation following a behavioral medicine consultation. As part of routine clinic care over a 24-month period, youth with epilepsy of 7-17years of age completed the Children’s Depression Inventory-Second Edition. Parents completed the PedsQL. A chart review was conducted to ascertain demographics, medical variables, and behavioral medicine visits and recommendations. A subsample with Time 1 and Time 2 depression data was examined. Time 1 participants included 311 youth with epilepsy (Mage=11.9years, 50% female, 84% Caucasian, 46.0% with localization-related epilepsy, 71.0% with seizure control in the past 3months). Elevated depression was identified in 23% of youth, with 14% endorsing suicidal ideation. Depression significantly varied by age, antiepileptic drug, and insurance. After controlling for seizure status, HRQOL worsened with elevated depression. Depression significantly decreased from Time 1 to Time 2 (n=159), particularly for those referred for behavioral medicine services at Time 1. Systematic assessment and early detection of depression and/or suicidal ideation in youth with epilepsy can improve HRQOL and decrease depression. Depression screening can be implemented through clinic-based behavioral medicine services.