The impact of a short depression and anxiety screening tool in epilepsy care in primary health care settings in Zambia.
Up to 60% of the 50 million persons with epilepsy (PWE) worldwide have depression and anxiety and 80% of PWE live in low-income regions. Common psychiatric comorbidities are often unrecognized and undertreated. We developed and validated a 10-item screening tool for the detection of depression and anxiety at primary healthcare clinics in Zambia in which the baseline detection rate among PWE was 1%. We trained primary care clinic workers in selected clinics to use this screening tool. A retrospective chart review was conducted for 120 consecutive PWE who received care one month after training. Detection improved from 1% to 49%, and treatment was frequently initiated. Of the 120 screened, 59 (49.2%) scored above cutoff point of 18. Of these persons, 43 (73.0%) were positive for depression, 16 (23.0%) were positive for anxiety, 38 (64.4%) received counseling, 18 (30.5%) received antidepressants, and 3 (5.1%) were referred to a psychiatrist. Use of this screening tool resulted in improved mental health care for PWE.
Department of Mental Health and Clinical Psychiatry, Chainama College of Health Sciences, Lusaka, Zambia; School of Nursing and Public Health University of Kwa Zulu Natal, Durban, South Africa; Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia; University of Rochester, Department of Neurology, Epilepsy Division, Rochester, New York.
Edward K
EK
Mbewe
Leana R
LR
Uys
Gretchen L
GL
Birbeck
D000328:Adult; D000554:Ambulatory Care Facilities; D000928:Antidepressive Agents / Q000627:therapeutic use; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003376:Counseling; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation*; D008603:Mental Health; D011320:Primary Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires / Q000592:standards*; D015024:Zambia / Q000453:epidemiology
D000928:Antidepressive Agents