title: The relationship of depression to antiepileptic drug adherence and quality of life in epilepsy.
abstract: We sought to examine the impact of depression upon antiepileptic drug (AED) adherence in patients with epilepsy. We administered the Center for Epidemiologic Studies Depression Scale (CES-D), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Seizure Severity Questionnaire (SSQ), and Quality of Life in Epilepsy-10 (QOLIE-10) and measured AED adherence by utilizing the medication possession ratio (MPR) in adult patients with epilepsy identified through a pharmacy claims database. From a sampling frame of over 10,000 patients identified in claims, 2750 were randomly selected and contacted directly by mail to participate in the cross-sectional survey. A total of 465 eligible patients completed a survey. Survey data were combined with administrative claims data for analysis. We conducted a path analysis to assess the relationships between depression, adherence, seizure severity, and quality of life (QOL). Patients with depression scored significantly worse on measures of seizure severity (p=.003), QOL (p<.001), and adherence (p=.001). On path analysis, depression and QOL and seizure severity and QOL were related, but only the NDDI-E scores had a significant relationship with medication adherence (p=.001). Depression as measured by the NDDI-E was correlated with an increased risk of AED nonadherence. Depression or seizure severity adversely impacted QOL. These results demonstrate yet another important reason to screen for depression in epilepsy.
authors.affiliation: Neurological Surgery, P.C., Lake Success, NY 11042, USA. Electronic address: aettinge@gmail.com.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Ettinger
authors.affiliation: OptumInsight, Eden Prairie, MN 55344, USA.
authors.forename: Margaret B
authors.initials: MB
authors.lastname: Good
authors.affiliation: GlaxoSmithKline, Research Triangle Park, NC 27709, USA.
authors.forename: Ranjani
authors.initials: R
authors.lastname: Manjunath
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA 30322, USA.
authors.forename: R
authors.initials: R
authors.lastname: Edward Faught
authors.affiliation: OptumInsight, Eden Prairie, MN 55344, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Bancroft
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology*; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D000927:Anticonvulsants
keywords: Adherence; Antiepileptic drug; Depression; Quality of life; Seizure severity