title: Depression screening in pediatric epilepsy: evidence for the benefit of a behavioral medicine service in early detection.
abstract: 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.
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 3015, Cincinnati, OH 45229, USA; University of Cincinnati School of Medicine, Cincinnati, OH, USA. Electronic address: shanna.guilfoyle@cchmc.org.
authors.forename: Shanna M
authors.initials: SM
authors.lastname: Guilfoyle
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, 333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA. Electronic address: sally.monahan@cchmc.org.
authors.forename: Sally
authors.initials: S
authors.lastname: Monahan
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, 333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA. Electronic address: cindy.wesolowski@cchmc.org.
authors.forename: Cindy
authors.initials: C
authors.lastname: Wesolowski
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 3015, Cincinnati, OH 45229, USA; Center for Adherence Promotion and Self-Management, Division of Behavioral Medicine and Clinical Psychology, 3333 Burnet Ave., MLC 3079, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Cincinnati, OH, USA. Electronic address: avani.modi@cchmc.org.
authors.forename: Avani C
authors.initials: AC
authors.lastname: Modi
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D001524:Behavioral Medicine / Q000379:methods*; D002648:Child; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology; D042241:Early Diagnosis; D004827:Epilepsy / Q000150:complications* / Q000523:psychology; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D010342:Patient Acceptance of Health Care; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012640:Seizures / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D012959:Socioeconomic Factors; D059020:Suicidal Ideation
chemical_list: D000927:Anticonvulsants
keywords: Comorbidity; Depression; Epilepsy/seizures; Health-related quality of life; Psychology; Screening; Suicidal ideation