title: Screening of anxiety and quality of life in people with epilepsy.
abstract: OBJECTIVE
  Up to 60% of people with epilepsy (PwE) have psychiatric comorbidity including anxiety. Anxiety remains under recognized in PwE. This study investigates if screening tools validated for depression could be used to detect anxiety disorders in PWE. Additionally it analyses the effect of anxiety on QoL.
  
  
  METHODS
  261 participants with a confirmed diagnosis of epilepsy were included. Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Emotional Thermometers (ET), both validated to screen for depression were used. Hospital Anxiety and Depression Scale-Anxiety (HADS-A) with a cut off for moderate and severe anxiety was used as the reference standard. QoL was measured with EQ5-D. Sensitivity, specificity, positive and negative predictive value and ROC analysis as well as multivariate regression analysis were performed.
  
  
  RESULTS
  Patients with depression (n=46) were excluded as multivariate regression analysis showed that depression was the only significant determinant of having anxiety in the group. Against HADS-A, NDDI-E and ET-7 showed highest level of accuracy in recognizing anxiety with ET7 being the most effective tool. QoL was significantly reduced in PwE and anxiety.
  
  
  CONCLUSIONS
  Our study showed that reliable screening for moderate to severe anxiety in PwE without co-morbid depression is feasible with screening tools for depression. The cut off values for anxiety are different from those for depression in ET7 but very similar in NDDI-E. ET7 can be applied to screen simultaneously for depression and "pure" anxiety. Anxiety reduces significantly QoL. We recommend screening as an initial first step to rule out patients who are unlikely to have anxiety.
authors.affiliation: St George's University of London, London, UK; Department of Neuroscience, Graduate School of Health Sciences, Bahcesehir University, Istanbul, Turkey.
authors.forename: Selen
authors.initials: S
authors.lastname: Gur-Ozmen
authors.affiliation: Department of Neurology 1, Neuromed Campus, Kepler Universitaetsklinikum, Linz, Austria.
authors.forename: Annette
authors.initials: A
authors.lastname: Leibetseder
authors.affiliation: St George's University of London, London, UK; Atkinson Morley Neuroscience Centre, St. George's Hospital, London, UK.
authors.forename: Hannah R
authors.initials: HR
authors.lastname: Cock
authors.affiliation: St George's University of London, London, UK; Atkinson Morley Neuroscience Centre, St. George's Hospital, London, UK.
authors.forename: Niruj
authors.initials: N
authors.lastname: Agrawal
authors.affiliation: St George's University of London, London, UK; Department of Neurology 1, Neuromed Campus, Kepler Universitaetsklinikum, Linz, Austria. Electronic address: tvonoert@sgul.ac.uk.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: von Oertzen
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D004827:Epilepsy / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012372:ROC Curve; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D064232:Visual Analog Scale; D055815:Young Adult
keywords: Anxiety; Comorbidity; Depression; Epilepsy; Human; Questionnaire