Abstracts

Rationale: Up to 25% of individuals with epilepsy have depressive symptoms, which often complicate seizure management and reduce overall quality of life. In order to identify and manage depressive symptoms appropriately, clinicians need screening tools and other standardized instruments that can accurately identify those with clinically significant depression. This secondary analysis from 2 epilepsy self-management studies compared depression severity ratings and case identification using a “gold standard” self-rated depression screening tool and a “gold standard” rater-administered depression severity instrument. Methods: Data for this analysis was derived from pooled baseline and longitudinal data from 2 epilepsy self-management randomized controlled trial that tested a similar experimental intervention. Both studies assessed depression with the self-reported 9-item Patient Health Questionnaire (PHQ-9) and the rater-administered Montgomery Asberg Depression Rating Scale (MADRS). The PHQ-9 is widely used self-rated depression screening measure used in primary care settings and for population health surveillance, although it has been understudied as applied to people with epilepsy. The MADRS is a rater administered instrument widely used as a primary outcome measure in depression clinical trials. For this analysis, total depression severity scores and case identification using established thresholds for no/minimal, mild, moderate/moderately severe, and severe depression were assessed using both the PHQ-9 and MADRS. Results: The sample consisted of 164 adults with epilepsy, mean age 43.1 years (SD 12.2), with demographic and clinical variables between the 2 studies being generally similar. There were N= 107 women (64.8 %), N= 106 African-Americans (64.2%), and N=51 (30.9%) whites. Study participants had epilepsy for an average of 22.1(SD 15.5) years. Mean past 30-day seizure frequency at baseline was 3.1, SD 11.6. Baseline mean PHQ-9 was 10.8, SD 6.8 with 32 (19.6%) classified as minimally depressed, 47 (28.8%) classified as mildly depressed, 37 (22.7%) as moderately depressed, 27 (16.6%) as moderately severely depressed and 20 (12.3%) as severely depressed. Baseline mean MADRS was 18.5, SD 11.3 with 30 (18.8%) classified as not depressed, 27 (16.9%) classified as mildly depressed, 92 (56.1 %) as moderately depressed, and 11 (6.9%) as severely depressed. The Pearson correlation between total PHQ-9 and total MADRS was =.843 (p < 0.01), although case classification by depression severity varied somewhat between the two instruments. Conclusions: Standardized measures to screen and evaluate depression severity can help to identify cases and monitor treatment progress. The PHQ-9 and MADRS both perform well in assessing depression in patients with epilepsy, although administration burden is less with the PHQ-9 thus making it likely preferable for settings where time and epilepsy specialty resources are limited. Funding: This poster was supported by the Grant or Cooperative Agreement Number U48DP001930 (SIP12-057) and by U48DP005030 SIP14-007 funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.