Depression and Mental Health Interventions in Patients with Epilepsy Undergoing a Self-management Cognitive Therapy Program- community Trial
Abstract number :
3.546
Submission category :
17. Public Health
Year :
2024
Submission ID :
1636
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Taylor Shade, BS – Emory University School of Medicine
Jerik Leung, MPH – Emory University Rollins School of Public Health
Amanda Eakin, MS – Emory University School of Medicine
Archna Patel, MPH – Emory University Rollins School of Public Health
Barbara Jobst, MD, PhD – Dartmouth-Hitchcock Medical Center
Elaine Kiriakopoulos, MD, MPH, MSc – Dartmouth-Hitchcock Medical Center
Cam Escoffery, PhD – Emory University Rollins School of Public Health
Katie Bullinger, MD, PhD – Emory University School of Medicine
Rationale: Depression is the most common psychiatric comorbidity in those with epilepsy (Kanner, 2005). The HOBSCOTCH (HOme-Based Self-management and COgnitive Training CHanges lives) program, which aims to enhance cognition and quality of life in patients with memory issues and epilepsy is being evaluated as part of a community trial. Through this trial in Georgia, we continue to observe a high incidence of depressive symptoms. While addressing depression was not the primary focus of the study, the frequent weekly sessions allowed for timely intervention if depressive symptoms began to hinder patients’ progress. This study explores the prevalence of depression, interventions related to depression, and the effect of the HOBSCOTCH program on validated depression scores in the community trial.
Methods: 38 participants were recruited from epilepsy-serving community organizations and clinical settings and consented to the HOBSCOTCH GA randomized trial. Demographic data and medical history were collected at baseline. We conducted linear regression to assess any changes in the Patient Health Questionnaire-9 (PHQ-9) at 3 months. This is used to monitor depressive symptoms. We ran separate models for each outcome (QOLIE-31, Neuro-QOL, MARS, AESMMI-65, and PHQ-9). In each model, the outcome was the HOBSCOTCH assessment at the 3-month time point. The main predictor was treatment group (1=HOBSCOTCH, 0=Waitlist). We included a mental health variable, obtained during the sessions (1=discussed mental health obstacle, 0=did not discuss). This trial is ongoing.
Results: There were no significant changes in depression scores between baseline and the 3-month follow-up for the treatment or waitlist group. The changes in PHQ-9 scores were not statistically significant when including mental health consultation and intervention groups as predictors while controlling for baseline scores. 41.2% of patients in the treatment group and 55.6% in the waitlist group reported symptoms of depression (Table 1), which is lower than the rates observed in the clinical trial. The study staff's interventions included (1)problem-solving therapy with cognitive coaches, implemented for 15.4% of patients who had depression symptoms severe enough to affect their focus, (2)a brief suicide safety assessment by the study physician, which was not needed, and (3)the provision of mental health resources, offered to 7.7% of patients.
Conclusions: Although detecting symptoms of depression was not the primary aim of the community trial for the HOBSCOTCH program, the trial provided an opportunity to identify these issues. Despite this, neither the brief interventions offered (such as problem-solving therapy or resource provision), nor the program itself were effective in improving depression scores. It appears that more targeted and/or long-term mental health interventions may still be necessary as was the case in the original clinical trial. Expanding access to resources for those participants with depressive symptoms may be effective.
Funding: Centers for Disease Control and Prevention U48 DP006377-04-00
Public Health