Abstracts

Rationale: Depression is the most common co-morbid disorder in children with epilepsy, with as many as 20% reporting suicidal thoughts, according to the American Epilepsy Society. Through identification, training, and intervention, a goal for Epilepsy Clinics could be to improve support for patients with mental health co-morbidities. A brief screening tool, that provides an immediate and reliable assessment, is needed to identify patients with depression so appropriate referrals can be made. This project was undertaken to determine if the Patient Health Questionnaire-2 (PHQ-2), a shorter version of the Patient Health Questionnaire-9 (PHQ-9), could be used to reliably screen pediatric patients with epilepsy for depression. Therefore the clinical question posed was: for outpatient pediatric epilepsy patients, does the use of the PHQ-2 compared to parental report alone improve early detection of youth at risk for depression?

Methods: An electronic search of PubMed, CINAHL and PsycInfo used the key terms: depression, PHQ-2, PHQ-9, screening, pediatric, epilepsy, and ambulatory. The search was limited to articles published in English within 20 years. Of the 26 articles yielded, 18 articles were excluded because they were not relevant to the clinical practice question, leaving 8 articles for review.

Results: Using the Melnyk & Fineout-Overholt Critical Appraisal Guide, articles were appraised as one Level I, one Level II, two Level III, and four Level IV. The evidence revealed value in utilizing self-report measures, but more studies have examined parental report. Overall, the PHQ-2 and PHQ-9 have demonstrated reliability in identifying depression with adult primary care patients and adolescents but has not been studied specifically in pediatric patients with epilepsy. A systematic review examining the use of PHQ-2 suggests a minimum cut off score of > 2 was successful in identifying prevalence of depression in adults. The randomized controlled study validated PHQ-2 use with adolescents and also recommended a cut off score of > 2 to maximize sensitivity. The evidence supports routine screening of pediatric patients with epilepsy to identify co-morbid mental health conditions. The research is significantly lacking in terms of a screening tool or protocol for pediatric patients with epilepsy, the Intellectually Disabled (ID), a condition characterized by limitations of intellectual function and adaptive behavior, and patients with Autism Spectrum Disorder (ASD). A high proportion of pediatric patients with epilepsy also have these comorbidities.

Conclusions: Patients presenting to Epilepsy Clinics may benefit from implementation of a depression screening protocol that includes utilization of the PHQ. Incorporating the PHQ-2 and PHQ-9 into the electronic medical record (EMR) will facilitate the use of the PHQ-9 to confirm the findings of positive PHQ-2 depression screens and provide access to the results of the screens by all disciplines caring for the patients. Future studies are needed to validate the use of PHQ-2 in screening for depression in pediatric patients with epilepsy, especially those with ID, and ASD.

Funding: Please list any funding that was received in support of this abstract.: N/A.