Abstracts

Rationale: Project UPLIFT is a telephone-delivered program developed from mindfulness-based cognitive therapy (MBCT) that effectively reduces and prevents depression in English-speaking people with epilepsy (PWE). Hispanic PWE experience significant disparities in health care access and health outcomes. The NYU School of Medicine collaborating center in the CDC-funded Managing Epilepsy Well (MEW) Network adapted UPLIFT for Hispanic PWE and is conducting a randomized controlled trial of the adapted program. The purpose of this analysis is to evaluate the feasibility and acceptability of the adapted UPLIFT program and to explore differences between English- and Spanish-speaking Hispanic PWE. Methods: Project UPLIFT was adapted using a rigorous qualitative process conducted in collaboration with Hispanic PWE and academic and community partners. Study materials (written and audio) were translated into Spanish and focus groups and individual interviews were conducted with Hispanic PWE. Adaptations included reducing the overall literacy level of the UPLIFT workbook (English and Spanish), refining the Spanish translation to enhance communication of mindfulness concepts, and addressing the importance of family in the recruitment process. The target sample of 72 Hispanic PWE with elevated depressive symptoms was enrolled from epilepsy clinics at NYU and Bellevue Hospital. Participants were randomized 1:1 to UPLIFT or usual care and followed for 12 months. UPLIFT was delivered in groups of 6 participants; 4 cohorts received the program in Spanish and 2 in English. Recruitment and retention rates, session completion, and satisfaction ratings were examined to evaluate feasibility and acceptability of the adapted UPLIFT program among Hispanic PWE. Results: From October 2016 to April 2018, 323 patients were pre-screened using medical records and 233 were initially eligible based on age and diagnosis. Of 166 patients whose physicians approved contact and who were reached, 40 (24.1%) declined screening, 54 (32.5%) were ineligible, and 72 were eligible and enrolled (43.4%). The mean age was 42.8+-11.3 years and the majority of the sample was female (70.8%), Spanish-speaking (66.7%) and not working for pay (70.8%). Socioeconomic status was low, with 45.8% completing less than a high school education and 82.8% reporting <$25,000 annual household income. Almost half (45.7%) had at least one seizure in the prior month.The median number of UPLIFT sessions completed was 6 out of 8, and 61.4% (54.2% Spanish vs. 75.0% English, p=.23) completed 4 or more sessions, considered the minimum effective dose for MBCT programs. More than 90% reported being satisfied with the program. Retention rates were 93.1% at 8 weeks and 90.3% at 6 months; 12-month follow-up is ongoing. There were no significant differences in retention rates (p>.75) or satisfaction ratings (p=.76) by language.  Conclusions: Results suggest that the adapted UPLIFT program is feasible and acceptable among Hispanic PWE. Session completion was similar compared with prior studies of primarily Caucasian PWE but somewhat lower in the Spanish vs. English groups. Retention rates were high in both groups. Results of the ongoing trial will indicate the efficacy of the adapted UPLIFT program for reducing depressive symptoms in Hispanic PWE. If effective, UPLIFT has the potential to improve health outcomes and reduce disparities in this underserved population. Future research is needed to examine the generalizability of the adapted program for Hispanic PWE outside the NYC area.  Funding: Centers for Disease Control and Prevention