Abstracts

Rationale: Depression in patients with epilepsy is widely considered to be a significant comorbidity. However, there is scant analysis of nationwide survey data regarding prevalence and treatment in adults with epilepsy (AWE). Methods: We analyzed data from the Medical Expenditure Panel Survey (MEPS) from 2004-2015. We defined AWE as those ≥18 years in age with epilepsy as defined by ICD-9-CM codes 345.xx or 780.39. Patients were defined as having depression if they scored ≥ 3 on the Patient Health Questionnaire-2 (PHQ-2). We used logistic regression to determine the effect of socioeconomic factors and medical comorbidities as captured by a modified Charlson comorbidity index on PHQ-2 screen positive depression. Pooled survey weights using the “SAQWT” variable were employed. All analyses were performed with Stata 11. Results: Our sample comprised 2022 AWE, who represented 1,734,406 patients nationwide. We found that 23.1% of patients (95% CI 20.6%-25.8%) had a positive PHQ-2 screen for depression. In the overall sample, 16.8% (95% CI 14.7%-19.2%) had received any treatment for depression, 15.6% (95% CI 13.6%-17.8%) were prescribed either antidepressants or antipsychotics for depression, and 3.93% (95% CI 3.02%-5.08%) had obtained psychotherapy or mental health counseling. Among patients with PHQ-2 screen positive depression, 34.4% (95% CI 29.2%-40.0%) received any treatment for depression, 30.9% (25.9%-36.2%) received any pharmacotherapy for depression, and 9.5% (95% CI 7.06-12.7) received psychotherapy/counselling for depression (Table 1). A one-point increase in Charlson comorbidity index was associated with higher odds of PHQ-2 screen positive depression (OR 1.11, 95% CI 1.05-1.18, p<0.001), as was female gender (OR 1.42, 95% CI 1.05-1.92, p=0.023), age group 35-49 compared to age group 18-34 (OR 1.51, 95% CI 1.02-2.24, p=0.04), and having public health insurance as compared to private health insurance (OR 1.78, 95% CI 1.22-2.60). Family income greater than 400% of the federal poverty line as compared to family income at or below the federal poverty line (OR 0.34, 95% CI 0.20-0.61, p<0.001), and never married status compared to being currently married (OR 0.63, 95% CI 0.44-0.89, p=0.01) were associated with lower odds of screen-positive depression (Table 2). Conclusions: This data from a nationwide population-weighted sample confirms that depression is a prevalent comorbidity among AWE and that fewer than half of such patients receive any treatment. Gender, health comorbidities, and public insurance additionally show positive associations with screen-positive depression. This may suggest that further efforts should be made to screen AWE for depression and refer to appropriate treatment. Funding: No funding