Highlights
- •The mental health burden for people with epilepsy (PWE) is considerable.
- •Screening for mental distress, though recommended, is often not done routinely.
- •We report the feasibility of a postal-telephone mental distress screening pathway.
- •Mood and quality of life (QOL) outcomes improved for PWE included in the pathway.
- •However, 1 in 3 PWE could not be screened, possibly those struggling most with mood.
Abstract
Objective
Mental distress is present in a significant proportion of people with epilepsy (PWE),
with a negative impact across life domains. It is underdiagnosed and under-treated
despite guidelines recommending screening for its presence (e.g., SIGN, 2015). We
describe a tertiary-care epilepsy mental distress screening and treatment pathway,
with a preliminary investigation of its feasibility.
Methods
We selected psychometric screening instruments for depression, anxiety, quality of
life (QOL), and suicidality, establishing treatment options matched to instrument
scores on the Patient Health Questionnaire 9 (PHQ-9), along ‘traffic light’ lines.
We determined feasibility outcomes including recruitment and retention rates, resources
required to run the pathway, and level of psychological need. We undertook a preliminary
investigation of change in distress scores over a 9-month interval and determined
PWE engagement and the perceived usefulness of pathway treatment options.
Results
Two-thirds of eligible PWE were included in the pathway with an 88% retention rate.
At the initial screen, 45.8% of PWE required either an ‘Amber-2’ intervention (for
moderate distress) or a ‘Red’ one (for severe distress). The equivalent figure at
the 9-month re-screen was 36.8%, reflective of an improvement in depression and QOL
scores. Online charity-delivered well-being sessions and neuropsychology were rated
highly for engagement and perceived usefulness, but computerized cognitive behavioral
therapy was not. The resources required to run the pathway were modest.
Conclusion
Outpatient mental distress screening and intervention are feasible in PWE. The challenge
is to optimize methods for screening in busy clinics and to determine the best (and
most acceptable) interventions for screening positive PWE.
Keywords
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Article info
Publication history
Published online: February 17, 2023
Accepted:
January 1,
2023
Received in revised form:
December 19,
2022
Received:
October 18,
2022
Identification
Copyright
Crown Copyright © 2023 Published by Elsevier Inc. All rights reserved.
