Brief Communication| Volume 142, 109187, May 2023

Download started.


Screening for anxiety, depression and suicidality by epilepsy specialists in adult services in Scotland



      Clinical guidelines recommend screening people with epilepsy (PWE) regularly for mental distress, but it is unclear how guidelines are implemented. We surveyed epilepsy specialists in adult Scottish services to determine approaches used to screen for anxiety, depression, and suicidality; the perceived difficulty of screening; factors associated with intention to screen; and treatment decisions made following positive screens.


      An anonymous email-based questionnaire survey of epilepsy nurses and epilepsy neurology specialists (n = 38) was conducted.


      Two in every three specialists used a systematic screening approach; a third did not. Clinical interview was employed more often than standardized questionnaire. Clinicians reported positive attitudes towards screening but found screening difficult to implement. Intention to screen was associated with favorable attitude, perceived control, and social norm. Pharmacological and non-pharmacological interventions were proposed equally often for those screening positive for anxiety or depression.


      Routine screening for mental distress is carried out in Scottish epilepsy treatment settings but is not universal. Attention should be paid to clinician factors associated with screening, such as intention to screen and resulting treatment decisions. These factors are potentially modifiable, offering a means of closing the gap between guideline recommendations and clinical practice.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Epilepsy & Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kwon O.Y.
        • Park S.P.
        Depression and anxiety in people with epilepsy.
        J Clin Neurol. 2014; 10: 175-188
        • Hamid H.
        • Blackmon K.
        • Cong X.
        • Dziura J.
        • Atlas L.Y.
        • Vickrey B.G.
        • et al.
        Mood, anxiety, and incomplete seizure control affect quality of life after epilepsy surgery.
        Neurology. 2014; 82: 887-894
        • Zhao Y.
        • Liu X.
        • Xiao Z.
        Effects of perceived stigma, unemployment and depression on suicidal risk in people with epilepsy.
        Seizure. 2021; 91: 34-39
        • Mbizvo G.K.
        • Schnier C.
        • Simpson C.R.
        • Chin R.F.M.
        • Duncan S.E.
        A national study of epilepsy-related deaths in Scotland: Trends, mechanisms, and avoidable deaths.
        Epilepsia. 2021; 62: 2667-2684
        • Michaelis R.
        • Tang V.
        • Nevitt S.J.
        • Wagner J.L.
        • Modi A.C.
        • LaFrance Jr, W.C.
        • et al.
        Psychological treatments for people with epilepsy.
        Cochrane Database Syst Rev. 2020; (Art. No. CD012081)
        • Michaelis R.
        • Tang V.
        • Goldstein L.H.
        • Reuber M.
        • LaFrance Jr, W.C.
        • Lundgren T.
        • et al.
        Psychological treatments for adults and children with epilepsy: Evidence-based recommendations by the International League Against Epilepsy Psychology Task Force.
        Epilepsia. 2018; 59: 1282-1302
        • Jobst B.C.
        Progress in chronic disease: Self-management for patients with epilepsy.
        Ann Intern Med. 2019; 171: 137-138
        • Gandy M.
        • Modi A.C.
        • Wagner J.L.
        • LaFrance Jr, W.C.
        • Reuber M.
        • Tang V.
        • et al.
        Managing depression and anxiety in people with epilepsy: A survey of epilepsy health professionals by the ILAE Psychology Task Force.
        Epilepsia Open. 2021; 6: 127-139
      1. Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and Management of Epilepsy in Adults. Edinburgh: SIGN; 2015.

        • Kerr M.P.
        • Mensah S.
        • Besag F.
        • de Toffol B.
        • Ettinger A.
        • Kanemoto K.
        • et al.
        International consensus clinical practice statements for the treatment of neuropsychiatric conditions associated with epilepsy.
        Epilepsia. 2011; 52: 2133-2138
        • Riotto G.
        • Ali I.
        • Aziz R.
        • Hundal J.
        • Mani R.
        A survey of neurologists screening and management of depression in patients with epilepsy.
        Neurology. 2019; 92 (P1.5-008)
        • Scott A.J.
        • Sharpe L.
        • Thayer Z.
        • Miller L.A.
        • Nikpour A.
        • Parratt K.
        • et al.
        How frequently is anxiety and depression identified and treated in hospital and community samples of adults with epilepsy?.
        Epilepsy Behav. 2021; 115107703
        • Ajzen I.
        Attitudes Personality and Behavior.
        Oxford University Press, Milton Keynes1988
        • Hart S.
        • Morris R.
        Screening for depression after stroke: an exploration of professionals’ compliance with guidelines.
        Clin Rehabil. 2008; 22: 60-70
        • Gillespie D.C.
        • Cadden A.P.
        • West R.M.
        • Broomfield N.M.
        Non-pharmacological interventions for post-stroke emotionalism (PSE) within inpatient stroke settings: a Theory of Planned Behaviour survey.
        Top Stroke Rehabil. 2020; 27: 15-24
        • Lin C.Y.
        • Fung X.C.C.
        • Nikoobakht M.
        • Burri A.
        • Pakpour A.H.
        Using the Theory of Planned Behavior incorporated with perceived barriers to explore sexual counseling services delivered by healthcare professionals in individuals suffering from epilepsy.
        Epilepsy Behav. 2017; 74: 124-129
        • Francis J.
        • Eccles M.P.
        • Johnston M.
        • Walker A.E.
        • Grimshaw J.M.
        • Foy R.
        • et al.
        Constructing questionnaires based on the theory of planned behaviour: A manual for health services researchers.
        Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, UK2004
      2. Public Health Scotland. Data Tables (Workforce); 2014. [accessed 14 February 2023].

        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatr Scand. 1983; 67: 361-370
        • Gilliam F.G.
        • Barry J.J.
        • Hermann B.P.
        • Meador K.J.
        • Vahle V.
        • Kanner A.M.
        Rapid detection of major depression in epilepsy: a multicenter study.
        Lancet Neurol. 2006; 5: 399-405
        • Higgins A.
        • Downes C.
        • Varley J.
        • Doherty C.P.
        • Begley C.
        • Elliott N.
        Supporting and empowering people with epilepsy: Contribution of the Epilepsy Specialist Nurses (SENsE study).
        Seizure. 2019; 71: 42-49
      3. Epilepsy Action Scotland. Epilepsy Services in Scotland 2022. [accessed 14 February 2023].

      4. NHS Improvement. Psychological Care after Stroke: Improving Stroke Services for People with Cognitive and Mood Disorders; 2011. [accessed 14 February 2023].

        • Taylor J.
        • Anderson W.S.
        • Brandt J.
        • Mari Z.
        • Pontone G.M.
        Neuropsychiatric Complications of Parkinson Disease Treatments: Importance of Multidisciplinary Care.
        Am J Geriatr Psychiatry. 2016; 24: 1171-1180
        • Goodman R.
        The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden.
        J Child Psychol Psychiatry Allied Discip. 1999; 40: 791-799
        • George C.
        • Felix S.A.
        • McLellan A.
        • Shetty J.
        • Middleton J.
        • Chin R.F.
        • et al.
        Pilot project of psychological services integrated into a pediatric epilepsy clinic: Psychology Adding Value – Epilepsy Screening (PAVES).
        Epilepsy Behav. 2021; 120107968
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.W.
        • Lowe B.
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Scott A.J.
        • Sharpe L.
        • Thayer Z.
        • Miller L.A.
        • Hunt C.
        • MacCann C.
        • et al.
        Design and validation of two measures to detect anxiety disorders in epilepsy: The Epilepsy Anxiety Survey Instrument and its brief counterpart.
        Epilepsia. 2019; 60: 2068-2077
        • Rathore J.S.
        • Jehi L.E.
        • Fan Y.
        • Patel S.I.
        • Foldvary-Schaefer N.
        • Ramirez M.J.
        • et al.
        Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy.
        Epilepsy Behav. 2014; 37: 215-220
        • Seo J.G.
        • Cho Y.W.
        • Lee S.J.
        • Lee J.J.
        • Kim J.E.
        • Moon H.J.
        • et al.
        Validation of the generalized anxiety disorder-7 in people with epilepsy: a MEPSY study.
        Epilepsy Behav. 2014; 35: 59-63
        • Gillespie D.C.
        • Flewitt B.I.
        • Sacripante R.
        • Burns V.
        • Young L.
        • Chin R.F.
        • et al.
        Questionnaire-based screening for mental distress in epilepsy: Outline and feasibility of an outpatient screening and intervention pathway.
        Epilepsy Behav. 2023;
        • Woolf S.H.
        • Grol R.
        • Hutchinson A.
        • Eccles M.
        • Grimshaw J.
        Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines.
        BMJ. 1999; 318: 527-530