Assistant Professor of Clinical Neurology Keck School of Medicine, USC
Rationale: Patients with epilepsy frequently have comorbid psychiatric conditions, which often affects both seizure control and quality of life. Understanding barriers to mental health care in patients with epilepsy is critical to providing effective comprehensive care. The purpose of this research was to better understand perceptions of mental health care in adults with epilepsy, and how that relates to their current symptoms of depression and anxiety. Methods: One hundred patients in the Keck USC Adult Epilepsy Clinic participated. We excluded patients with intellectual disability and those who could not read English. They completed a self-report questionnaire about their perceptions of mental health related to their diagnosis and treatment of epilepsy. Depression and anxiety were screened for with the Neurologic Disorders Depression Inventory (NDDI-E) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. The data was analyzed with Chi-Squared tests using SPSS software. Results: Our results demonstrated that 49% of patients reported having symptoms of depression or anxiety prior to onset of first seizure, and 44% said they had worsening of their mood after their diagnosis of epilepsy. There were 75% of patients who reported that their epilepsy specialist asked about their mood symptoms, 65% of whom asked every visit. There were 57% of patients who thought their epilepsy specialist should also treat them for their mood symptoms. If their mood symptoms are treated, 52% of patients thought their seizures would decrease in frequency. Only 27% of patients see a mental health therapist regularly and only 25% of patients see a Psychiatrist regularly. NDDI-E score was > 15 suggesting major depression in 32% of patients and GAD-7 score was ≥ 10 suggesting moderate or severe anxiety in 37% of patients. Those who did not see a therapist regularly were significantly more likely to have a lower NDDI-E score (p=0.014) and those who did not see a Psychiatrist regularly were significantly more likely to have lower NDDI-E and GAD-7 scores, p=0.004 and p=0.021, respectively. Conclusions: In conclusion, patients felt that the majority of the providers in our epilepsy group were asking about their mood symptoms frequently. However, only slightly more than half of patients felt that their epilepsy specialist should also treat their mood symptoms, but only approximately one-fourth of patients were seeing a mental health provider. Common barriers to seeing a mental health provider included that patients did not think they needed to see them, that insurance did not cover visits/were too expensive, and that patients did not have time to see them. Only approximately half of patients understood that treating their mood symptoms might decrease their seizure frequency, which underscores the importance of educating patients about the relationship between seizures and mood. Approximately one-third of patients had an NDDI-E and/or GAD-7 score suggesting major depression and/or moderate-severe anxiety. Lower NDDI-E and GAD-7 scores in those not seeing a mental health provider regularly may be due to appropriately referring patients with more severe symptoms, though duration of mental health treatment and improvement with treatment was not assessed. These data support that even in a practice that is frequently asking about mood symptoms, a third of patients continue to have significant mood symptoms and are experiencing barriers to establishing with a mental health provider. This emphasizes the importance of both educating epileptologists about treating psychiatric comorbidity and the need to advocate for treatment by a mental health provider when appropriate. Funding: Please list any funding that was received in support of this abstract.: None
