Depression and Mental Health Interventions in Patients with Epilepsy Undergoing a Self-management Cognitive Therapy Program
Abstract number :
1.409
Submission category :
17. Public Health
Year :
2023
Submission ID :
775
Source :
www.aesnet.org
Presentation date :
12/2/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Taylor Shade, BS – Emory School of Medicine
Jerik Leung, MPH – Emory University Rollins School of Public Health; Archna Patel, MPH – Emory University Rollins School of Public Health; Barbara Jobst, MD/PhD – Dartmouth-Hitchcock Medical Center; Elaine Kiriakopoulos, MD/MSc – Dartmouth-Hitchcock Medical Center; Cam Escoffery, PhD – Emory University Rollins School of Public Health; Katie Bullinger, MD/PhD – Emory University School of Medicine
Rationale: Depression is common in patients with epilepsy and can negatively impact cognitive function and quality of life (Mula 2021, Hammar 2009). In delivery of the HOBSCOTCH (HOme-Based Self-management and COgnitive Training CHanges lives) program, a program designed to improve cognition and quality of life in patients with memory concerns and epilepsy, we perceived a very high number of patients reporting symptoms of depression. Although not the primary goal of the study, frequent weekly visits with cognitive coaches provided an opportunity to intervene if symptoms of depression appeared to interfere with patients’ ability to move forward in the program or if there was any acute safety concern (for example, suicidality). In this study, we examine the rates of depression, depression/suicidality related interventions, and the impact of the HOBSCOTCH program on validated depression scores.
Methods: Fifty-nine patients were recruited from Emory’s Comprehensive Epilepsy Center and consented to participate in the HOBSCOTCH Georgia Replication trial. Complete data sets were available for 40 patients s. Demographic data and medical history were collected at baseline. Severity of depression, measured through Patient Health Questionnaire-9 (PHQ-9), was measured at baseline and three months (immediately post intervention for the treatment group and preintervention for the waitlist control group). Additional descriptive data was collected during each session by the cognitive coach. Data was collected and stored in the REDCap research database. Statistical analysis was performed using PROC MIXED in SAS 9.4.
Results: 70.4% of patients in the treatment group and 60.7% in the waitlist control group reported symptoms of depression at baseline (Table 1). Interventions performed by the study staff included (1) problem-solving therapy (PST) with cognitive coaches which was performed in 41.7% of all patients due to symptoms of depression significant enough to impede their ability to focus on memory during the cognitive therapy program, (2) a brief suicide safety assessment provided by the study physician in the 25.0% of all patients who were thought to be potentially at risk for acute suicidality, none of whom ultimately required immediate medical assistance, and (3) providing mental health resources in 5.6% of all patients. For the severity of depression (PHQ-9) score, the interaction of treatment over time was not significant for the group as a whole (p = 0.30) or for patients with reported symptoms of depression. (p= 0.33)
Conclusions: The HOBSCOTCH cognitive therapy program, though not the program’s primary purpose, can provide an opportunity to detect symptoms of depression and suicidality. However, in this population, neither brief intervention (PST, safety checks or providing resources) nor the program itself were sufficient to improve depression scores. More targeted and/or longer-term interventions for mental health are likely needed.
Funding: Centers for Disease Control and Prevention U48 DP006377-04-00.
Public Health