Abstracts

Rationale: Mood disorders such as depression are more common in people with epilepsy (PWE) than in the general population and affect quality of life independent of seizure frequency. Many PWE, particularly Hispanics, prefer nonpharmacological approaches to manage depression, but there are few evidence-based programs. Project UPLIFT (Using Practice and Learning to Increase Favorable Thoughts) is a telephone-based program that effectively teaches skills to treat and prevent depression in English-speaking PWE. Its efficacy in Spanish-speaking PWE has not been evaluated. We analyzed baseline data from a randomized controlled trial of UPLIFT in Hispanic PWE to test the hypothesis that depressive symptom severity is associated with low mindfulness and high rumination, two psychosocial factors targeted by the UPLIFT program. Methods: Project UPLIFT has been adapted for Hispanic PWE at the NYU School of Medicine Managing Epilepsy Well (MEW) Network collaborating center and a trial testing the adapted program is underway. For this analysis, we used the baseline data of 72 English- and Spanish-speaking Hispanic PWE with elevated depressive symptoms enrolled in the trial. Participants completed validated self-report measures of depressive symptoms (Patient Health Questionnaire [PHQ-9]), trait mindfulness (Five Facet Mindfulness Questionnaire), trait rumination (Rumination Response Scale) and perceived social support (Interpersonal Support Evaluation List). Other baseline data included age, gender, language, education, use of antidepressant medications, and seizure frequency. Multivariable linear regression was used to test associations between baseline depressive symptoms and sociodemographic, clinical and psychosocial factors. Results: Participants (N=72) were mostly female (70.8%), Spanish-speaking (66.7%), unmarried (66.7%), and not working for pay (70.8%). The mean age was 42.8 ± 11.3 years and 54.2% had at least a high school education. The mean PHQ-9 score was 8.4 ± 4.7, 34.7% of participants met criteria for moderate depressive symptoms (PHQ-9 =10), and 31.9% were taking antidepressants. In the multivariable regression model, higher depressive symptoms were associated with higher education (p=.033), use of antidepressants (p=.015), higher rumination (p=.049) and lower mindfulness (p=.003). Having a seizure in the last 30 days fell just short of statistical significance (p=.051). Age, gender, language and social support were not associated with depressive symptoms (all ps >.42). Conclusions: Our results suggest that mindfulness and rumination are associated with depressive symptoms independent of seizures and sociodemographic characteristics. These modifiable psychosocial factors are key intervention targets of the UPLIFT program. Results of the ongoing trial testing the culturally adapted UPLIFT program for Hispanic PWE will indicate its feasibility, acceptability and efficacy in reducing depressive symptoms in this underserved population. Funding: Centers for Disease Control and Prevention (CDC) Managing Epilepsy Well (MEW) Network