Abstracts

Rationale: Roughly 50% of youth with epilepsy require ongoing medical management of this condition into adulthood (Camfield et al., 2012), making transition from pediatric to adult epilepsy care an important area of study. Adult psychosocial outcomes of youth with epilepsy are poor: previous studies show less education, lower rates of employment and marriage, and higher rates of mental health assessments, substance use, and unplanned pregnancies in this population (Carrizosa et al., 2014; Jalava et al., 1997, Wirrell et al., 1997). Symptoms of depression are also common in patients with epilepsy, with a prevalence between 6-30% in population-based studies (Kanner, 2003). However, little is known about the prevalence of depression at the time of transition, or how depressive symptoms may influence patient adherence to medical recommendations during this period. These relationships are explored in the context of a chart review of 31 patients who have transitioned from pediatric to adult epilepsy care at a Level 4 epilepsy center. Methods: All 31 patients in the study had a confirmed diagnosis of epilepsy, had been followed by a pediatric epileptologist for outpatient visits, had completed at least one outpatient visit with an adult epileptologist, and had filled out the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) at their first outpatient visit with their adult epileptologist. Chi-square analyses and odds ratios examined relationships between mental health difficulties and medical adherence (patient-reported medication adherence and length of time between medical visits). Results: 13% of patients screened positive for depression on the NDDI-E (scored = or < 15). An additional 16% of patients were in mental health treatment, resulting in 29% of the sample exhibiting mental health concerns at their first adult outpatient visit. 52% had mental health concerns documented in the history section of their first adult visit note. Mean age at the final pediatric visit was 18.1 years, and mean age at the first adult visit was 19.3 years, with a mean of 14.6 months between patients' last pediatric visit and first adult visit. 58% had their first adult visit at least 3 months later than what was medically recommended at their last pediatric visit; of this 58%, the average appointment delay was 9.6 months. Medication adherence data was available for 65% of the sample; within this group, adherence issues were self-reported in 40% of the patients. 68% of the sample was on monotherapy drug treatment and 63% had a focal epilepsy diagnosis. Chi-square tests and odds ratios revealed that at the initial adult visit, patients with a history of mental health difficulties were 1.4 times more likely to have a positive depression screen on the NDDI-E (p=.04) and 1.5 times more likely to be in psychotherapy (p=.01). At trend level, patients who endorsed mental health concerns at their first adult outpatient visit were more likely to have their first visit with an adult epileptologist on time or ahead of what was recommended at their last pediatric visit (p=.07). Conclusions: Findings highlight the prevalence of depressive symptoms in a transition-age sample, and reveal meaningful relationships between medical adherence variables and psychiatric concerns during this time. This study is ongoing; an additional 35-45 patients will be added, with an N of nearly 75 by AES. Variables related to broader psychosocial functioning (e.g., patient employment, education level) will also be explored in relation to their impact on transition. Funding: NA