Authors :
Presenting Author: Lydia Wolkiewicz, MD – Northwestern University
Elizabeth Hoover Papendick, RN, BSN – Northwestern Memorial Hospital
Elizabeth Gerard, MD – Northwestern University
Amy Corcoran, MD – Northwestern University
Erica Cotton, PsyD, ABPP – Northwestern University
Stephan Schuele, MD, MPH – Northwestern University
Cody Nathan, MD – Northwestern University
Rationale:
Mood disorders are common in patients with epilepsy. Depression, specifically, impacts 20-55% of adult patients and the rate of suicide is 10 times that of the general population. Having comorbid depression and epilepsy is associated with a decreased probability of seizure freedom, increased risk of medication side effects, cognitive changes, and increased mortality (Bermeo-Ovalle, A. Epilepsy & Behavior. 2018). Based on the consensus statement published by the National Association of Epilepsy Centers (NAEC) in 2024, patients with epilepsy should be screened for depression. However, barriers including lack of standardized screening tools, insufficient appointment duration, and limited access to mental health resources all pose challenges to implementing a screening process. To address these barriers, we implemented a standardized screening process for both depression and suicidality alongside a response-based triage process to ensure expedited psychiatric care.
Methods:
This is a retrospective study of adult patients seen as an outpatient in an attending telehealth clinic at a Level 4 epilepsy center in Chicago, Illinois. Participants were identified through the electronic medical record from August 2024 to May 2025. An epilepsy nurse administered the Patient Health Questionnaire (PHQ) 2 by phone immediately prior to the telehealth visit. If positive, this was followed by the PHQ-9. Suicidality was assessed by inquiring about suicidal ideation, duration of symptoms, and history of prior attempts. All the above questions were scored within the electronic medical record (EMR) flowsheet. Based on severity of symptoms, patients were referred either routinely, urgently, or emergently to appropriate psychiatric providers (Figure 1).
Results:
A total of 124 patients underwent the screening ahead of their visit. Around 10% of patients (13/124) screened positive with the PHQ-2. Of those, 9 completed the PHQ-9 in which 33% (3/9) scored mild depression, 22% (2/9) scored moderate depression, and 44% (4/9) scored moderately severe. Two patients reported death ideation and two mild suicidal ideations (without plan or intent). All of these patients were recommended to have routine psychiatric evaluation. Three of these patients did not have a prior established diagnosis of depression nor were actively receiving mental healthcare and were provided referrals. No one required urgent or emergent mental health evaluation. The timing of recommended psychiatric follow-up was triaged based on depression severity.
Conclusions:
While the majority of patients had negative screenings, those who screened positive were provided expedited referrals to psychiatric care. The screening process appropriately identified a small subset of patients with depression who did not have a known pre-existing diagnosis. The timing of psychiatric follow-up was triaged based on severity of symptoms which can help reduce a bottle-neck effect in the referral process. Depression and suicidality screening using this integrated EMR questionnaire is a feasible way to identify comorbid depression/suicidality in patients with epilepsy.
Funding: None