Abstracts

Rationale: PEARL (Program for Encouraging Active, Rewarding Lives) is a community-based, in-home intervention for treating depression and improving function in patients with epilepsy. The program consists of problem-solving, behavioral activation and comprehensive psychiatric supervision and support. Collaborative care processes, that include patients’ neurologists, facilitate initiation/change of antidepressants or modification of anti-epileptic drugs with “depressogenic” adverse effects. Using data from an ongoing RCT evaluating this program, we assess baseline characteristics of participants to determine if depression severity is associated with clinical or psychosocial characteristics. Methods: We recruited patients from the University of Washington Regional Epilepsy Center or neurology clinics, with most patients attending Harborview Medical Center, the primary safety-net county hospital in Seattle, Washington. Our recruitment goal of 80 patients has been attained. Using data from eligibility screening and a baseline questionnaire at randomization, we characterize patients on demographic, clinical and psychosocial characteristics. Using independent t-tests we explore which baseline clinical or psychosocial characteristics are associated with depression severity based on the Patient Health Questionnaire (PHQ-9). We hypothesize that patients with functional or social impairment related to epilepsy have greater depression severity. Results: Enrollees with epilepsy in the study were a working age cohort (mean age 43.9±11.0 years), but were largely unemployed (25.0%) or disabled (42.5%). Fifty-three percent reported having a seizure within the prior month and on average patients had 2.9±2.3 additional medical conditions. Over the prior 6 months, 20% of patients had at least one inpatient hospitalization and 48% had at least one ER visit. Patients were relatively isolated with 31.3% living alone and 68.8% unmarried. Seventy percent reported driving limitations due to epilepsy or anti-epileptic drug side effects. While all patients met criteria for depression, 69% had major depression and 79% had dysthymia (chronic depression) with 60% having “double depression” (both conditions). Depression severity was associated with having at least one inpatient hospitalization in the prior 6 months (p<.01), and with patient reports that epilepsy interfered with: social activities and hobbies (p<.001), health (p<.05), ability to work (p<.05), and standard of living (p<.01). Conclusions: PEARL is a program targeted at individuals with epilepsy who have impairment in social and occupational functioning and significant morbidity related to epilepsy and other conditions. While baseline data showing an association between depression severity and functional limitations are cross-sectional, the PEARL intervention, which focuses on improving function and activities, is likely to lead to improvements in depression and quality of life as was previously demonstrated in a trial of a similar intervention for homebound, frail elderly (e.g. Program for Encouraging Active, Rewarding Lives for Seniors).