Abstracts

Rationale: People with epilepsy have an increased risk of active and lifetime depression impacting both health outcomes and quality of life. The Patient Health Questionnaire-2 (PHQ-2), a validated screen for depression, has been identified as a useful tool for integrated care settings. The prevalence of comorbid mood disorders in epilepsy requires more robust and standardized provision of screening for depression. This pilot study examined the feasibility of implementing depression screening with the (PHQ-2) at a community organization, Epilepsy Foundation Central and South Texas (EFCST), serving people with epilepsy in Texas.

Methods: Behavioral health program staff at EFCST received training to administer the PHQ-2 depression screening tool to constituents calling into the Social Services Coordinator (SSC) help desk and to patients referred from neurologists at the 6 free epilepsy clinics administered by EFCST (Austin, San Antonio, Corpus Christi, Laredo, Harlingen and Uvalde average of 800 patients seen each year). A network of 21 behavioral health provider organizations able to accept referrals, both insured and uninsured, from EFCST was established.

Results: Over the course of 14 months 305 PHQ-2 depression screenings were completed (n=305; 267 English and 38 Spanish speaking) between ages 3 and 75 years. Screenings were completed in person at EFCST-epilepsy clinics (109) and over telephone (196). Patients who underwent depression screening in this cohort identified as uninsured (n=167) and insured (n=105); 7 patients did not report. In total 24% (n=72) people scored 3 or greater on PHQ-2 and were referred to behavioral health provider services for appropriate treatment; 10 people were referred to evidence-based epilepsy self-management programs; 8 people referred to EFCST community support groups. Interval 4-month follow up screening (n=23) was carried out by EFCST-SSC and depressive symptoms were documented as improved (n=4), unchanged (n=7) or increased/worse (12).

Conclusions: This pilot implementation study demonstrated feasibility for integrating PHQ-2 depression screening and referral in community-based epilepsy organizations serving people with epilepsy. Required elements for implementation include PHQ-2 training for staff, established pathways for referrals to the SSC, an established network of behavioral health providers accepting referrals, organizational protocols for managing acute mental health crisis and a mechanism for reporting and follow-up of referrals. Community organizations serving people with epilepsy and offering support services from appropriately trained social service staff are well positioned to aid in PHQ-2 screening and referral to appropriate mental health services.

Funding: Please list any funding that was received in support of this abstract.: This program was made possible with funding from the Centers for Disease Control and Prevention (CDC) under cooperative agreement number 7U58DP0026256-03-00, CFDA 93.850.