Abstracts

Rationale: The prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), and suicide risk (SR) is high in epilepsy patients. Studies suggest a higher prevalence of depression and anxiety in women with epilepsy (WWE). Our aim was to determine prevalence and predictors for MDD, GAD, and SR in WWE utilizing the Mini International Neuropsychiatry Interview (MINI). Methods: 87 WWE in Cleveland Clinic Epilepsy Monitoring Unit were interviewed with the MINI. The MINI is a validated psychiatric diagnostic interview designed to assess for Axis I disorders based on the DSM-IV. Subjects also completed a menopause questionnaire, Quality of Life in Epilepsy-10 (QOLIE-10), European Quality of Life 5 (EQ-5), Liverpool Seizure Severity Scale (LSSS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Menopause was defined as cessation of menses for > 12 months and > 60 days of amenorrhea regardless of cause. Results: Mean age was 40 ± 14 and 46% (41) were employed. Mean age of epilepsy onset was 21 ± 17, monthly seizure frequency was 12 ± 25, number AEDs was 2.4 ± 1, and 93% (83) had focal epilepsy including 33% (29) with temporal lobe epilepsy (TLE). Based on the MINI, the prevalence of Axis I disorders (lifetime or current) were: 31% (27) MDD, 25% (22) anxiety disorder, 11% (10) GAD, and 34% (30) SR. Predictors of MDD were: Older age of epilepsy onset (p = 0.01), worse QOL on EQ-5 (p = 0.04), and more depressive symptoms on the PHQ-9 (p = 0.001) and anxiety symptoms on GAD-7 (p = 0.002) were associated with MDD. Predictors GAD were: Poor QOL on the QOLIE-10 (p = 0.002) and EQ-5 (p = 0.02), increased seizure severity on LSSS (p = 0.001), and more depressive symptoms on PHQ-9 (p = 0.02) as well anxiety symptoms on GAD-7 (p = 0.007). Predictors of SR were: More than 2 AEDs (p = 0.04), poor QOL on QOLIE-10 (p = 0.001) and EQ-5 (p = 0.001), more depressive and anxiety symptoms [PHQ-9 (p = 0.001); GAD-7 (p = 0.002)], and a comorbid diagnosis of any anxiety disorder on the MINI (p = 0.001). There was no significant difference in the prevalence of MDD, GAD, or SR between premenopausal and menopausal WWE. However, premenopausal WWE were more likely to have a MDD diagnosis if unemployed (p = 0.03) or had TLE (p = 0.01), while for menopausal WWE, older age of epilepsy onset (p =0.03) was a significant predictor of MDD. Conclusions: To our knowledge, this is the first study to investigate prevalence and predictors of Axis I disorders and suicide risk in WWE using a structured diagnostic interview. While the prevalence of MDD, GAD, and SR is high in WWE, menopausal status does not seem to be a significant predictor of Axis I disorders, although this requires confirmation in larger series. Predictors associated with MDD, GAD, and SR included poor QOL and high severity scores of current depression and anxiety symptoms. Additionally, older age of epilepsy onset and higher number of AEDs are important predictors of MDD and SR, respectively, in WWE. Larger studies exploring causative factors and burden of psychiatric co-morbidities in WWE are warranted.