Abstracts

Rationale: Depression affects over 19 million people in the United States, and is more frequent among those with chronic illnesses like epilepsy. Jones et al.13 reported that up to 48% of people with epilepsy are depressed. Funded by the Centers for Disease Control and Prevention (CDC) as a home-based treatment for people with epilepsy, Project UPLIFT (Using Practice and Learning to Increase Favorable Thoughts) was originally developed to provide group delivery of depression treatment by telephone or Web. Materials were based upon both cognitive-behavioral therapy and mindfulness. Recently, the National Institutes of Health provided funding through the Challenge Grant Initiative to: 1) revise the Project UPLIFT materials for use preventing depression, rather than treating it; and 2) estimate the effectiveness of the revised materials. This paper will focus on what we encountered in creating a version of Project UPLIFT for use in prevention. Methods: The curriculum was revised with language and content modified for prevention, and feedback was obtained from epilepsy experts collaborating on the project. Focus groups were then co-facilitated by a graduate student and a person with epilepsy to formatively evaluate the revised curriculum. They were audio recorded and data transcribed and qualitatively analyzed. All participants had taken part in the treatment version of Project UPLIFT. Results of recruiting for the prevention intervention were also explored. Results: Language and content modifications for prevention required revisions such as referring to as low mood or feeling blue, rather than depression. Coping was discussed in terms of precursors of depression, (e.g., stress) instead of depression itself. Skills were framed as means of keeping from becoming depressed, rather than directly addressing depression. Sessions on finding pleasure were emphasized, and preventing relapse into depression was modified to preventing relapse into old, unhealthy behaviors (e.g., negative thinking). Focus group participants perceived the changes to the curriculum to be acceptable, but suggested simplifying several exercises, establishing real-time contact in the Web group, and clarifying that epilepsy was only one of many factors in their lives that can lead to depression. Recruiting results indicated that many people with epilepsy were already depressed, making prevention impossible. Conclusions: The resources found to be effective in treating depression among people with epilepsy were successfully adapted for prevention. The changes to the materials were well accepted by people with epilepsy, but it is important to continue simplifying them to improve their usability and adoption. More research is needed to determine the onset of depression relative to epilepsy, as there is difficulty reaching participants before they are depressed, allowing for prevention.