Abstracts

Rationale:
The Institute of Medicine recommends that neurologists screen youth with epilepsy (YWE) for psychosocial comorbidities and refer to behavioral health professionals as needed (2012). However, screening for depression symptoms in a busy ambulatory subspecialty medical clinic, that does not have behavioral health embedded, can be challenging. As such, it is important to determine an efficient and effective method to identify YWE at risk for depression and to make data-informed referrals in order to decrease symptoms of depression.  The current study examined whether the Patient Health Questionnaire-Adolescent (PHQ-A) is useful in a YWE population to identify symptoms of depression, whether providers use these results to refer for treatment with a pediatric psychologist, and if referral to the psychologist led to subsequent decrease in PHQ-A scores. 
Method:
 This study was a retrospective chart review of participants ages 6 to 24 who had a diagnosis of epilepsy, and completed the PHQ-A between July 2016 and April 2019. The resultant sample was 353 YWE with a median age of 14.4 years. If the participant scored at or over 10 on the PHQA, referral to pediatric psychology may be considered, because this is considered a positive screening and a moderate score (Spitzer et. al., 1999). Using the PHQ-A, we determined the rate of referral after the first administration based on a positive screening and whether referral led to subsequent decrease in depressive symptoms.
Results:
Results indicated that 14.6% of patients had a score that qualified as moderate depression upon the first administration of the PHQ-A. Additionally, 11 participants, or 3%, had a moderately severe score, and 3 people, making up 1% of the sample, had a score in the severe range. Furthermore, 61 of participants were referred due to their score and/or provider concerns. 50 participants (82%) followed through on that recommendation, based on their medical records. Using the Dwass, Steel, Critchlow-Fligner Method, the three groups (not referred, referred, and followed through) were compared to each other at three separate administrations. In the first administration, patients who were referred for mental health treatment had significantly higher scores on the PHQ-A (M = 7.9, SD = 5.1 versus M = 3, SD = 3.3, p < .001). In the second administration, those who were referred and followed through, had lower scores when compared to those who were referred and did not follow through ((M = 7.1, SD = 6.1 versus M = 8.3, SD = 6.1, p < .001).  The third administration identified additional patients with elevated scores,  and those with higher PHQ-A scores were referred ((M = 6.6, SD = 5.2 versus M = 2.6, SD = 3.5, p < .001).
Conclusion:
Participants in this study had an elevated rate of depression similar to the literature. Additionally, the findings suggest that the screening tool (PHQ-A) was successful in identifying those in need of mental health treatment. Those patients who followed the neurologists’ referral to a pediatric psychologist experienced a decrease in depression symptoms. However, patients who were referred and did not follow up with a mental health therapist had higher depression scores. Patients in need of evaluation and treatment with a pediatric psychologist were identified for the first time during the 3rd administration of the PHQA, supporting the need for evaluation to occur at each neurology follow up appointment.  Future research should investigate barriers to follow-up in this high-risk population. In general, these results support the practice of administering the PHQ-A to identify and manage YWE who have depression symptoms.
Funding:
:No funding was received for this project