PREVENTING DEPRESSION IN EPILEPSY: PROJECT UPLIFT
Authors: N. J. Thompson, A. Patel, L. M. Selwa, C. E. Begley, R. T. Fraser, E. Johnson, S. Stoll Instit: Rollins School of Public Health of Emory University
Depression is a common psychiatric disorder among people with epilepsy. It has more strongly predicted reduced quality of life than seizure frequency, although individuals with epilepsy and depression also perceive increased levels of seizure severity. A review of studies reported the rate of depression in people with epilepsy is between 32% and 48%. Project UPLIFT was originally developed as a home-based treatment for depression in people with epilepsy, funded by the Centers for Disease Control and Prevention. The UPLIFT materials include modules for eight sessions based upon Mindfulness-based Cognitive Therapy for Depression, and are designed for group delivery by telephone or Web. A pilot effectiveness study found they significantly reduced depressive symptoms more than a treatment-as-usual (TAU) waitlist condition. The goals of this multi-site project, funded by the National Center for Minority Health and Health Disparities, were to revise the Project UPLIFT materials for use in prevention (rather than treatment) of depression, and estimate their effectiveness in reducing the risk of depression in people with epilepsy.
Persons diagnosed with epilepsy for at least 3 months were recruited through epilepsy clinics at Emory University, University of Michigan, University of Texas—Houston, and University of Washington. Each state's target enrollment was 42 people. Investigators modified the language and activities for use in prevention; two focus groups of people with epilepsy assisted in re-evaluating the revised intervention, before it was tested. Supervised by a licensed psychologist, two co-facilitators led each intervention group: a graduate student in public health and a person with epilepsy. The outcomes of the preventive intervention were assessed using a cross-over design. The 130 consenting participants were randomized to intervention or TAU; those assigned to UPLIFT who required a specific mode of delivery were assigned to that mode and the remainder were assigned to equalize the groups. UPLIFT groups received the program immediately (some by telephone conference call, and some by Web) and TAU groups received the program later. Data, collected at baseline and about 8 and 20 weeks afterward, included measures of depression, knowledge and skills, self-efficacy, self-compassion, satisfaction with life, and quality of life.
The intervention was effective. None (0%) of 52 in UPLIFT group developed Major Depressive Disorder compared to 6 (11%) of 56 in TAU (p = 0.028). A repeated measures ANOVA found that Beck Depression scores decreased more in UPLIFT than in TAU (F1,102 = 9.46, p = 0.003), as did number of seizures (F1,105 = 4.06, p = 0.046). Knowledge and Skills (F1,105 = 4.09, p = 0.046) and Satisfaction with Life (F1,106 = 6.93, p = 0.010) increased more in UPLIFT than TAU.
UPLIFT prevented depression at relatively low cost, while reducing seizures and increasing life satisfaction. In addition, distance delivery reduced access problems, reducing health disparities for those who were mobility-limited or located in rural areas.
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