Abstracts

Rationale: Screening for depression and suicidality in an epilepsy clinic assists in identifying patients in need of immediate intervention as well as mental-health follow-up. The purpose of the current project is to review outcome and depression screening scores in patients identified as depressed and recommended for treatment. Methods: Adult patients at the Minnesota Epilepsy Group (MEG) who were identified as depressed on the NDDI-E (a score of16+), or who endorsed suicidal thinking, were reviewed. Additional selection criteria included: no mental-health services reported at the time of screening; recommended future mental-health intervention; and a subsequent comparative depression screening score. Results: A total of 1928 patients completed the MEG depression screening during routine clinic visits from May 2014-May 2016. Of this total, 17% (336) scored in the clinically depressed range (16+) on the NDDI-E, of which, 73% (244) were not followed by a psychiatrist or therapist at the time of screening. The final study sample consisted of 99 patients for whom follow-up mental-health treatment was recommended by the neurologist, and who completed a NDDI-E at a return clinic appointment. Of these patients, 26% followed treatment recommendations while 74% did not. The treatment group (n=26) was 54% female and 46% male; and had a mean pre-treatment NDDI-E score of 18.1 and post-treatment NDDI-E score of 15.9, with an average interval between screenings of 10.7 months. The treatment group included three patients who endorsed suicidal thinking pre-treatment and one after treatment. The no-treatment group (n=73) was 52% female and 48% male; and had a mean initial NDDI-E score of 17.6 and follow-up mean NDDI-E score of 16.3, with an average interval between screenings of 10.6 months. The no-treatment group included one patient who endorsed suicidal thinking at both screenings. Follow-up depression screening NDDI-E scores revealed similar trends in symptom change between the two groups; however, the group receiving treatment had a slightly greater reduction in reported symptoms. Conclusions: The majority of individuals with co-morbid epilepsy and depression are not receiving mental-health services even when recommended by a neurology provider following clinic depression screening. Patients who do participate in treatment demonstrate only modest improvement on NDDI-E scores. Epilepsy screening effectively identifies individuals who may benefit from further evaluation and intervention; however, more focused efforts are needed to increase participation in recommended services and improve the efficacy of intervention. Multi-disciplinary epilepsy clinics are uniquely positioned to offer improved and targeted interventions. Funding: no funding