Abstracts

Rationale: Previous studies point to increased mental health issues in children with epilepsy (CYE), including depression, suicidal ideation, and suicidal or parasuicidal behavior.Methods: Eligible participants were CYE and their families seen at the Pediatric Epilepsy Center, The Cleveland Clinic, from 2008 through 2015. A total of 5,303 mental health screenings for 400 different CYE were recorded. The Knowledge Program is a patient-generated data collection system developed by The Cleveland Clinic Neurological Institute (NI) for use with the EPIC electronic health record (EHR) system. The EHR provides systematic collection of patient health status measures (HSM). Screening begins with the PHQ-2 and proceeds according to the following algorithm.Results: Of the 400 people screened, 106 screened positive for suicide, for a baserate of 26.5%. Of these, 50.9% were male and 49.1% were female. Twelve patients were referred to the Emergency room and 13 suicides were prevented. Please see chart 1 for summary of the patient clinical characteristics.Patients were seen by one psychiatrist (T.F). The algorithm was used to continue evaluating suicide risk among patients who screened positive for suicide. Of the 13 patients, 9 were female and 4 were male; all were Caucasian. Ages range from 9 to 18 years (M = 15.25 years, SD = 2.34). All patients reported suicidal ideation; number of suicide attempts ranged between 0 and 3 (M = 1, SD= 1.05), 12 suicide attempts total. Half of the patients reported thoughts of harming others. All were taking SSRIs (Selective Serotonin Reuptake Inhibitor). Nine had been admitted to the pediatric psychiatry inpatient unit (M = 2.56 admissions; SD= 1.74). The overall mean score for the SCARED was 47.69 (significant for clinical anxiety), the overall mean score for Children Depression inventory (CDI) was 88.3 (significant for depression). The mean score of exposure to emotional trauma according to the Adverse childhood experiences was 2, the total number of visits to the ER for SI or SA in the group of 13 patients was 41 visits with a mean of 3.1 visits.Conclusions: The development of an algorithm that integrates pediatric epilepsy screening with psychiatry follow-up facilitated the screening of 400 CYE. Of these, 26.5% screened positive for SI, which is a bit higher than rates found in other studies of CYE. The process of further screening and referral is illustrated in the patients of one psychiatrist’s practice. The algorithm proved useful in organizing and systematizing the screening process. Significance: Evidence suggests that integrated mental health care in the epilepsy clinic can help improve care for CYE. Routine screening at least every six months for mood disorders and suicidal ideation could aid in early referral and appropriate treatment and potentially save lives.