Abstracts

Rationale: NEEDS is an inter-disciplinary initiative aimed at addressing the burden and impact of depression in neurological conditions. The aim of this paper was to describe the social and clinical characteristics of the first NEEDS cohort: Persons with epilepsy (PWE).Methods: 300 consecutive PWE were recruited from the only epilepsy program serving a population of >1 million. Participants filled out a detailed questionnaire including socio-demographics, the Patient Health Questionnaire (PHQ-9), the Hospital Anxiety Depression Scale (HADS) and the Epilepsy Adverse Events Profile (AEP). They then underwent within two weeks of recruitment the extensively validated Structured Clinical Interview for DSM-IV (SCID). Results: Of 300 PWE approached, 268 agreed to participate (89.3%). 52.1% of participants were female, with a mean age of 40.3 years. 53.1% of PWE were married or common law, 64% had less than a university education, and 67.2% were working. Current use of alcohol was reported by 60% of PWE, smoking by 20.2%, and illicit drug use by 15.3%. EPILEPSY-RELATED FINDINGS: 31.7% of participants had generalized epilepsy, 67.6% focal and 0.7% of unknown onset. 34.0% of epilepsies were of structural-metabolic etiology, 27.9% of presumed genetic and 8.2% of unknown etiology. 9.9% reported their epilepsy as being quite, very or extremely severe while 22.2% reported their seizures as quite, very or extremely disabling. 35.5% reported medication side effects. According to the AEP, the most common adverse events were tiredness, headache and difficulty concentrating. DEPRESSION: According to the SCID, 16.7% of PWE were currently depressed and 19.4% had experienced a lifetime depressive episode. 11.1% reported currently taking medication for their depression, while chart review confirmed 13.4% were taking psychotropic agents. 6.1% reported receiving other forms of treatment for their depression. Using the self-report PHQ-9, 22.8% of participants were classified as depressed, while 27.6% of participants endorsed clinically significant symptoms of anxiety according to the HADS. Overall, 12.2% of PWE endorsed suicidal ideation, with 46.7 % of PWE who were currently depressed reporting suicidal ideation. Conclusions: Lifetime depression is common in PWE. Although the lifetime prevalence is only slightly higher than that expected in the general population, the current prevalence is 4 to 5 times that expected in the general population. This suggest that the temporal course of depression in PWE is dramatically different the large burden of depression in PWE being more related to the duration of time spent in the depressed state as opposed to the overall frequency of occurrence being the main explanation. In addition, nearly one in two PWE with depression reported suicidal ideation. Finally self-report of anxiety was prevalent in PWE, as was substance use. This study highlights the importance of screening for mental health disorders in those with epilepsy.