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(Abst. 3.347), 2017

Depressive symptoms and suicidality among individuals with epilepsy enrolled in self-management studies: Results from the from the US Centers for Disease Control and Prevention Managing Epilepsy Well Network
Authors: Daniel Friedman, NYU Langone Medical Center, New York, NY, USA; Tanya Spruill, New York University School of Medicine; Hongyan Liu, Case Western Reserve University, School of Medicine; Curtis Tatsuoka, Case Western Reserve University; Shelley Stoll, University of Michigan; Barbara C. Jobst, Dartmouth-Hitchcock Medical Center; Robert T. Fraser, University of Washington School of Medicine; Erica K. Johnson, University of Washington School of Public Health; Naomi Chaytor, Washington State University; and Martha Sajatovic, Case Western Reserve University, School of Medicine
Content: Rationale: Depression is a common comorbidity in people with epilepsy (PWE) that negatively affects self-management and a variety of health outocmes. Suicidal ideation is also more common among PWE than the general population. The occurrence of suicidality as it may relate to depression severity vs. other factors in PWE has been a point of some controversy. This analysis examined correlates of depressive symptoms and suicidal ideation using pooled data from epilepsy self-management studies conducted by sites in the CDC Prevention Research Center’s Managing Epilepsy Well (MEW) Network. We also examined the relationship between suicidal ideation and other depressive symptoms to determine if suicidality is an independent symptom in PWE. Methods: Pooled baseline data included 687 subjects from eight studies [HOBSCOTCH, N=66; PEARLS, N=80; PACES, N=200; FOCUS (Pilot), N=21; FOCUS (RCT), N=159; SMART, N=101; TIME, N=44; FACES Pilot, N=16].  Datasets were included if they assessed depression severity with the 9-item Patient Health Questionnaire (PHQ9). Additional variables included age, gender, ethnicity/race, education, relationship status, and 30-day seizure count. We examined the relationship between demographic and seizure variables and depressive symptoms/suicidality using univariate statistics and multivariate logistic regression. Spearman correlation was used to assess the relationship between suicidal ideation (PHQ9, item 9) and other depressive symptoms (sum of PHQ9 items 1-8).  Results: Of the 687 subjects in the analysis, 60.5% were female, 34.8% were non-white, and the mean age was 42.4±13.1. The mean total PHQ9 score was 9.48 ± 6.64; 303 subjects (45.9%) had moderate to severe depressive symptoms (PHQ9 ≥ 10). Suicidality (PHQ9, item 9 score ≥ 1) was endorsed by 137 subjects (22.7%). In univariate analysis, lower education (high school/GED or less), lack of a partner, and active seizures (≥1 seizure in prior month) were all associated with higher total PHQ9 scores (Mann-Whitney U test, p < 0.05). Moderate or greater depression, female gender and lower education were associated with suicidality (Chi Square test, p < 0.05). Depressive symptoms excluding suicidality were significantly correlated with suicidality (Spearman rho = 0.43, p< 0.001). A multivariate logistic regression of suicidal ideation revealed a borderline significant association with gender (p = .051), while other factors (age, race, education, seizure count) were not associated at a significance level of 0.05.  Conclusions: Both depression and suicidal ideation are common among PWE enrolled in self-management studies. Similar to other studies, active seizures were associated with depression. In this U.S. integrated research dataset, depressive symptoms, female gender and lower education appear to be predictors of suicidality. Future studies are need to examine whether suicidality exists independently of other depressive symptoms in some epilepsy populations and investigate other correlates of suicidality that may inform screening practices.  Funding: CDC grants U48DP001930, U48DP005030 and U48DP005008, under the Health Promotion and Disease Prevention Research Centers Program