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(Abst. 1.388), 2018

Depression Screening In Pediatric Epilepsy
Authors: Hillary M. Thomas, UT Southwestern Medical Center, Children's Health System Texas; Lauren Suttle, Children's Health System Texas; Kara Morrison, Children's Health System Texas; and Susan T. Arnold, UT Southwestern Medical Center, Children's Health System Texas
Content: Rationale: Depression is often a comorbid diagnosis with pediatric epilepsy, with prevalence rates of 5.2-39.6% (Maryam & Parviz, 2013). In accordance with the national guidelines (American Academy of Neurology, 2015) the Children’s Health Comprehensive Epilepsy Center developed a behavioral health screening protocol for teens with epilepsy. The goal is to identify patients with depressive symptoms and ensure referral to appropriate behavioral health services. Additionally, the data from the depressive screener is analyzed with various seizure variables to inform clinical care and to better understand the relationship between depressive symptoms and seizure diagnosis and treatment. Methods: The Patient Health Questionnaire-9 (PHQ-9, Adolescent Version) is administered to all patients between 15-18 years during their epilepsy clinic visit. Exclusion criteria include intellectual disability or other factors that prohibit the patient from providing valid responses. When a patient’s PHQ-9 score is elevated beyond the range of mild depressive symptoms, and/or they endorse suicidal ideation, medical providers follow a specific response protocol (i.e., provide referrals, encourage follow-up with current mental health provider, suicide risk assessment by psychologist or social worker). Demographic and clinical data (e.g., seizure diagnosis, medication, number of clinic and/or emergency room visits, etc) is retrieved from the patient’s medical record after completion of the screener and included in a comprehensive database for analysis to improve quality of care. Results: To date, the Epilepsy Clinic has screened 394 youth with epilepsy. The average age was 16 years old, and gender was split evenly (50% male/female). Of those screened, 87% fell into the minimal/mild range of depressive symptoms; 8% fell into the moderate/moderately severe depressive symptoms range; and 5% of the patients rated suicidal ideation or previous suicide attempt. Of those that rated suicidal ideation, several had an existing mental health provider, and the remainder required a risk assessment in clinic. Overall, 13% of those screened required behavioral health referral or intervention. Chi-Square analysis revealed no significant association between seizure type (e.g., generalized vs. focal) and depression severity.   Conclusions: The teens served through the Epilepsy Center demonstrated rates of depression similar to those identified in prior research studies. This supports the importance of regularly screening pediatric epilepsy patients for depression. 13% of the population needed some type of behavioral health intervention, highlighting the importance of having a behavioral health protocol within an epilepsy clinic. In most cases, the level of intervention needed was referral to a mental health provider. Only a small number of patients needed active intervention during the clinic visit.  Seizure diagnosis alone was not associated with depression severity. Future analyses will explore the relationship between other seizure-related variables (e.g.., seizure frequency, medication) and depressive symptoms.   Funding: None