Feasibility and Insights from Automated Depression and Anxiety Screening for People with Epilepsy
Lilian Coelho1, Maria A. Donahue1, Yashmi S. Sevak1, Poojith Nuthalapati1, Jeffrey Buchhalter1, Brandy Fureman2, Susan Herman3, Lidia MVR Moura1
1Neurology, Massachusetts General Hospital, 2Epilepsy Foundation of America, 3Neurology, Barrow Neurological Institute
Objective:

To describe how systematic screening for depression and anxiety was accomplished in a tertiary epilepsy clinic and describe the insights that the data provided to quality improvement teams.

Background:

Mental health comorbidities are highly prevalent among people living with epilepsy (PWE), leading to poor quality of life. Thus, routine screening for anxiety and depression allows for early diagnosis, referral, and treatment of these comorbidities for PWE, improving health outcomes. Mental health screening feasibility concerns have emerged in multiple clinical practices, challenging epilepsy clinics to adopt new practices.

Design/Methods:

We conducted a retrospective data analysis from the Electronics Health Record as part of a Quality Improvement initiative in two tertiary epilepsy clinics (Massachusetts General Hospital and Barrow Neurological Institute), comprising January 2019 to October 2022. PWE were offered patient-reported e-questionnaires to create a cohort based on the completion of depression (PHQ-9) and anxiety (GAD-7) screenings. We stratified the records by demographic measures and classified patients based on the severity of depression and anxiety. Moreover, we created a sub-cohort that includes only the records that met Seizure Freedom criteria and calculated the number of observations for Seizure Freedom about the severity of both depression and anxiety.

Results:

A total of 813 PWE offering depression and anxiety e-questionnaires were filtered, of which n=500 and n=94 completed PHQ-9 and GAD-7 questionnaires respectively, with a completion rate of 73%. For PHQ-9 completed patients, 54% had no/minimal depression, 20.2% mild depression, 13% moderate depression, and 12.8% severe depression. Most patients achieving seizure freedom were with no/minimal depression. For GAD-7 completed patients, 22.3 % had no/minimal anxiety, 19.2 % mild anxiety, 30.8 % moderate anxiety, and 27.7 % severe anxiety.

Conclusions:

Virtual routine screening is feasible in busy tertiary epilepsy clinics as part of care for PWE to identify psychiatric comorbidities, serving as a crucial tool to guide further treatment decisions.

10.1212/WNL.0000000000202283