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. 2021 Feb 8;6(1):127-139.
doi: 10.1002/epi4.12455. eCollection 2021 Mar.

Managing depression and anxiety in people with epilepsy: A survey of epilepsy health professionals by the ILAE Psychology Task Force

Milena Gandy  1 , Avani C Modi  2 , Janelle L Wagner  3 , W Curt LaFrance Jr  4 , Markus Reuber  5 , Venus Tang  6   7 , Kette D Valente  8 , Laura H Goldstein  9 , Kirsten A Donald  10 , Genevieve Rayner  11 , Rosa Michaelis  12   13
Affiliations

Managing depression and anxiety in people with epilepsy: A survey of epilepsy health professionals by the ILAE Psychology Task Force

Milena Gandy et al. Epilepsia Open. .

Abstract

Objectives: The Psychology Task Force of the Medical Therapies Commission of the International League Against Epilepsy (ILAE) has been charged with taking steps to improve global mental health care for people with epilepsy. This study aimed to inform the direction and priorities of the Task Force by examining epilepsy healthcare providers' current practical experiences, barriers, and unmet needs around addressing depression and anxiety in their patients.

Methods: A voluntary 27-item online survey was distributed via ILAE chapters and networks. It assessed practices in the areas of screening, referral, management, and psychological care for depression and anxiety. A total of 445 participants, from 67 countries (68% high income), commenced the survey, with 87% completing all components. Most respondents (80%) were either neurologists or epileptologists.

Results: Less than half of respondents felt adequately resourced to manage depression and anxiety. There was a lack of consensus about which health professionals were responsible for screening and management of these comorbidities. About a third only assessed for depression and anxiety following spontaneous report and lack of time was a common barrier (>50%). Routine referrals to psychiatrists (>55%) and psychologists (>41%) were common, but approximately one third relied on watchful waiting. A lack of both trained mental health specialists (>55%) and standardized procedures (>38%) was common barriers to referral practices. The majority (>75%) of respondents' patients identified with depression or anxiety had previously accessed psychotropic medications or psychological treatments. However, multiple barriers to psychological treatments were endorsed, including accessibility difficulties (52%).

Significance: The findings suggest that while the importance of managing depression and anxiety in patients with epilepsy is being recognized, there are ongoing barriers to effective mental health care. Key future directions include the need for updated protocols in this area and the integration of mental health professionals within epilepsy settings.

Keywords: mental health; psychiatric comorbidity; psychotherapy; screening; suicide; treatment.

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Conflict of interest statement

Author Gandy, Modi, Wagner, LaFrance, Reuber, Tang, Valente, Donald, and Michaelis received a travel stipend from the ILAE to attend the 33rd International Epilepsy Congress in Bangkok Thailand (June 2019), during which the Task Force had one‐day meeting where the promotion and results of the survey were discussed. Author Gandy is supported by a Macquarie University Research Fellowship. She develops and evaluates psychological treatment programs for adults with neurological disorders, including epilepsy. These clinical trials follow CONSORT reporting standards and are ethics committee‐approved and peer‐reviewed to address any potential bias. Author Modi receives research funding from the National Institutes of Health for clinical trials related to psychological treatments for youth with epilepsy. These clinical trials follow CONSORT reporting standards and are ethics committee‐approved and peer‐reviewed to address any potential bias. Author Wagner receives research funding from the National Institutes of Health for clinical trials related to psychological treatments for youth with epilepsy. These clinical trials follow CONSORT reporting standards and are ethics committee‐approved and peer‐reviewed to address any potential bias. Author LaFrance receives author royalties for the seizure treatment book Taking Control of Your Seizures: Workbook, Oxford University Press, 2015. He studies evidence‐based nonpharmacological interventions for people with seizures and receives funding from the US Congressionally Directed Medical Research Programs (CDMRP) (Award Number W81XWH‐17‐1‐0619) that are ethics committee‐approved and peer‐reviewed to address any potential bias. Author Reuber is responsible for developing and supervising a team of psychotherapists working in a clinical neurology department and provides treatment to people with epilepsy. He therefore has an interest in demonstrating the effectiveness of psychotherapy. However, this potential bias is outweighed by his interest in the development of evidence‐based treatments, encouraging him to assess the existing evidence as objectively and impartially as possible. Author Tang works as a clinical psychologist in a public hospital in Hong Kong under the Hospital Authority (“HA”). The views expressed are those of the author, and not necessarily those of the HA. She has received honoraria for speaking, and educational activities not funded by industry. She has no conflicts of interest to report. Author Valente receives personal grant from the National Council for Scientific and Technological Development (307817/2019‐9) and is responsible for four projects with grants from The Sao Paulo Research Foundation (2019/04956‐8; 2018/23798‐1; 2018/03228‐6; 2017/09870‐9). Author Donald works in a clinical environment where she sees and manages children with epilepsy, developmental, and intellectual disabilities and challenging behavior. She has received funding for unrelated research projects supported by the South African National Research Foundation and Medical Research Council, by an Academy of Medical Sciences Newton Advanced Fellowship (NAF002\1001), funded by the UK Government’s Newton Fund, by the National Institutes of Health (NIAAA, NIMH); UK MRC (MR/T002816/1) and by the US Brain and Behaviour Foundation Independent Investigator grant (24467). She has no conflicts of interest. Author Goldstein has received honoraria for speaking, and educational activities not funded by industry; she receives royalties from the publication of Clinical Neuropsychology (Wiley, 2004, 2013) and The Clinical Psychologist's Handbook of Epilepsy Cull 1997. This work represents independent research part‐funded by the NIHR Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. The views expressed are those of the author, and not necessarily those of the NHS, the NIHR or the Department of Health.

Figures

FIGURE 1
FIGURE 1
Clinicians believed responsible for the organization of the screening and management for depression and anxiety of patients with epilepsy.
FIGURE 2
FIGURE 2
Frequency of screening practices
See this image and copyright information in PMC

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