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

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Summary

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.

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Most cited references 56

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Chronic pain (CP) seriously affects the patient’s daily activities and quality of life, but few studies on CP have considered its effects on the patient’s social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient’s daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient’s life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives.

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Gerhard Andersson, Nickolai Titov, Blake Dear … (2019)

Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.

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Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition.

Vikram Patel, Dan Chisholm, Rachana Parikh … (2016)

The burden of mental, neurological, and substance use (MNS) disorders increased by 41% between 1990 and 2010 and now accounts for one in every 10 lost years of health globally. This sobering statistic does not take into account the substantial excess mortality associated with these disorders or the social and economic consequences of MNS disorders on affected persons, their caregivers, and society. A wide variety of effective interventions, including drugs, psychological treatments, and social interventions, can prevent and treat MNS disorders. At the population-level platform of service delivery, best practices include legislative measures to restrict access to means of self-harm or suicide and to reduce the availability of and demand for alcohol. At the community-level platform, best practices include life-skills training in schools to build social and emotional competencies. At the health-care-level platform, we identify three delivery channels. Two of these delivery channels are especially relevant from a public health perspective: self-management (eg, web-based psychological therapy for depression and anxiety disorders) and primary care and community outreach (eg, non-specialist health worker delivering psychological and pharmacological management of selected disorders). The third delivery channel, hospital care, which includes specialist services for MNS disorders and first-level hospitals providing other types of services (such as general medicine, HIV, or paediatric care), play an important part for a smaller proportion of cases with severe, refractory, or emergency presentations and for the integration of mental health care in other health-care channels, respectively. The costs of providing a significantly scaled up package of specified cost-effective interventions for prioritised MNS disorders in low-income and lower-middle-income countries is estimated at US$3-4 per head of population per year. Since a substantial proportion of MNS disorders run a chronic and disabling course and adversely affect household welfare, intervention costs should largely be met by government through increased resource allocation and financial protection measures (rather than leaving households to pay out-of-pocket). Moreover, a policy of moving towards universal public finance can also be expected to lead to a far more equitable allocation of public health resources across income groups. Despite this evidence, less than 1% of development assistance for health and government spending on health in low-income and middle-income countries is allocated to the care of people with these disorders. Achieving the health gains associated with prioritised interventions will require not just financial resources, but committed and sustained efforts to address a range of other barriers (such as paucity of human resources, weak governance, and stigma). Ultimately, the goal is to massively increase opportunities for people with MNS disorders to access services without the prospect of discrimination or impoverishment and with the hope of attaining optimal health and social outcomes.

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Author and article information

Contributors

Milena Gandy:

ORCID: https://orcid.org/0000-0003-2161-3298

milena.gandy@mq.edu.au

Journal

Journal ID (nlm-ta): Epilepsia Open

Journal ID (iso-abbrev): Epilepsia Open

Journal ID (doi): 10.1002/(ISSN)2470-9239

Journal ID (publisher-id): EPI4

Title: Epilepsia Open

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2470-9239

Publication date (Electronic): 08 February 2021

Publication date Collection: March 2021

Volume: 6

Issue: 1 ( doiID: 10.1002/epi4.v6.1 )

Pages: 127-139

Affiliations

[ ¹ ] The eCentreClinic Department of Psychology Faculty of Medicine, Health and Human Sciences Macquarie University Sydney Australia

[ ² ] Division of Behavioral Medicine and Clinical Psychology Cincinnati Children’s Hospital Medical Center University of Cincinnati College of Medicine Cincinnati OH USA

[ ³ ] College of Nursing Medical University of South Carolina Charleston SC USA

[ ⁴ ] Departments of Psychiatry and Neurology Rhode Island Hospital Brown University Providence RI USA

[ ⁵ ] Academic Neurology Unit Royal Hallamshire Hospital University of Sheffield Sheffield UK

[ ⁶ ] Department of Clinical Psychology Prince of Wales Hospital, Hospital Authority Sha Tin Hong Kong

[ ⁷ ] Division of Neurosurgery Department of Surgery Faculty of Medicine Chinese University of Hong Kong Shatin Hong Kong

[ ⁸ ] Department of Psychiatry Faculty of Medicine University of Sao Paulo (HCFMUSP) Sao Paulo Brazil

[ ⁹ ] Department of Psychology Institute of Psychiatry, Psychology and Neuroscience King’s College London London UK

[ ¹⁰ ] Division of Developmental Paediatrics Department of Paediatrics and Child Health Red Cross War Memorial Children’s Hospital and the Neuroscience Institute University of Cape Town Cape Town South Africa

[ ¹¹ ] Melbourne School of Psychological Sciences University of Melbourne Melbourne Victoria Australia

[ ¹² ] Department of Neurology Gemeinschaftskrankenhaus Herdecke University of Witten/Herdecke Herdecke Germany

[ ¹³ ] Department of Neurology University Hospital Knappschaftskrankenhaus Bochum Ruhr‐University Bochum Bochum Germany

Author notes

[*] [* ] Correspondence

Milena Gandy, 4FW, Department of Psychology, Macquarie University, NSW, 2109, Australia.

Email: milena.gandy@ 123456mq.edu.au

Author information

Milena Gandy https://orcid.org/0000-0003-2161-3298

Avani C. Modi https://orcid.org/0000-0002-7580-3751

W. Curt LaFrance Jr https://orcid.org/0000-0002-4901-3852

Kette D. Valente https://orcid.org/0000-0002-5008-0809

Laura H. Goldstein https://orcid.org/0000-0001-9387-3035

Genevieve Rayner https://orcid.org/0000-0002-0747-3877

Article

Publisher ID: EPI412455

DOI: 10.1002/epi4.12455

PMC ID: 7918327

PubMed ID: 33681656

SO-VID: eacebb29-0811-4db6-9a72-5d1e02ea2432

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date received : 16 October 2020

Date revision received : 09 November 2020

Date accepted : 23 November 2020

Page count

Figures: 2, Tables: 4, Pages: 13, Words: 8587

Funding

Funded by: International League Against Epilepsy

Funded by: Epilepsy Society of Australia , open-funder-registry 10.13039/501100001064;

Custom metadata

source-schema-version-number 2.0

cover-date March 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.9 mode:remove_FC converted:01.03.2021

Keywords: mental health,psychiatric comorbidity,psychotherapy,screening,suicide,treatment

Data availability:

Keywords: mental health, psychiatric comorbidity, psychotherapy, screening, suicide, treatment

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

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Summary

Objectives

Methods

Results

Significance

Related collections

Stigmatisation of mental illnesses

Most cited references 56

A review of chronic pain impact on patients, their social environment and the health care system

Internet‐delivered psychological treatments: from innovation to implementation

Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition.

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