A primary healthcare screening tool to identify depression and anxiety disorders among people with epilepsy in Zambia

Abstract

Among the 50 million people with epilepsy (PWE) worldwide, ~15 to 60% also likely suffer from depression and/or anxiety disorders and 80% reside in low-income regions where these comorbidities are often under-recognised and undertreated. We developed a 10-item screening tool for the detection of depression and anxiety disorders for use in Zambian primary care clinics where the baseline detection rate of depression and/or anxiety disorders among PWE is ~1%. Consenting adults (n=595) completed the screening tool and 53.7% screened positive. The screen was validated by a Psychiatric Clinical Officer using DMS-IV criteria. Cronbach’s Alpha was 0.77 overall, and 0.67 and 0.57 for the depression and anxiety components, respectively. Other test characteristics included sensitivity 56.63%, specificity 68.05%, positive predictive value 67.3%, and negative predictive value 57.5%. Interrater reliability (kappa) was 0.85. The psychometric qualities of the tool are inadequate. Development of further, better quality instruments is needed though this will likely require a longer tool which the healthcare workers delivering epilepsy care services have previously deemed non-feasible for routine use. As we work toward development and acceptability of a more optimal instrument, use of this initial screening tool which healthcare workers are willing to use may increase the identification of comorbid depression and anxiety in the low resource setting described in the study.

Depression screening tools in persons with epilepsy: A systematic review of validated tools

“…The various gold and/or reference standards used to validate the screening tools were the Mini International Neuropsychiatric Interview (MINI; multiple versions in different languages, n = 19 validations, including the MINI, MINI‐Plus, MINI 5.0.0, and MINI 6.0.0), undifferentiated structured or semi‐structured psychiatric/psychology interviews including expert opinions based on psychiatric consultation (n = 10 validations), Composite International Diagnostic Interview (CIDI; n = 1 validation), Schedule for Affective Disorders and Schizophrenia for School Aged Children‐ Present (K‐SADS‐P; n = 1 validation), and Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and Fourth Edition‐Text Revision (SCID DSM‐IV and IV‐TR; n = 3 validations). The BDI (n = 2 validations) and the Major Depression Inventory (MDI; n = 3 validations) were also used as reference standards.…”

“…Of the 38 studies included, 13 had unclear risk of bias in at least one of the four categories, whereas six studies had a high risk of bias in at least one of the four QUADAS‐2 rating system categories (Appendix S3). Generally, this unclear or high risk of bias was in the “index test” category.…”

Anxiety disorders in people with epilepsy

“…An attempt was recently made but the authors themselves concluding that the psychometric properties of the tested instrument were not sufficient (Mbewe et al, 2013).…”

A Comprehensive Review on Comorbid Depression in Patients With Epilepsy

“…It has also been noted that 30-50% of epileptic patients reported with clinical depression [35,36]. Among 50 million PWE worldwide, 15-60% are also likely to experience any forms of depression or anxiety disorders, and 80% of those people are from a low economic status where these comorbidities remain concealed and thus untreated [37,38].…”