Access to healthcare and prevalence of anxiety and depression in persons with epilepsy during the COVID-19 pandemic: A multicountry online survey

Abstract

Objective The objective of this study was to assess access to healthcare and to estimate the prevalence of depression and anxiety among persons with epilepsy (PWE) during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Methods We conducted a multicountry online survey among PWE. Persons with epilepsy were invited to participate through various social media channels. The Hospital Anxiety and Depression Scale (HADS) and 9-item Patient Health Questionnaire (PHQ-9) scale were used to score anxiety and depression. Logistic regression modeling was used to investigate factors associated with anxiety and depression. Results Three hundred ninety-nine PWE were included (mean age: 38.22 ± 12.09 years), the majority were female (80.2%) and living in high-income countries (83.2%). Two hundred three PWE reported symptoms of a cold since January 2020. Nine (25%) of the 36 PWE tested for COVID were positive. A total of 72 PWE (19.6%) reported problems to obtain antiseizure medication (ASM), which in 25% of cases was directly COVID-related. Of the 399 PWE, 201 (50.4%) screened positive for anxiety according to the HADS; 159 (39.8%) and 187 (46.9%) PWE screened positive for depression based on the HADS and PHQ-9 scale, respectively. Female gender and financial problems were associated with both depression and anxiety. A planned follow-up consultation with the treating physician was associated with a lower risk of depression, whereas difficulties to access ASM treatment increased the odds of depression. In 65/137 (47.4%) PWE with a planned follow-up visit with the treating physician, this consultation was canceled. Conclusions Innovative approaches are needed to ensure continuity in access to ASM treatment. Healthcare workers should ensure continued follow-up, either through inperson or telehealth appointments, to timely identify symptoms of anxiety and depression and act accordingly.

The Impact of the COVID-19 Pandemic on People With Epilepsy. An Italian Survey and a Global Perspective

“…Neither our survey nor the other reported surveys were designed to provide information on SARS-CoV-2 infection in PwE, however their collective data seem to indicate prevalence rates reflecting those in the general population (9). A worsening of seizures has been signaled in some cases (12), including one of the two patients who reported the infection in our survey.…”

“…In this latter study, female gender and financial problems were significantly associated both with anxiety and with depression. Living in high-income countries decreased the odds for anxiety, while difficulties accessing ASMs increased the odds for depression (12).…”

“…Postponed neurological tests were reported by 14.5-61% of responders in three studies (3,9,12). Issues with drug supply were reported by 2.7-73% (3,5,6,8,9).…”

Data_Sheet_1.PDF

“…However, due to the lack of uniformity between these studies, we here focus solely on confirmed diagnoses. The rate of confirmed SARS-CoV-2 infections was 0.2-2.5% (3,5,7,9,12), which generally corresponded to the expected background for the given country in the same period. In the study by Assenza et al, the rate of infection in people with and without epilepsy was comparable (0.2 vs. 0.4%) (9).…”

“…(10) In a large multinational survey, 22.8% of PwE reported financial problems, including difficulty paying housing costs/bills, eating properly and paying for ASMs. These issues were significantly more common in people living in lowto middle-income countries (12).…”