Which symptoms are indicative of depression in epilepsy settings? An analysis of the diagnostic significance of somatic and non-somatic symptoms

PURPOSEUp to 60% of people with epilepsy (PwE) have psychiatric comorbidity including anxiety.Anxiety remains under recognized in PwE. This study investigates if screening tools validated for depression could be used to detect anxiety disorders in PWE. Additionally it analyses the effect of anxiety on QoL. METHODS261 participants with a confirmed diagnosis of epilepsy were included. Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Emotional Thermometers (ET), both validated to screen for depression were used. Hospital Anxiety and Depression ScaleAnxiety (HADS-A) with a cut off for moderate and severe anxiety was used as the reference standard. QoL was measured with EQ5-D. Sensitivity, specificity, positive and negative predictive value and ROC analysis as well as multivariate regression analysis were performed. RESULTSPatients with depression (n=46) were excluded as multivariate regression analysis showed that depression was the only significant determinant of having anxiety in the group. Against HADS-A, NDDI-E and ET-7 showed highest level of accuracy in recognizing anxiety with ET7 being the most effective tool. QoL was significantly reduced in PwE and anxiety. CONCLUSIONSOur study showed that reliable screening for moderate to severe anxiety in PwE without comorbid depression is feasible with screening tools for depression. The cut off values for anxiety are different from those for depression in ET7 but very similar in NDDI-E. ET7 can be applied to screen simultaneously for depression and "pure" anxiety. Anxiety reduces significantly QoL. We recommend screening as an initial first step to rule out patients who are unlikely to have anxiety.Highlights  Moderate to severe anxiety is a frequent comorbidity in epilepsy, in our cohort prevalence was 26,4%  Depression was the only significant determinant for anxiety, prevalence of anxiety in non-depressed PwE was 15,8%. Screening for anxiety independent from depression can be achieved with the ET7 tool.

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“…This is in line with our previous observation that PwE and depression report more somatic symptoms 27,28 .…”

Section: Moreover Our Findings Demonstrate That the Presence Of Anxiesupporting

confidence: 93%

Screening of anxiety and quality of life in people with epilepsy

Özmen

Leibetseder

Cock

et al. 2017

Seizure

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“…This supports the notion that PHQ-9 can and indeed has been used to screen for depression in epilepsy. The findings in some of these papers further support the idea that somatic and non-somatic symptoms from PHQ-9 may contribute as reported by Mitchell et al (25) that four of these symptoms were rated as excellent initial screening questions for depression namely, “Moving or speaking so slowly that other people could have noticed” “Little interest or pleasure in doing things”, “Feeling down depressed or hopeless”, “Trouble concentrating on things such as reading.” The item “Moving or speaking so slowly that other people could have noticed” from the PHQ9 was endorsed in about 90% of depressed patients with epilepsy but only about 6% of non-depressed patients. Having said that, to the best of our knowledge our study is the first to attempt validation of the PHQ-9 in patients with epilepsy.…”

Section: Introductionsupporting

confidence: 87%

Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy

Rathore

Jehi

Fan

et al. 2014

Epilepsy & Behavior

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Objective Assess accuracy and operating characteristics of the Patient Health Questionnaire-9 (PHQ-9) for depression-screening in adults with epilepsy. Methods Tertiary epilepsy center patients served as the study population with 237 agreeing to structured interview using the Mini-International Neuropsychiatric Interview (MINI), a “gold standard” instrument developed for rapid diagnosis of neuropsychiatric disorders, including major depressive disorder (MDD); 172 also completed the PHQ-9, and 127 completed both the PHQ-9 and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) within two days of the MINI. Sensitivity, specificity, positive & negative predictive values & areas under the ROC curves for each instrument were determined. Cut-points of 10 for the PHQ-9 and 15 for the NDDI-E were used and ratings at or above the cut-points were considered screen-positive. The PHQ-9 was divided into cognitive/affective (PHQ-9/CA) and somatic (PHQ-9/S) subscales to determine comparative depression-screening accuracy. Results The calculated areas under the ROC curves for the PHQ-9 (n=172) and the PHQ-9/CA and PHQ-9/S sub-scales were 0.914, 0.924, and 0.846, respectively, with the PHQ-9 more accurate than the PHQ-9/S (p=0.002) but no different than the PHQ-9/CA (p=0.378). At cut-points of 10 and 15, respectively, the PHQ-9 had higher sensitivity (0.92 vs 0.87), but lower specificity (0.74 vs 0.89) than the NDDI-E. The areas under the ROC curves of the PHQ-9 and the NDDI-E showed similar accuracy (n=127; 0.930 vs 0.934; p=0.864). Significance The PHQ-9 is an efficient & non-proprietary depression screening instrument with excellent accuracy validated for use in adult epilepsy patients as well as multiple other medical populations.

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“…All studies included male and female participants, and sample sizes ranged from 44 to 575 (median 143). Twenty‐seven studies examined participants ≥18 years old, seven studies >16 years old, and only one study examined youth (10–17 years old) . In three studies it was inferred from the reported mean and median ages that these participants were adults .…”

Section: Resultsmentioning

confidence: 99%

“…A number of studies did more than one validation for each tool (i.e., against different reference standards), or validated different versions of a screening tool. The most commonly validated screening tools were the NDDI‐E (n = 26 validations), Beck Depression Inventory (BDI; n = 12 validations, including the modified BDI, BDI‐Fast Screen, BDI‐I, BDI‐II, and the Cognitive Affective Subscale for the BDI), Hospital Anxiety and Depression Scale (HADS; n = 10 validations, including the HADS total score, HADS‐Depression [HADS‐D] Score, and one study used the HADS‐Anxiety [HADS‐A] score to assess depression), Emotional Thermometers (ETs; n = 5 validations, including the ET7, ET4, and individual questions on anxiety and depression), Patient Health Questionnaire 9 (PHQ‐9; n = 4 validations), Patient Health Questionnaire 2 (PHQ‐2; n = 2 validations), and the Hamilton Rating Scale for Depression (HAM‐D or HRSD; n = 4 validations, including the HRSD 17 and 21 question versions). The NDDI‐E was validated in 13 languages including Arabic, Chinese, Danish, English, French, German, Greek, Italian, Japanese, Korean, Portuguese, Spanish, and Serbian …”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2017

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A number of studies validated depression screening tools; however, estimates of diagnostic accuracy were inconsistently reported. The validity of scales in practice may have been overestimated, as cutpoints were often selected post hoc based on the study sample. The NDDI-E, which performed well, was the most commonly validated screening tool, is free to the public, and is validated in multiple languages and is easy to administer, although selection of the best tool may vary depending on the setting and available resources.

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Which symptoms are indicative of depression in epilepsy settings? An analysis of the diagnostic significance of somatic and non-somatic symptoms

Cited by 19 publications

References 31 publications

Screening of anxiety and quality of life in people with epilepsy

Screening of anxiety and quality of life in people with epilepsy

Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy

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

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