Depression self-management in people with epilepsy: Adapting project UPLIFT for underserved populations

Abstract

Data from the 2015 National Health Interview Survey found that the prevalence of active epilepsy has increased to three million adults. Although findings have been mixed, some research indicates that Blacks and Hispanics share a higher burden of epilepsy prevalence compared with non-Hispanic whites. Moreover, depression is a common comorbid condition among people with epilepsy (PWE), affecting up to 55% of the epilepsy population. Widespread use and increased public health impact of evidence-based self-management interventions is critical to reducing disease burden and may require adapting original interventions into more culturally relevant versions for racial and ethnic minority groups. Project UPLIFT provides access to mental health self-management skills training that is distance-delivered, does not interfere with medication management, and has been shown to be effective in reducing depressive symptoms. This paper presents the process of exploring the adaptation of Project UPLIFT for Black and Hispanic PWE and herein suggests that evidence-based interventions can be successfully adapted for new populations or cultural settings through a careful and systematic process. Additional key lessons learned include the importance of community engagement and that language matters. Ultimately, if the adapted Project UPLIFT intervention produces positive outcomes for diverse populations of PWE, it will extend the strategies available to reduce the burden of depression. Implementing evidence-based interventions such as Project UPLIFT is critical to reducing disease burden; however, their delivery may need to be tailored to the needs and culture of the populations of interest.

Burden of Chronic and Acute Conditions and Symptoms in People With Epilepsy

“…These self-management programs that place an emphasis on psychiatric conditions have shown strong evidence of their ability to be tailored for specific populations while also highlighting the need to reach out to diverse populations. 49,50 This study is not without its limitations. First, our analysis focused on those individuals who were enrolled in Medicaid for the entire study period or 60 consecutive months, potentially introducing a bias to the type of patient who is captured in this study.…”

“…These self-management programs that place an emphasis on psychiatric conditions have shown strong evidence of their ability to be tailored for specific populations while also highlighting the need to reach out to diverse populations. 49,50…”

Markers of Quality Care for Newly Diagnosed People With Epilepsy on Medicaid

“…Even when controlling for having undergone testing, these comorbidities remained positively associated with NHEs. The research surrounding the role of depression in the self-management of epilepsy is reinforced in these findings as evidenced by its negative association with adherence and strong positive association with being in the top quartile of NHEs, even when controlling for medication adherence and other comorbidities 40–44. This would suggest a renewed attention to screening and management for depression and other psychiatric conditions for newly diagnosed PWE.…”

“…The research surrounding the role of depression in the self-management of epilepsy is reinforced in these findings as evidenced by its negative association with adherence and strong positive association with being in the top quartile of NHEs, even when controlling for medication adherence and other comorbidities. [40][41][42][43][44] This would suggest a renewed attention to screening and management for depression and other psychiatric conditions for newly diagnosed PWE. Also elucidated in these findings is the impact of less commonly examined and discussed comorbidities, including SUD, which were associated with receiving diagnostic evaluation, worse/suboptimal adherence, and with more hospitalizations and emergency department visits.…”