Rates of DSM-IV mood, anxiety disorders, and suicidality in Australian adult epilepsy outpatients: A comparison of well-controlled versus refractory epilepsy

Gandy, Milena; Sharpe, Louise; Perry, Kathryn Nicholson; Miller, Laurie A.; Thayer, Zoë; Boserio, Janet; Mohamed, Armin

doi:10.1016/j.yebeh.2012.10.023

Cited by 59 publications

(37 citation statements)

References 46 publications

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“…The findings from the present study are consistent with the available literature in neurological disorders [33], respiratory disease [34], diabetes [35] and chronic pain [14]. Given the strong relationship between pain and depressed mood in other studies (e.g., [19, 22, 23, 36]), it is perhaps unsurprising that pain predicted depressive symptoms in the context of multi-morbidity as well.…”

Section: Discussionsupporting

confidence: 91%

Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults

et al. 2017

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BackgroundMulti-morbidity in older adults is commonly associated with depressed mood. Similarly, subjective reports of pain are also associated with both physical illness and increased depressive symptoms. However, whether pain independently contributes to the experience of depression in older people with multi-morbidity has not been studied.MethodsIn this study, participants were 1281 consecutive older adults presenting to one of 19 primary care services in Australia (recruitment rate = 75%). Participants were asked to indicate the presence of a number of common chronic illnesses, to rate their current pain severity and to complete the Geriatric Depression Scale.ResultsResults confirmed that the number of medical illnesses reported was strongly associated with depressive symptoms. Twenty-six percent of participants with multi-morbidity scored in the clinical range for depressive symptoms in comparison to 15% of participants with no illnesses or a single illness. In regression analyses, the presence of chronic pain (t = 5.969, p < 0.0005), diabetes (t = 4.309, p < 0.0005), respiratory (t = 3.720, p < 0.0005) or neurological illness (t = 2.701, p = 0.007) were all independent contributors to depressive symptoms. Even when controlling for each individual illness, and the overall number of illnesses (t = 2.207, p = 0.028), pain severity remained an independent predictor of depressed mood (F change = 28.866, p < 0.0005, t = 5.373, p < 0.0005).ConclusionsPhysicians should consider screening for mood problems amongst those with multi-morbidity, particularly those who experience pain.

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Section: Discussionsupporting

confidence: 91%

Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults

et al. 2017

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“…This meta‐analysis found no evidence that people with drug‐resistant epilepsy experience higher rates of anxiety or depressive disorders compared to those with well‐controlled epilepsy. This is consistent with individual studies that demonstrate no difference in the prevalence of psychiatric comorbidity between individuals with well‐controlled vs. drug‐resistant epilepsy . This evidence together challenges a widely held assumption that psychiatric comorbidity is more common in people with drug‐resistant epilepsy .…”

Section: Discussionsupporting

confidence: 86%

“…There have been valuable advances in addressing challenging confounds of psychiatric comorbidity in epilepsy; Mintzer and Lopez constructed an epilepsy addendum to the MINI, which aids clinicians by more closely examining disorders that may be confounded (such as ictal fear and panic disorder) . Only one of the included studies utilized this addendum, and found the overall prevalence of anxiety disorders to be 29%. The higher prevalence of anxiety disorders reported in this study supports the view that anxiety disorders are being underrecognized in routine care, which is cause for concern given the adverse outcomes and clinically significant distress experienced by PWE with anxiety disorders …”

Section: Discussionmentioning

confidence: 99%

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Anxiety and depressive disorders in people with epilepsy: A meta‐analysis

et al. 2017

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Findings suggest the prevalence of anxiety and depressive disorders in PWE are equivalent, and variability in prevalence of anxiety disorders across studies can be attributed partly to the method of diagnosis. These findings also challenge widely held assumptions that psychiatric comorbidity is more common in people with drug-resistant epilepsy. Future research should aim to improve the detection and management of these comorbidities in PWE, particularly anxiety disorders, which have remained relatively neglected.

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“…Other authors pointed out the role of adverse effects of AEDs and a previous history of febrile convulsions . Severity of the seizure disorder does not seem to be a relevant factor, whereas depression is, at present, the major risk factor, especially if comorbid with other psychiatric problems (i.e., paranoid ideation or anxiety disorders) . However, it is likely that other, still unknown, biologic factors contribute to the increased risk of suicide in epilepsy, given the bidirectional relationship between epilepsy, depression, and suicide .…”

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confidence: 99%

Validation of rapid suicidality screening in epilepsy using the NDDIE

et al. 2016

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SUMMARYObjective: Standard mortality ratio for suicide in patients with epilepsy is three times higher than in the general population, and such a risk remains high even after adjusting for clinical and socioeconomic factors. It is thus important to have suitable screening instruments and to implement care pathways for suicide prevention in every epilepsy center. The aim of this study is to validate the use of the Neurological Disorder Depression Inventory for Epilepsy (NDDIE) as a suicidality-screening instrument. Methods: The study sample included adult patients with epilepsy assessed with the Mini International Neuropsychiatric Interview (MINI) and the NDDIE. A high suicidality risk according to the Suicidality Module of the MINI was considered the gold standard. Receiver operating characteristic analyses for NDDIE total and individual item scores were computed and subsequently compared using a nonparametric approach. The best possible cutoff was identified with the highest Youden index (J). Likelihood ratios were then computed, and specificity, sensitivity, positive, and negative predictive values calculated. Results: The study sample consisted of 380 adult patients with epilepsy: 46.3% male; mean age was 39.4 AE 14.6; 76.7% had a diagnosis of focal epilepsy; mean age at onset of the epilepsy was 23.3 AE 17.5. According to the MINI, 74 patients (19.5%) fulfilled criteria for a major depressive episode and 19 (5%) presented a high suicidality risk. A score >2 (J = 0.751) for item 4 "I'd be better off dead" of the NDDIE displayed excellent psychometric properties with a good to excellent validity (area under the curve [AUC] 0.906; 95% confidence interval [CI] 0.820-0.992; p < 0.001), sensitivity 84.21% (95% CI 60.4-96.6), specificity 90.86% (95% CI 87.4-93.6), likelihood ratio+ 9.21 (95% CI 6.3-13.5), likelihood ratio-0.17 (95% CI 0.06-0.50). Significance: Item 4 of the NDDIE has shown to be an excellent suicidality screening instrument allowing the development of further care pathways for suicide prevention in epilepsy centers.

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Rates of DSM-IV mood, anxiety disorders, and suicidality in Australian adult epilepsy outpatients: A comparison of well-controlled versus refractory epilepsy

Cited by 59 publications

References 46 publications

Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults

Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults

Anxiety and depressive disorders in people with epilepsy: A meta‐analysis

Validation of rapid suicidality screening in epilepsy using the NDDIE

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