Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
Epilepsy Behav. 2020 Apr;105:106973. doi: 10.1016/j.yebeh.2020.106973. Epub 2020 Mar 9.
Depressive symptoms are a common comorbidity among adults with epilepsy (AWE). Prior estimates regarding prevalence and treatment of depressive symptoms in AWE have been largely based on samples of tertiary care cohorts that may not be generalizable. We aimed to provide a representative population estimate of the prevalence and treatment of depressive symptoms over time in AWE in the United States as measured by a validated depression screen.
Data from the Medical Expenditure Panel Survey (MEPS) were analyzed from 2004 to 2015 to determine the prevalence of "screen positive" depressive symptoms (SPDS) among AWE as evaluated by the Patient Health Questionnaire-2 (PHQ-2). We defined pharmacotherapy for depressive symptoms as the prescription of any antidepressant, antipsychotic, anxiolytic, or central nervous system stimulant for the "Clinical Classification Code" of mood disorders within the year sampled, and psychotherapy as any outpatient or office-based visit for "mood disorders" for that year sampled. We analyzed temporal trends and explanatory variables for treatment using the Cochran-Armitage test and logistic regression, respectively.
Our sample included 2024 AWE, representing 1,736,023 patients nationwide. This included 517 AWE with SPDS (AWE-SPDS), representing 401,452 AWE, and 1507 AWE who screened negative for depressive symptoms (AWE-SNDS), representing 1,334,571 AWE. The prevalence of SPDS was 23.1% (95% confidence interval [CI]: 20.6%-25.8%). Women (odds ratio [OR]: 1.40, 95% CI: 1.05-1.87), patients ages 35-49 (OR: 1.83, 95% CI: 1.23-2.72; compared with patients ages 18-34), and patients with Charlson Comorbidity Index ≥1 (OR: 1.92, 95% CI: 1.41-2.61) had higher odds of SPDS. There was no significant change in depressive symptoms' prevalence or treatment in AWE between the epochs of 2004-2006 and 2013-2015.
Despite a quarter of AWE in the United States with SPDS, fewer than half received treatment. This indicates a need for improved efforts to screen AWE for depression and treat appropriately.
抑郁症状是成人癫痫（AWE）的常见合并症。先前关于 AWE 中抑郁症状的患病率和治疗的估计主要基于可能无法推广的三级护理队列的样本。我们旨在通过经过验证的抑郁筛查，提供美国 AWE 中抑郁症状的患病率和治疗的代表性人群估计，以时间为衡量标准。
从 2004 年到 2015 年，对医疗支出面板调查（MEPS）的数据进行了分析，以确定通过患者健康问卷-2（PHQ-2）评估的 AWE 中“筛查阳性”抑郁症状（SPDS）的患病率。我们将抗抑郁药、抗精神病药、抗焦虑药或中枢神经系统兴奋剂的处方定义为当年“临床分类代码”中为情绪障碍开具的药物治疗，将当年门诊或基于办公室的“情绪障碍”就诊定义为心理治疗。我们分别使用 Cochran-Armitage 检验和逻辑回归分析了治疗的时间趋势和解释变量。
我们的样本包括 2024 名 AWE，代表全国范围内的 1736023 名患者。其中包括 517 名患有 SPDS（AWE-SPDS）的 AWE，代表 401452 名 AWE，以及 1507 名 SPDS 筛查阴性的 AWE（AWE-SNDS），代表 1334571 名 AWE。SPDS 的患病率为 23.1%（95%置信区间[CI]：20.6%-25.8%）。女性（比值比[OR]：1.40，95%CI：1.05-1.87）、年龄在 35-49 岁的患者（OR：1.83，95%CI：1.23-2.72；与 18-34 岁的患者相比）和 Charlson 合并症指数≥1 的患者（OR：1.92，95%CI：1.41-2.61）的 SPDS 可能性更高。在 2004-2006 年和 2013-2015 年期间，AWE 中抑郁症状的患病率或治疗没有明显变化。
尽管美国四分之一的 AWE 有 SPDS，但不到一半的人接受了治疗。这表明需要加强努力，为 AWE 筛查抑郁并进行适当治疗。
