Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
Department of Neurology, NYU Langone Health, New York, NY, USA.
Transl Behav Med. 2021 Jul 29;11(7):1451-1460. doi: 10.1093/tbm/ibab045.
Depression is associated with adverse outcomes in epilepsy but is undertreated in this population. Project UPLIFT, a telephone-based depression self-management program, was developed for adults with epilepsy and has been shown to reduce depressive symptoms in English-speaking patients. There remains an unmet need for accessible mental health programs for Hispanic adults with epilepsy. The purpose of this study was to evaluate the feasibility, acceptability, and effects on depressive symptoms of a culturally adapted version of UPLIFT for the Hispanic community. Hispanic patients with elevated depressive symptoms (n = 72) were enrolled from epilepsy clinics in New York City and randomized to UPLIFT or usual care. UPLIFT was delivered in English or Spanish to small groups in eight weekly telephone sessions. Feasibility was assessed by recruitment, retention, and adherence rates and acceptability was assessed by self-reported satisfaction with the intervention. Depressive symptoms (PHQ-9 scores) were compared between study arms over 12 months. The mean age was 43.3±11.3, 71% of participants were female and 67% were primary Spanish speakers. Recruitment (76% consent rate) and retention rates (86-93%) were high. UPLIFT participants completed a median of six out of eight sessions and satisfaction ratings were high, but rates of long-term practice were low. Rates of clinically significant depressive symptoms (PHQ-9 ≥5) were lower in UPLIFT versus usual care throughout follow-up (63% vs. 72%, 8 weeks; 40% vs. 70%, 6 months; 47% vs. 70%, 12 months). Multivariable-adjusted regressions demonstrated statistically significant differences at 6 months (OR = 0.24, 95% CI, 0.06-0.93), which were slightly reduced at 12 months (OR = 0.30, 95% CI, 0.08-1.16). Results suggest that UPLIFT is feasible and acceptable among Hispanic adults with epilepsy and demonstrate promising effects on depressive symptoms. Larger trials in geographically diverse samples are warranted.
抑郁症与癫痫患者的不良预后相关，但在该人群中治疗不足。基于电话的抑郁症自我管理项目 Project UPLIFT 专为癫痫患者开发，已被证明可减少英语患者的抑郁症状。西班牙裔癫痫患者仍然需要可获得的心理健康项目。本研究的目的是评估 UPLIFT 的文化适应版本对西班牙裔社区的可行性、可接受性和对抑郁症状的影响。从纽约市的癫痫诊所招募了有抑郁症状升高的西班牙裔患者（n = 72），并将他们随机分配到 UPLIFT 或常规护理组。UPLIFT 以英语或西班牙语在八周的每周电话会议中以小组形式提供。通过招募、保留和依从性率评估可行性，通过自我报告对干预的满意度评估可接受性。在 12 个月内比较研究臂之间的抑郁症状（PHQ-9 评分）。平均年龄为 43.3±11.3 岁，71%的参与者为女性，67%的参与者为主要西班牙语使用者。招募率（76%的同意率）和保留率（86-93%）较高。UPLIFT 参与者完成了八节课程中的六节，满意度评分较高，但长期实践率较低。在整个随访过程中，UPLIFT 组的临床显著抑郁症状（PHQ-9≥5）发生率低于常规护理组（8 周时为 63%比 72%，6 个月时为 40%比 70%，12 个月时为 47%比 70%）。多变量调整后的回归分析显示，6 个月时有统计学意义的差异（OR=0.24，95%CI，0.06-0.93），12 个月时略有降低（OR=0.30，95%CI，0.08-1.16）。结果表明，UPLIFT 在西班牙裔癫痫患者中是可行且可接受的，并显示出对抑郁症状的有希望的影响。需要在地理上多样化的样本中进行更大规模的试验。
