Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Epilepsy Behav. 2023 Dec;149:109537. doi: 10.1016/j.yebeh.2023.109537. Epub 2023 Nov 15.
Routine detection of depression, anxiety and suicidal ideation in people with epilepsy (PWE) remains suboptimal. We investigated the level of agreement between PWE and their proxies when evaluating these psychiatric symptoms.
From October 2021 to March 2022, we conducted a cross-sectional anonymous survey at Vilnius University Hospital Santaros Klinikos (Vilnius, Lithuania). Persons accompanying PWE completed different scales measuring symptoms of depression and anxiety and evaluated suicidal ideation among PWE (defined as a non-zero score of the suicide item of the Beck depression inventory (BDI) or as a score > 1 of the item 4 of the Neurological Disorders Depression Inventory for Epilepsy, NDDI-E). Agreement between PWE and their proxies was measured using the Wilcoxon test for paired samples and Pearson's correlation analysis.
The study included 140 PWE (mean age 41.0 ± 18.1, 71 (50.7 %) female) and 140 proxies (mean age 49.0 ± 15.01, 105 (75.0 %) female, 57 (40.7 %) were parents, 51 (36.4 %) - spouses, 15 (10.7 %) - partners, 11 (7.9 %) - children and 6 (4.3 %) - siblings of PWE). There were no statistical differences in paired scores of the BDI, Hospital Anxiety and Depression scale, Generalized Anxiety Disorder scale-7, and the NDDI-E (p > 0.05). Proxies reported statistically higher scores on the Geriatric Depression Scale (Z = - 2.026, p = 0.043) than PWE. The correlation between PWE and proxy evaluations for all instruments was moderate (varying from r = 0.500 to r = 0.688, p < 0.001). For most psychometric scales proxies became less accurate with higher scale scores for anxiety and depression and tended to underestimate the level of such symptoms (correlation between scale results and signed (PWE - proxy) mismatch varied from r = 0.368 to r = 0.641, p < 0.001). The measure of proxy-PWE agreement on suicidal ideation was low (Cohen's Κ = 0.192, p = 0.025); proxies missed 63 % (NDDI-E) to 70 % (BDI) of cases of suicidal ideation.
Companions of PWE provided comparable reports of participant anxiety and depression on a group level but tended to underestimate psychiatric symptoms as their scale scores became higher. Proxies significantly underreported suicidal ideation in those people who did express it. While proxy reporting should not be used interchangeably on an individual level, its use in group studies may be useful and ought to be investigated further.
在癫痫患者 (PWE) 中常规检测抑郁、焦虑和自杀意念仍然不理想。我们研究了 PWE 及其代理人在评估这些精神症状时的一致性水平。
从 2021 年 10 月到 2022 年 3 月，我们在立陶宛维尔纽斯大学桑塔罗斯临床医院 (Vilnius, Lithuania) 进行了一项横断面匿名调查。陪同 PWE 的人员完成了不同的量表，以测量抑郁和焦虑症状，并评估 PWE 的自杀意念（定义为贝克抑郁量表 (BDI) 的自杀项目得分为非零或神经障碍抑郁量表癫痫版 (NDDI-E) 的第 4 项得分为 1 分以上）。使用 Wilcoxon 检验配对样本和 Pearson 相关分析来衡量 PWE 和其代理人之间的一致性。
该研究纳入了 140 名 PWE（平均年龄 41.0 ± 18.1，71 名[50.7%]为女性）和 140 名代理人（平均年龄 49.0 ± 15.01，105 名[75.0%]为女性，57 名[40.7%]为父母，51 名[36.4%]为配偶，15 名[10.7%]为伴侣，11 名[7.9%]为子女，6 名[4.3%]为兄弟姐妹）。BDI、医院焦虑和抑郁量表、广泛性焦虑障碍量表-7 和 NDDI-E 的配对评分无统计学差异（p > 0.05）。代理人报告的老年抑郁量表评分明显高于 PWE（Z = -2.026，p = 0.043）。PWE 和代理人为所有仪器评估的相关性为中度（从 r = 0.500 到 r = 0.688，p < 0.001）。对于大多数心理测量量表，随着焦虑和抑郁量表评分的升高，代理人的准确性降低，并且往往低估了这种症状的水平（量表结果与签名（PWE-代理）不匹配的相关性从 r = 0.368 到 r = 0.641，p < 0.001）。代理人-PWE 对自杀意念的一致性衡量标准较低（Cohen's Κ= 0.192，p = 0.025）；代理人错过了 63%（NDDI-E）到 70%（BDI）的自杀意念病例。
PWE 的同伴在群体水平上提供了类似的焦虑和抑郁报告，但随着量表评分的升高，他们往往会低估精神症状。代理人显著低估了那些确实表达过自杀意念的人的自杀意念。虽然代理报告不能在个体水平上互换使用，但在群体研究中使用可能是有用的，并且应该进一步研究。
