Depression and mental health help-seeking behaviors in a predominantly African American population of children and adolescents with epilepsy
Ruth Roeder
Departments of Pediatrics
Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan, U.S.A.
Search for more papers by this authorKathryn Roeder
Departments of Pediatrics
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, U.S.A.
Search for more papers by this authorEishi Asano
Departments of Pediatrics
Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan, U.S.A.
Search for more papers by this authorHarry T. Chugani
Departments of Pediatrics
Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan, U.S.A.
Search for more papers by this authorRuth Roeder
Departments of Pediatrics
Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan, U.S.A.
Search for more papers by this authorKathryn Roeder
Departments of Pediatrics
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, U.S.A.
Search for more papers by this authorEishi Asano
Departments of Pediatrics
Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan, U.S.A.
Search for more papers by this authorHarry T. Chugani
Departments of Pediatrics
Neurology, Children’s Hospital of Michigan, Wayne State University, Detroit Medical Center, Detroit, Michigan, U.S.A.
Search for more papers by this authorSummary
Purpose: To determine whether previously undetected symptoms of depression and psychiatric help-seeking behaviors are associated with demographic or epilepsy-related variables in a predominantly African American sample of pediatric epilepsy patients.
Methods: Ninety-six serially recruited parent–child dyads (55% African American, 39% Caucasian) completed the Short Mood and Feelings Questionnaire (SMFQ). Regression analyses determined whether depressive symptoms measured by the SMFQ were associated with demographic (age, gender, and ethnic background) or epilepsy-related variables (age of seizure onset, duration of epilepsy, seizure type, time since last seizure, and number of antiepileptic drugs). Dyads with positive SMFQ screens (score ≥12) received information about depression and were advised to seek mental health services. Six months later, parents completed follow-up interviews to ascertain mental health service utilization.
Results: Thirty-five participants (36.5%) screened positive for probable depression. Greater number of antiepileptic drugs was the only predictor variable independently associated with greater (worse) depression scores (p = 0.005). At 6-month follow-up, 12 patients (36.4%) had received mental health care, whereas 21 guardians (63.6%) denied depressive symptoms in their child and never sought mental health services (two dyads lost to follow-up). Logistic regression analyses found no associations between demographic, epilepsy-related, or depressive variables and psychiatric help-seeking.
Discussion: This study indicates the necessity and feasibility of screening for previously undetected symptoms of depression in pediatric epilepsy clinics serving diverse populations, particularly among patients receiving antiepileptic polytherapy. Additional research on the correlates of depressive symptoms and determinants of psychiatric help-seeking is needed to develop evidence-based interventions for youths with epilepsy and symptoms of depression.
Supporting Information
Table S1. Prediction of severity of depressive symptoms using demographic profiles and epilepsy variables (univariate linear regression analyses)
Table S2. Prediction of severity of depressive symptoms using demographic profiles and epilepsy variables (multiple linear regression analysis)
Table S3. Prediction of mental health-seeking behaviors using measures of severity of depressive symptoms, demographic profiles, and epilepsy variables (univariate logistic regression analyses)
Please note: Wiley-Blackwell is not responsible for the content or functionality of any supporting materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article.
| Filename | Description |
|---|---|
| EPI_2046_sm_tablesS1-S3.doc61.5 KB | Supporting info item |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- Adewuya AO, Ola BA. (2005) Prevalence of and risk factors for anxiety and depressive disorders in Nigerian adolescents with epilepsy. Epilepsy Behav 6: 342–347.
- Alwash RH, Hussein MJ, Matloub FF. (2000) Symptoms of anxiety and depression among adolescents with seizures in Irbid, Northern Jordan. Seizure 9: 412–416.
- Angold A, Costello EJ, Messer S. (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res 5: 237–249.
- Austin JK, Dunn DW, Caffrey HM, Perkins SM, Harezlak J, Rose DF. (2002) Recurrent seizures and behavior problems in children with first recognized seizures: a prospective study. Epilepsia 43: 1564–1573.
- Baker GA, Spector S, McGrath Y, Soteriou H. (2005) Impact of epilepsy in adolescents: a UK controlled study. Epilepsy Behav 6: 556–562.
- Baki O, Erdogan A, Kantarci O, Akisik G, Kayaalp L, Yalcinkaya C. (2004) Anxiety and depression in children with epilepsy and their mothers. Epilepsy Behav 5: 958–964.
- Ben-Menachem E, Gilland E. (2003) Efficacy and tolerability of levetiracetam during 1-year follow-up in patients with refractory epilepsy. Seizure 12: 131–135.
- Besag FM. (2001) Behavioural effects of the new anticonvulsants. Drug Saf 24: 513–536.
- Bootsma HP, Ricker L, Diepman L, Gehring J, Hulsman J, Lambrechts D, Leenen L, Majoie M, Schellekens A, De Krom M, Aldenkamp AP. (2008) Long-term effects of levetiracetam and topiramate in clinical patients: A head-to-head comparison. Seizure 17: 19–26.
- Brent DA. (1986) Overrepresentation of epileptics in a consecutive series of suicide attempters seen at a children’s hospital, 1978-1983. J Am Acad Child Psychiatry 25: 242–246.
- Burgess DJ, Ding Y, Hargreaves M, Van Ryn M, Phelan S. (2008) The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. J Health Care Poor Underserved 19: 894–911.
- Caplan R, Siddarth P, Gurbani S, Hanson R, Sankar R, Sheilds WD. (2005) Depression and anxiety disorders in pediatric epilepsy. Epilepsia 46: 720–730.
- Commission on Classification and Terminology of the International League Against Epilepsy. Guidelines for epidemiologic studies in epilepsy. (1993) Epilepsia 34: 592–596.
- Costello EJ, Erkanli A, Angold A. (2006) Is there an epidemic of child or adolescent depression? J Child Psychol Psychiatry 47: 1263–1271.
- Cunningham PJ, Freiman MP. (1996) Determinants of ambulatory mental health services use for school-age children and adolescents. Health Serv Res 31: 409–427.
- Davies S, Heyman I, Goodman R. (2003) A population survey of mental health problems in children with epilepsy. Dev Med Child Neurol 45: 292–295.
- Douma JC, Dekker MC, De Ruiter KP, Verhulst FC, Koot HM. (2006) Help-seeking process of parents for psychopathology in youth with moderate to borderline intellectual disabilities. J Am Acad Child Adolesc Psychiatry 45: 1232–1242.
- Dunitz M, Scheer PJ, Wurst L, Grientschnigg G, Urban EC. (1991) Depression in children with cancer. Padiatr Padol 26: 267–270.
- Dunn DW, Austin JK, Huster GA. (1999) Symptoms of depression in adolescents with epilepsy. J Am Acad Child Adolesc Psychiatry 38: 1132–1138.
- Epilepsy Foundation. (2003) Living well with epilepsy II: report of the 2003 National Conference on Public Health and Epilepsy. Landover, Maryland.
- Ettinger AB, Weisbrot DM, Nolan EE, Gadow KD, Vitale SA, Andriola MR, Lenn NJ, Novak GP, Hermann BP. (1998) Symptoms of depression and anxiety in pediatric epilepsy patients. Epilepsia 39: 595–599.
- Flisher AJ, Kramer RA, Grosser RC, Alegria M, Bird HR, Bourdon KH, Goodman SH, Greenwald S, Horwitz SM, Moore RE, Narrow WE, Hoven CW. (1997) Correlates of unmet need for mental health services by children and adolescents. Psychol Med 27: 1145–1154.
- Garrison CZ, Addy CL, Jackson KL, McKeown RE, Waller JL. (1992) Major depressive disorder and dysthymia in young adolescents. Am J Epidemiol 135: 792–802.
- Ghaemi SN, Zablotsky B, Filkowski MM, Dunn RT, Pardo TB, Isenstein E, Baldassamo CF. (2006) An open prospective study of zonisamide in acute bipolar depression. J Clin Psychopharmacol 26: 385–388.
- Glauser TA. (2004) Behavioral and psychiatric adverse events associated with antiepileptics commonly used in pediatric patients. J Child Neurol 19: S25–S38.
- Gomer B, Wagner K, Frings L, Saar J, Carius A, Harle M, Steinhoff PJ, Bonhage A. (2007) The influence of antiepileptic drugs on cognition: a comparison of levetiracetam with topiramate. Epilepsy Behav 10: 486–494.
- Goodwin RD, Messineo K, Bregante A, Hoven CW, Kairam R. (2005) Prevalence of probable mental disorders among pediatric asthma patients in an inner-city clinic. J Asthma 42: 643–647.
- Hankin BL, Abramson LY, Moffitt TE, Silva PH, McGee R, Angell KE. (1998) Development of depression from preadolescence to young adulthood: Emerging gender differences in a 10-year longitudinal study. J Abnorm Psychol 107: 128–140.
- Hedderick E, Buchhalter J. (2003) Co morbidity of childhood-onset epilepsy and psychiatric and behavioral disorders: a population-based study. Ann Neurol 54(suppl): S155.
- Hesdorffer DC, Hauser WA, Olafsson E, Ludvigsson P, Kjartansson O. (2006) Depression and suicide attempt as risk factors for incident unprovoked seizures. Ann Neurol 59: 35–41.
- Jones JE, Watson R, Sheth R, Caplan R, Koehn M, Seidenberg M, Hermann B. (2007) Psychiatric co morbidity in children with new onset epilepsy. Dev Med Child Neurol 49: 493–497.
- Katon W, Russo J, Richardson L, McCauley E, Lozano P. (2008) Anxiety and depression screening for youth in a primary care population. Ambul Pediatr 8: 182–188.
- Kent L, Vostanis P, Feehan C. (1997) Detection of major and minor depression in children and adolescents: evaluation of the Mood and Feelings Questionnaire. J Child Psychol Psychiatry 38: 565–573.
- Levinson DF, Devinsky O. (1999) Psychiatric adverse events during vigabatrin therapy. Neurology 53: 1503–1511.
- Lewinsohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA. (1993) Adolescent psychopathology: I. prevalence and incidence of depression and other DSM-III-R disorders in high school students. J Abnorm Psychol 102: 133–144.
- McMiller WP, Weisz JR. (1996) Help-seeking preceding mental health clinic intake among African-American, Latino and Caucasian youths. J Am Acad Child Adolesc Psychiatry 35: 1086–1094.
- Mishory A, Winokur M, Bersudsky Y. (2003) Prophylactic effect of phenytoin in bipolar disorder: a controlled study. Bipolar Disord 5: 464–467.
- Mokhber N, Lane CJ, Azarpazhooh MR, Aalari E, Fayazi R, Sharkeri MT, Young AH. (2008) Anticonvulsant treatments of dysphoric mania: a trial of gabapentin, lamotrigine and carbamazepine in Iran. Neuropsychiatr Dis Treat 4: 227–234.
- Mula M, Sander JW. (2007) Negative effects of antiepileptic drugs on mood in patients with epilepsy. Drug Saf 30: 555–567.
- Oguz A, Kurul S, Dirik E. (2002) Relationship of epilepsy-related factors to anxiety and depression scores in epileptic children. J Child Neurol 17: 37–40.
- Ott D, Caplan R, Guthrie D, Siddarth P, Komo S, Shields WD, Sankar R, Kornblum H, Chayasirisobhon S. (2001) Measures of psychopathology in children with complex partial seizures and primary generalized epilepsy with absence. J Am Acad Child Adolesc Psychiatry 40: 907–914.
- Ott D, Siddarth P, Gurbani S, Koh S, Tournay A, Shields WD, Caplan R. (2003) Behavioral disorders in pediatric epilepsy: unmet psychiatric need. Epilepsia 44: 591–597.
- Pavuluri MN, Henry DB, Carbray JH, Naylor MR, Janicak PG. (2005) Divalproex sodium for pediatric mixed mania: a 6-month prospective trial. Bipolar Disord 7: 266–273.
- Pescosolido BA, Jensen PS, Martin JK, Perry BL, Olafsdottir S, Fettes D. (2008) Public knowledge and assessment of child mental health problems: findings from the National Stigma Study-Children. J Am Acad Child Adolesc Psychiatry 47: 399–49.
- Rickwood DJ, Braithwaite VA. (1994) Social-psychological factors affecting help-seeking for emotional problems. Soc Sci Med 39: 563–572.
- Rutter M, Graham P, Yule WA. (1970) A neuropsychiatric study in childhood. J.B. Lippincott, Philadelphia.
- Saxena K, Howe M, Simeonova D, Steiner H, Change K. (2006) Divalproex sodium reduces overall aggression in youth at high risk for bipolar disorder. J Child Adolesc Psychopharmacol 16: 252–259.
- Sen B. (2004) Adolescent propensity for depressed mood and help seeking: race and gender differences. J Ment Health Policy Econ 7: 133–145.
- Sharp C, Goodyer IM, Croudace TJ. (2006) The short mood and feedings questionnaire (SMFQ): a unidimensional item response theory and categorical data factor analysis of self-report ratings from a community sample of 7-through 11-year-old children. J Abnorm Child Psychol 34: 379–391.
- Smith K, Siddarth P, Zima B, Sankar R, Mitchell W, Gowrinathan R, Shewmom A, Caplan R. (2007) Unmet mental health needs in pediatric epilepsy: insights from providers. Epilepsy Behav 11: 401–408.
- Thome-Souza S, Kuczynski E, Assumpcao F Jr, Rzezak P, Fuentes D, Fiore L, Valente KD. (2004) Which factors may play a pivotal role in determining the type of psychiatric disorder in children and adolescents with epilepsy? Epilepsy Behav 5: 988–994.
- Thome-Souza S, Kuczynski E, Valente KD. (2007) Sertraline and fluoxetine: safe treatments for children and adolescents with epilepsy and depression. Epilepsy Behav 10: 417–425.
- Turky A, Beavis JM, Thapar AK, Kerr MP. (2008) Psychopathology in children and adolescents with epilepsy: an investigation of predictive variables. Epilepsy Behav 12: 136–144.
- Wagner JL, Smith G. (2007) Psychological services in a pediatric epilepsy clinic: referral patterns and feasibility. Epilepsy Behav 10: 129–133.
- Wu P, Hoven CW, Cohen P, Liu X, Moore RE, Tiet Q, Okezie N, Wicks J, Bird HR. (2001) Factors associated with use of mental health services for depression by children and adolescents. Psychiatr Serv 52: 189–195.
- The NSDUH Report: Major Depressive Episode among Youths Aged 12 to 17 in the United States: 2004 to 2006. (May 13, 2008). Substance abuse and mental health services administration, office of applied studies, Rockville, MD.
- Zahner GE, Daskalakis C. (1997) Factors associated with mental health, general health, and school-based service use for child psychopathology. Am J Public Health 87: 1440–1448.
- Zimmerman FJ. (2005) Social and economic determinants of disparities in professional help-seeking for child mental health problems: evidence from a national sample. Health Serv Res 40: 1514–1533.
Citing Literature
