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Preventing Depression in Epilepsy: Project UPLIFT

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Title: Preventing Depression in Epilepsy: Project UPLIFT


1
Preventing Depression in Epilepsy Project UPLIFT
  • Nancy J. Thompson, Ph.D., M.P.H.,
  • Archna Patel, M.P.H., Linda M. Selwa, M.D.,
  • Charles E. Begley, Ph.D., Robert T. Fraser,
    Ph.D.,
  • Erica Johnson, Ph.D., Shelley Stoll, M.P.H.

2
Epilepsy, Depression, UPLIFT
  • Epilepsy and Depression
  • 32-48 of people with epilepsy are depressed
  • May avoid antidepressants because of epilepsy
    meds
  • Psychotherapy attendance limited by driving
    restrictions
  • Project UPLIFT
  • Created with CDC funding as a home-based
    intervention for depression in epilepsy
  • Based upon
  • Mindfulness (Using Practice)
  • Cognitive-behavioral Therapy (Learning to
    Increase Favorable Thoughts
  • Delivered to groups by Web or telephone
  • Both Web and telephone were more effective than
    treatment-as-usual in reducing symptoms of
    depression

3
From Treatment to Prevention
  • Mindfulness-based Cognitive Therapy had been used
    for prevention, so why not UPLIFT?
  • Received stimulus funds from the National
    Institute of Minority Health and Health
    Disparities
  • Revised materials and tested in focus groups
  • Like the original, comprised of 8 hour-long
    sessions
  • Co-delivered by trainees and peers with epilepsy
    from GA (mostly), supervised by a licensed
    psychologist
  • Supported by a mental health professional in each
    state

Monitoring Thoughts The Present as a Calm Place
Challenging and Changing Thoughts Thoughts as Changeable Impermanent
Coping and Relaxing Pleasure and Reinforcement
Attention and Mindfulness Relapse Action Plans
4
Method
  • Design Randomized, controlled trial
  • Stratum 1 Pretest 8 wk phone
    Interim as usual Follow-up
  • Stratum 2 Pretest 8 wk Web
    Interim as usual Follow-up
  • Stratum 3 Pretest as usual
    Interim 8 wk phone Follow-up
  • Stratum 4 Pretest as usual
    Interim 8 wk Web Follow-up
  • Participants
  • People with epilepsy age 21 and over
  • With mild-to-moderate symptoms of depression
    (8ltCES-Dlt27)
  • Without Major Depressive Disorder (MDD)
  • No suicidal ideation
  • Mentally stable
  • Recruited from their respective states by Emory
    University (GA) University of Michigan (MI)
    University of Texas, Houston (TX) University of
    Washington (WA)

5
Measures
  • Mediators
  • Knowledge Skillsdeveloped with UPLIFT
  • Depression Coping Self-efficacy
  • Self Compassion
  • Outcomes
  • Depression
  • Modified Beck Depression Inventory (mBDI)/(BDI)
  • Patient Health Questionnaire (PHQ-9)
  • Neurological Disorders Depression Inventory for
    Epilepsy (NDDI-E)
  • Seizures
  • Self-reported number of seizures
  • Liverpool Seizure Severity Scale
  • Quality of Life
  • SF-36 Physical and Mental Health QOL
  • Satisfaction with Life

6
Results
  • Incidence of MDD 10.7 (TAU) vs. o.o (UPLIFT)
    (p 0.028)

Knowledge/Skills (p 0.043)
BDI (p 0.005)
PHQ-9 (p 0.049)
7
Results (continued)
Satisfaction w/ Life (p 0.006)
Seizure Severity (p 0.10)
Seizures (p 0.025)
past 4 weeks
8
Results (continued)
  • There was a dose relationship between number of
    sessions attended and mean change in each
    outcome
  • All other measures changed in the expected
    direction, although they did not achieve
    significance.
  • The effects were maintained over the 8 weeks of
    follow-up

0-4 sessions 5-7 sessions All 8 sessions
Depression 1.3 -3.0 -4.6
Number of Seizures 0.5 -0.8 -5.8
Knowledge and Skills 1.9 9.7 13.7
Satisfaction with Life 1.7 1.8 2.9
9
Conclusions
  • Project UPLIFT for treatment constituted a leap
    forward in delivery of depression treatment
  • Reaches those whose mobility is impaired by
    disability, or even the fatigue and loss of
    energy associated with depression
  • Reaches people in rural or otherwise
    hard-to-reach areas
  • Those with specific conditions who live far apart
    can be brought together in a group to connect and
    share experiences
  • Builds capacity for intervention among
    populations with chronic disease by training
    peers to deliver the intervention
  • This study demonstrates its efficacy for
    prevention
  • Averts disability and lost productivity from
    depression
  • Eliminates tangible and intangible costs of
    treating depression
  • Provides participants with skills to manage
    future stress and difficult life circumstances

10
Acknowledgements
  • To the people with epilepsy who took part in this
    study
  • To all of our facilitators with and without
    epilepsy
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