Preventing Depression in Epilepsy: Project UPLIFT
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Transcript 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.
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
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
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
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
Method
Design: Randomized, controlled trial
Stratum 1:
Stratum 2:
Stratum 3:
Stratum 4:
Pretest
Pretest
Pretest
Pretest
8 wk phone
8 wk Web
as usual
as usual
Interim
Interim
Interim
Interim
as usual
as usual
8 wk phone
8 wk Web
Follow-up
Follow-up
Follow-up
Follow-up
Participants
People with epilepsy age 21 and over
With mild-to-moderate symptoms of depression (8<CES-D<27)
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)
Measures
• Mediators
•
•
•
Knowledge & Skills—developed with UPLIFT
Depression Coping Self-efficacy
Self Compassion
• Outcomes
•
Depression
–
–
–
•
Seizures
–
–
•
Modified Beck Depression Inventory (mBDI)/(BDI)
Patient Health Questionnaire (PHQ-9)
Neurological Disorders Depression Inventory for Epilepsy
(NDDI-E)
Self-reported number of seizures
Liverpool Seizure Severity Scale
Quality of Life
– SF-36 Physical and Mental Health QOL
– Satisfaction with Life
Results
• Incidence of MDD: 10.7% (TAU) vs. o.o% (UPLIFT) (p = 0.028)
BDI
(p = 0.005)
PHQ-9
(p = 0.049)
Knowledge/Skills
(p = 0.043)
Results (continued)
Satisfaction w/ Life
(p = 0.006)
Seizure Severity
(p = 0.10)
# Seizures*
(p = 0.025)
*past 4 weeks
Results (continued)
There was a dose relationship between number of
sessions attended and mean change in each outcome
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
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
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
Acknowledgements
To the people with epilepsy who took part in this study
To all of our facilitators with and without epilepsy