دانلود رایگان مقاله انگلیسی ارزیابی افسردگی در صرع: ابزار اندازه گیری افسردگی خودسنجی بیماری خاص - تیلور و فرانسیس 2017

ABSTRACT

Objectives: Depression is common in epilepsy, with rates ranging from 20 to 55% in most samples and reports as high as 70% in patients with intractable epilepsy. However, some contend that depression may be over- and/or under-reported and treated in this population. This may be due to the use of common self-report depression measures that fail to take into account the overlap of disease and depressive symptoms and also the host of side effects associated with antiepileptic medication, which may also be construed as depression. Methods: The present study examined the utility of common selfreport depression measures and those designed specifically for the medically ill, including a proposed new measure, to determine which may be more appropriate for use among people with epilepsy. Results: We found that common self-report depression measures are useful for screening depression in epilepsy, particularly with a raised cutoff for one, with sensitivities ranging from .91 to .96. A measure designed for the medically ill obtained the greatest specificity of .91, suggesting its use as a diagnostic tool with a slightly raised cutoff. The positive likelihood ratio of this latter measure was 8.76 with an overall classification accuracy of 88%. Conclusions: Assessment of depression in epilepsy can be improved when utilizing self-report measures that better differentiate disease symptoms from neurovegetative symptoms of depression (e.g. fatigue, sleep disturbance). This was demonstrated in the present study. Clinical implications are discussed.

Discussion

The purpose of the present investigation was to determine whether screening measures designed for the general population, the medically ill, or PWE are superior for use in detecting depression in PWE. It has previously been suggested that common self-report depression screening measures, particularly those more heavily weighted with neurovegetative symptoms of depression such as the BDI-II, may result in inaccurate reports of depression, particularly a high false positive rate and subsequent inflated prevalence rates. Conversely, those designed specifically for the medically ill, which remove confounding neurovegetative items, may miss important depression-related symptoms such as seen in ‘masked depression.’ Thus, the new measure developed within, which excludes items only based on patient report was hypothesized to yield better specificity and overall accuracy at differentiating depressed versus non-depressed PWE as compared to existing measures.

As expected, the proposed EPI-BDI-M was found to obtain greater specificity (85%) than previously proposed cutoffs of the BDI-II and CES-D (70 and 77%, respectively). It also obtained a higher specificity than the previous cutoff of 4 on the BDI-PC. The prevalence rate derived from this measure was also most akin to the rate derived from a clinical interview, suggesting some merit to utilizing follow-up questions on a self-report measure; similar to what is done through a clinical interview. However, while the measure demonstrated an improved specificity, it came at a sacrifice to its sensitivity, which is not seen with a raised cutoff of 6 on the BDI-PC, which has superb specificity and good sensitivity. Findings of the EPI-BDI in this sample suggests that there is need for improvement with this measure if it is to be utilized with PWE.