Collaborative Care to Improve Quality of Life for Anxiety and Depression in Post-Traumatic Epilepsy
Abstract
People with epilepsy, and especially post-traumatic epilepsy, commonly experience depression and anxiety, and these symptoms affect their quality of life more than seizures. In addition to being the most significant predictors of poor quality of life in epilepsy, anxiety and depression can lead to other problems including hospitalizations, worsened side effects, worsened memory, and even death from suicide. In spite of this importance, anxiety and depression often go unrecognized and untreated, due in part to shortages of psychiatrists and other behavioral health specialists. Based on our prior research, neurologists are willing to potentially prescribe medications for anxiety and depression, and patients have indicated desire to receive anxiety and depression treatment from neurologists. However, our prior research also shows that usual neurology care does not improve quality of life. Therefore, better treatments are needed that can be started in a neurology clinic and help overcome shortages of behavioral health specialists. A promising potential solution is collaborative care. This is a team-based treatment similar to treatments already used in Department of Veterans Affairs (VA) primary care settings, other primary care settings, and some specialty clinics that improves anxiety, depression and quality of life. This type of clinic-based collaborative care has not been tested in neurology settings or post-traumatic epilepsy, yet it could be highly effective and has the potential to be used widely in settings that can benefit individuals with post-traumatic epilepsy in Veteran, military, and civilian communities. In this study, we will assess a neurology-oriented collaborative care intervention among 60 adults with post-traumatic epilepsy and anxiety or depression who receive care at a VA or a university specialty clinic. Half of the participants will be randomly assigned to collaborative care, and the other half will be assigned to receive their usual neurology care. We will evaluate three main areas to see how the intervention works. First, we will assess implementation of the collaborative care intervention among the people assigned to it, to see if they are able to participate in the collaborative care calls (fidelity) and to see if they and their neurologists consider the intervention acceptable, feasible, and appealing. Second, and most importantly, we will assess the impact of the 24-week collaborative care intervention on emotional quality of life, epilepsy-related and general quality of life, along with anxiety and depression. We will also explore whether seizure frequency or severity influences quality of life in the intervention, and whether medication side effects or missed medication affects quality of life with the intervention. This study is new and exciting because the intervention is brand new to neurology clinics, it is delivered without the need for additional in-person visits, and because we are using study methods to examine how the intervention could be introduced in other settings (using implementation science), which increases the chances the intervention can be spread rapidly to other places if it works well. This is important because the intervention improves quality of life in other groups of patients, and is a way that neurologists could help improve the most important drivers of poor quality of life in post-traumatic epilepsy (anxiety and depression), which are often untreated or not treated effectively. This has a high chance to impact Veteran, military, and civilian communities because it directly addresses anxiety and depression, which are so common in post-traumatic epilepsy, and are especially relevant for Veteran and military communities that are particularly vulnerable to both post-traumatic epilepsy and anxiety or depression after traumatic brain injury.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210630
Entities
People
- Heidi Munger Clary
Organizations
- United States Army
- Wake Forest University