Help-seeking and treatment preferences for depression in epilepsy Kerrie L. Margrove a, ⁎, Ajay K. Thapar b , Seth A. Mensah c , Michael P. Kerr d a Department of Mental Health and Learning Disabilities, Anglia Ruskin University, Chelmsford, UK b Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff, Wales, UK c Welsh Neuropsychiatry Service, Whitchurch Hospital, Cardiff and Vale University Health Board, Cardiff, Wales, UK d Department of Psychological Medicine and Neurology, Cardiff University, Heath Park, Cardiff, Wales, UK abstract article info Article history: Received 13 July 2011 Revised 30 August 2011 Accepted 31 August 2011 Available online 20 October 2011 Keywords: Epilepsy Depression Primary care Patient Health Questionnaire-2 Mental health Depression among people with a diagnosis of epilepsy is common, underrecognized, and undertreated, yet the reasons for this are unclear. In this study people with a diagnosis of epilepsy recruited from primary care were mailed a questionnaire covering help seeking for psychological distress, treatment preferences for depression, and current symptoms of depression using the Patient Health Questionnaire-2 (PHQ2). Eighty-six people with epilepsy responded to the survey and 44% of the sample reported they would not seek help if they were feeling stressed, worried, or low and it was affecting their daily lives. Almost 40% of the participants screened positive for current depression and PHQ2 scores were statistically unchanged over an average of 8.6 months. The most popular treatment for depression was advice from a general practi- tioner or from family and friends. The majority of respondents felt speed of treatment should take priority over receiving preferred treatment for depression care. © 2011 Elsevier Inc. All rights reserved. 1. Introduction In patients with chronic health conditions who are routinely screened for depression in primary care settings, such as those with heart disease and diabetes, depression levels are reported to be higher than in the gen- eral population [1,2]. In people with epilepsy, who are not automatically screened in the United Kingdom, depression levels are higher still [3], and this is also the case when making comparisons with other neurolog- ical disorders [4]. Some reports put depression levels in people with ep- ilepsy at between 10 and 40% in community samples [5,6] and much higher in patients with epilepsy evaluated for surgery [7]. Comorbid depression is associated with poor health outcomes for people with chronic illness, which promotes the need for improvement in depression screening techniques [8]. In a large U.S. postal question- naire study, patients with epilepsy and comorbid depression reported taking longer to recover from seizures than those who did not have depression, and comorbid depression was associated with poorer health-related quality of life [9]. People with epilepsy experiencing depression may also be less likely to take their medication as instructed, compared with those without persistent negative mood [10]. Less than one-third of people with a diagnosis of epilepsy having co- morbid depression are treated for their mood disorder [11]. Reasons commonly proposed to explain this are that depression symptoms are incorrectly attributed to antiepileptic drugs [12], and that the focus of busy general practitioners (GPs) is likely to be directed to the primary characteristics of epilepsy [13]. However, no studies have been con- ducted that provide information about the possible contribution of patient-related reasons to low recognition of and treatment for depression in this group. In line with previous research into psycholog- ical distress in the general population [14,15], there is a need to identify whether people with epilepsy would be likely to seek help for psycho- logical distress and what their depression treatment preferences are. The primary aim in conducting this study was to explore patient help- seeking and treatment preferences for symptoms of depression in a group of people with epilepsy. Understanding the reasons why there is low recognition and treatment of depression in people with epilepsy is the important first step in delivering an optimal intervention package. 2. Methods 2.1. Participants Twenty-six general practices were recruited for a previous study [5] in South Wales and Mid Glamorgan. In this previous study, people with epilepsy were identified via their GPs, according to the following criteria: age N 18 years, diagnosis of epilepsy, no learning disability, no diagnosis of dementia. A subset of participants (n = 189) from the earlier study [5] who had indicated they might be willing to take part in future research were sent out a postal questionnaire to invite them to participate in the current research project. An additional 70 willing people who had participated in the same earlier study [5] could not be contacted, because a decision was not made by the Cwm Taf Health Board about whether or not to approve the research. Epilepsy & Behavior 22 (2011) 740–744 ⁎ Corresponding author at: Department of Mental Health and Learning Disabilities, Anglia Ruskin University, William Harvey Building, Bishop Hall Lane, Chelmsford, CM1 1SQ Wales, UK. Fax: +44 1245351300. E-mail address: kerrie.margrove@anglia.ac.uk (K.L. Margrove). 1525-5050/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2011.08.042 Contents lists available at SciVerse ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh