Suicidality and depression in patients with Epilepsy: provider education module and patient screening in an outpatient clinic setting.

Mood disorders are common in patients with epilepsy. The rate of suicide is considerably higher in patients with epilepsy compared to the general population. In order to provide appropriate mental healthcare for these patients, it is mandatory to screen for suicidality in an epilepsy clinic. However, there are multiple challenges when establishing a screening system to ensure such timely and adequate intervention. A team of psychologists, psychiatrists, and epileptologists, at our quaternary hospital in Chicago, Illinois designed a concise yet thorough hybrid virtual/in-person module to screen for and teach providers about the implications of psychiatric comorbidities in adult patients with epilepsy. Providers participated in the learning module and took a pre/post-training assessment to measure confidence and knowledge of the content presented. Patients in a single provider's clinic were then screened for depression and suicidality using the Patient Health Questionnaire (PHQ) alongside an internal severity triage protocol. There were statistically significant improvements in the nine providers' confidence specifically involving the ability to screen for risk of depression, assessment of suicide completion risk factors, and response plan for clinic patients with high risk for suicide. Of the 124 patients screened with the PHQ-2, 13/124 (10.5%) tested positive. Of those, 9 completed the PHQ-9 in which 3/9 (33.3%) scored mild, 2/9 (22.2%) moderate, and 4/9 (44.4%) moderately severe depression. Two patients reported death ideation and two mild suicidal ideations. All patients were referred for timely psychiatric evaluation. Three patients who scored moderately severe depression did not have a prior established diagnosis of depression or received mental healthcare in the past. A brief educational intervention for providers increases confidence regarding depression and suicidality in patients with epilepsy. Utilization of the PHQ can help identify patients with depression. Our severity-based triage system for those patients with suicidal ideation provides a standardized way for patients to be referred appropriately for psychiatric care.