Johannesburg - Due to to the nature of the illness and training of health practitioners, most cases of depression go undetected and untreated in people living with epilepsy.
This is what prompted Dr Edward Mbewe, a PhD graduate at the University of KwaZulu-Natal, to begin his study on the problem.
His dissertation is titled “Improving the Detection of Depression and/or Anxiety Psychiatric Co-morbidities in People with Epilepsy in Primary Health Care Institutions in Zambia”.
What has resulted is a 10-item screening tool for detection that Mbewe said could also be used in South African primary healthcare facilities.
His study – supervised by the late Professor Leana Uys and Professor Gretchen Lano Birbeck – has been published in The American Journal of Tropical Medicine and Hygiene and two other international medical journals.
Mbewe said they had conducted a three-phase study that included establishing the prevalence of psychiatric co-morbidities of depression or anxiety.
At the time the study began in 2012, the baseline detection rate of depression and/or anxiety among people with epilepsy was one percent.
Mbewe – the principal lecturer at Chainama College of Health Sciences in Zambia – said 595 patients, who were diagnosed with epilepsy and on treatment, consented to be screened using the tool. Of that number, 53.7 percent tested positive for depression and anxiety.
“In training to treat epilepsy, what is not emphasised is that there are co-morbidities (the presence of one or more other disorder occurring with a primary disorder). Depression occurs in 90 percent of people with epilepsy,” he said.
The second phase was the development of a screening tool for the psychiatric co-morbidities, and phase three was the implementation of the screening tool to see if there was improvement of screening among primary-care workers.
The tool is a set of 10 questions with the codes: agree, strongly disagree and strongly agree.
“Questions range from the patient’s appetite, their sleeping patterns and whether in the past month they’ve felt like killing themselves. The maximum someone can score is 30, but the cut-off is 18. If you have 18 you need to be treated for depression or anxiety,” Mbewe continued.
Primary healthcare workers were trained to use the screening tool in selected clinics in Lusaka.
A retrospective chart, conducted for 120 patients living with epilepsy who had received care a month after the workers were trained, found that detection improved from one percent to 49 percent.
Mbewe said the causes of depression in people with epilepsy ranged from the side effects of medication to the patient worrying about when they would be cured.
Four of the patients screened during the study committed suicide because of depression.
Mbewe said: “While I am humbled at the reception of my work and that it has been published in peer-reviewed journals, and my theory has been proved, if it had been done much sooner, a lot more lives could have been saved.”
The Star