Unmet mental health needs in pediatric epilepsy: Insights from providers

Division of Adult Psychiatry, University of California, Los Angeles, Los Ángeles, California, United States
Epilepsy & Behavior (Impact Factor: 2.26). 12/2007; 11(3):401-8. DOI: 10.1016/j.yebeh.2007.05.009
Source: PubMed


Eighteen pediatric neurologists and 18 pediatricians completed a 5-point Likert scale questionnaire on their knowledge of, attitudes toward, and management of the behavioral, cognitive, and psychosocial aspects of pediatric epilepsy, before and after a lecture on this topic. They also responded to questions about possible barriers to mental health care of children with epilepsy. The brief educational intervention modified the knowledge/attitudes of pediatricians compared with pediatric neurologists on the impact of epilepsy on behavior and cognition in children with epilepsy. However, there were no between-group differences in how providers perceived their competence to assess behavioral and cognitive comorbid conditions in pediatric epilepsy. Responses to open-ended questions suggested insufficient mental health coverage for and expertise on pediatric epilepsy, resistance of mental health clinicians to treat children with epilepsy, and the stigma of mental health as possible barriers to mental health care in children with epilepsy. In addition to the need for provider education about the behavioral and cognitive comorbid conditions of pediatric epilepsy, these findings emphasize the importance of examining alternative routes to increasing mental health care for children with epilepsy.

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    • "Studies from the general population suggest that mental health care utilization is especially low among children of minority groups (Wu et al., 2001; Zimmerman, 2005; Burgess et al., 2008). Previous authors have suggested that lack of parental knowledge, minimization of symptoms, and inadequate resources widen the gap between mental health care and youth with epilepsy (Ott et al., 2003; Smith et al., 2007; Wagner & Smith, 2007), but these barriers have not yet been thoroughly studied in this population. "
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    ABSTRACT: To determine whether previously undetected symptoms of depression and psychiatric help-seeking behaviors are associated with demographic or epilepsy-related variables in a predominantly African American sample of pediatric epilepsy patients. Ninety-six serially recruited parent-child dyads (55% African American, 39% Caucasian) completed the Short Mood and Feelings Questionnaire (SMFQ). Regression analyses determined whether depressive symptoms measured by the SMFQ were associated with demographic (age, gender, and ethnic background) or epilepsy-related variables (age of seizure onset, duration of epilepsy, seizure type, time since last seizure, and number of antiepileptic drugs). Dyads with positive SMFQ screens (score > or = 12) received information about depression and were advised to seek mental health services. Six months later, parents completed follow-up interviews to ascertain mental health service utilization. Thirty-five participants (36.5%) screened positive for probable depression. Greater number of antiepileptic drugs was the only predictor variable independently associated with greater (worse) depression scores (p = 0.005). At 6-month follow-up, 12 patients (36.4%) had received mental health care, whereas 21 guardians (63.6%) denied depressive symptoms in their child and never sought mental health services (two dyads lost to follow-up). Logistic regression analyses found no associations between demographic, epilepsy-related, or depressive variables and psychiatric help-seeking. This study indicates the necessity and feasibility of screening for previously undetected symptoms of depression in pediatric epilepsy clinics serving diverse populations, particularly among patients receiving antiepileptic polytherapy. Additional research on the correlates of depressive symptoms and determinants of psychiatric help-seeking is needed to develop evidence-based interventions for youths with epilepsy and symptoms of depression.
    Full-text · Article · Feb 2009 · Epilepsia
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    • "Barriers to obtaining appropriate mental health care need to be addressed. The findings from previous research emphasize the importance of examining what physicians know about behavioral and emotional disorders in Mental health care 6 pediatric epilepsy, their attitudes toward the need for mental health services for these children, and their knowledge of available tools to screen for these problems (Smith et al., 2007). Indeed, the results from this larger project will undoubtedly shed light on this issue. "

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