PREVALENCE AND ASSOCIATED RISK FACTORS OF UNDIAGNOSED DEPRESSION AMONGST PEOPLE WITH EPILEPSY IN A MULTIETHNIC SOCIETY

ABSTRACT BACKGROUND Depression, being the most frequent psychiatric comorbidity, has always been closely linked with epilepsy. However, there is a lack of screening for depressive symptoms resulting in failure to detect depression among people with epilepsy (PWE). While many studies have described the risks associated with depression in epilepsy, very few have elaborated whether these risks are similar for undiagnosed depression, especially in a multiethnic community. METHODS We aim to investigate the prevalence and associated risk factors of undiagnosed depression in PWE through a cross-sectional study at a tertiary teaching hospital. Epilepsy patients aged between 18 and 65 years old were recruited after excluding those with background illnesses, which may contribute to depressive symptoms. A total of 129 participants were recruited. We collated their demographic and clinical details before interviewing them using two questionnaires; the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Beck’s Depression Inventory-II (BDI-II). Subsequently, if a participant is screened positive for depression, the diagnosis is confirmed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) questionnaire and a psychiatric clinic referral is offered. RESULTS Among the 129 participants, 9.3% had undiagnosed major depressive disorder (MDD), which had a female preponderance (66.7%). Risk factors of undiagnosed depression among PWE include low socioeconomic backgrounds (p = 0.026), generalized epilepsy (p = 0.036) and temporal lobe epilepsy (p = 0.010). Otherwise, while some variables such as being underweight and unmarried may be seen in a higher proportion in those who were depressed; we did not find a statistically significant relationship among them. CONCLUSION The prevalence of undiagnosed depression among PWE is higher when compared to population-based studies carried out in Western countries. While questionnaires to screen for depression are widely available, their infrequent use would lead to failure in identifying patients who may benefit from psychosocial support and treatment, which would subsequently improve their disease outcomes and quality of life. This study recommends the use of screening questionnaires to identify undiagnosed depression in PWE.