Improving detection of depression and/or anxiety as comorbidities of epilepsy in primary health care settings in Zambia.

Abstract

The focus of this study was on common psychiatric comorbidities of depression and anxiety in people with epilepsy (PWE). While international published data show that up to 60% of PWE suffer from depression and/or anxiety, most primary care (PHC) settings in developed countries display some oversight in this area. The study was conducted in Zambia, in three phases; which each culminated in submissions for publication in an internationally peer reviewed journal. Phase one involved chart review to establish the rate of detection of depression and/or anxiety in PWE at the outpatient clinic of Chainama Hills College Hospital. The detection rate was only 1%. This formed the basis for phase two where we developed a ten item screening tool for depression and/or anxiety for use by PHC workers in busy clinical settings. The tool was validated, its sensitivity and specificity were determined and the inter-rater reliability was also calculated. Phase three involved implementation of the tool validated screening tool. We measured the ability of PHC workers to use and interpret the screening tool in busy clinical settings. One month after training and implementing the use of the screening tool, a retrospective chart review was undertaken using the same tool that was employed in phase one chart review. There was a marked improvement when 120 files of PWE were reviewed as the percentage of screening for depression and anxiety increased from 1% to 49%.