Health care access, psychosocial outcomes and mental health in adults living with epilepsy during the COVID-19 pandemic

• Published in: Epilepsy & behavior 2024-02, Vol.151, p.109617-109617, Article 109617
• Main Authors: Mc Carthy, L., Mathew, B., Blank, L.J., Van Hyfte, G., Gotlieb, E., Goldstein, J., Agarwal, P., Kwon, C.S., Singh, A., Fields, M., Marcuse, L., Yoo, J.Y., Sivarak, E., Gururangan, K., Navis, A., Jetté, N.
• Format: Article
• Language: English
• Subjects: Coronavirus; Depression; Employment; Health services; Seizures
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2023.109617

•People living with epilepsy (PLWE) experienced mental health challenges during the COVID-19 pandemic, with prominent symptoms of anxiety and depression.•This cohort of PLWE also encountered financial and employment-related stressors.•Seizure burden improved during the COVID-19 pandemic for many patients, however a minority experienced worsening seizure frequency.•Telehealth played an important role in healthcare access for PLWE. People living with epilepsy (PLWE) have a higher prevalence of mental health comorbidities and poorer psychosocial outcomes compared to the general population. The aim of this study was to examine psychosocial outcomes, mental health, healthcare accessibility, and seizure burden in PLWE during the COVID-19 pandemic. We conducted a cross-sectional study of adults with epilepsy treated in an urban multicenter health system from 2021 to 2022. A standardized questionnaire assessed for COVID-19 history, comorbidities, access to antiseizure medications (ASMs) and neurological care, seizure burden, and psychosocial outcomes (e.g., employment, social and financial support). The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were administered to evaluate for depression and anxiety. Frequency and proportions for categorical variables and median and interquartile ranges for continuous variables were calculated. Fifty-five PLWE participated (95 % response rate). Median age was 40 years (IQR 31.5–66.5), 61.8 % were women, 47.3 % had a bachelor's degree or higher and 29.1 % each had Medicaid and Medicare insurance. Race (from highest to lowest %) was: 32.7 % White, 20 % Black, 20 % Latinx, 14.5 % Asian, and 12.7 % selected “other” or “prefer not to say.” COVID-19 had been diagnosed in 21.8 % of participants. Symptoms of anxiety and depression were self-reported by 43.6 % and 34.5 % of patients, respectively, with many describing this symptom as new post-pandemic (37.5 % and 31.6 %, respectively). Using validated scales, 52.7 % had depression (PHQ-9 score ≥ 5) with 30.9 % having moderate/severe depression (PHQ-9 score ≥ 10), while 29.1 % had probable generalized anxiety disorder (GAD-7 score ≥ 8). Seizure burden increased in 21.8 % of participants, while 20 % reported fewer seizures and 29.1 % were seizure free since the COVID-19 pandemic. Economic impacts of the pandemic included job loss (25 % amongst those employed at onset of pandemic), new or worsened financial difficulties (40 %), and new or worsened soci