Preventing Depression in People with Epilepsy: An Extension of Project UPLIFT

Summary

Principal Investigator: Nancy J Thompson
Abstract: DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05): Comparative Effectiveness Research, and Specific Challenge Topic (05-MD-102): Prevention of Chronic Diseases in Disparity Populations. It describes an intervention to prevent depression, a significant chronic disease, among a specific disparity population: people with epilepsy. Funded by the Centers for Disease Control and Prevention (CDC) as a home-based treatment for depression in people with epilepsy, Project UPLIFT was developed to provide group delivery of depression treatment by telephone or Web. The UPLIFT materials, based upon Mindfulness-based Cognitive Therapy for Depression, include modules for eight sessions as follows: (1) Monitoring Thoughts, (2) Challenging and Changing Thoughts, (3) Coping and Relaxing, (4) Attention and Mindfulness, (5) The Calm Present, (6) Thoughts as Changeable, Thoughts as Impermanent, (7) Focus on Pleasure and the Importance of Reinforcement, and (8) Preventing Relapse and Giving Thanks. The goals of this multi-site project are two-fold: (1) to revise the Project UPLIFT materials for use in prevention (rather than treatment) of depression;and (2) to estimate their effectiveness in reducing the risk of depression in people with epilepsy as well as increasing their knowledge and skills for preventing depression and improving their quality of life. While this proposal targets people with epilepsy, the intervention could be easily adapted to serve other disparity populations, many of whom have elevated rates of depression. An effective intervention combining home-based treatment with group cognitive therapy and mindfulness enhances the standard treatment of depression by reducing barriers to receiving services and increasing opportunities for sharing experiences. Extending such an intervention for use in preventing depression avoids the lost productivity associated with depression and the significant costs associated with treating depression after it has already occurred, while building people's capacity for managing future encounters with stress and difficult life circumstances. The project will have two phases: a formative phase, during which the Project UPLIFT materials will be revised for use as a preventive intervention, and a pilot-testing phase, during which the acceptability and estimates of effectiveness of the intervention, presented in the two different modes, are assessed. Two aspects of this project provide a unique and timely opportunity to conduct this research. One is that Emory recently developed the Project UPLIFT depression treatment intervention materials with funding from the Centers for Disease Control and Prevention (CDC). The other is that Emory, the University of Michigan, the University of Texas Health Science Center at Houston, and the University of Washington have spent the past year collaborating as members of the Managing Epilepsy Well (MEW) network, also funded by CDC. Emory is the coordinating center for this network. Having ready access to both these materials and these collaborators allows us to rapidly begin this intervention program. Pilot-testing of the telephone and web-based prevention intervention groups will use a cross-over design. A total of 168 participants will be randomly assigned to one of four strata, each comprised of six 7-person groups. After each 28 people are recruited, they will be randomly assigned to a group in one of the four strata. During the first 8 weeks of their participation, two of the groups will receive the prevention intervention: one by telephone conference call, and one by Web. When the 8-week intervention is complete, there will be 3 weeks to complete the interim assessment and then the groups assigned to the other two strata will receive the intervention;one by telephone conference call, and one by internet. Major milestones of the project are completing: (1) revised materials, (2) intervention in the first two strata, and (3) the final evaluation in all strata. Meta-analysis showed that 12% to 19% of new cases of depression were prevented through cognitive-behavioral interventions. Among people with epilepsy, the prevalence of depression is reported to be between 32% and 48%. If one-third of the more than 3 million people in the United states with epilepsy are depressed and we can reduce that number by 12%, 120,000 people will be protected.
Funding Period: ----------------2009 - ---------------2011-
more information: NIH RePORT