Screening of Major Depression Disorder in Patients With Epilepsy in Indonesian National Referral Hospital

Astri Budikayanti; Izati Rahmi; Lilir Amalini; Diatri Nari Lastri; Herqutanto; Joedo Prihartono; Fitri Octaviana

doi:10.1212/CPJ.0000000000200152

Screening of Major Depression Disorder in Patients With Epilepsy in Indonesian National Referral Hospital

Neurol Clin Pract. 2023 Jun;13(3):e200152. doi: 10.1212/CPJ.0000000000200152. Epub 2023 May 2.

Authors

Astri Budikayanti¹, Izati Rahmi¹, Lilir Amalini¹, Diatri Nari Lastri¹, Herqutanto¹, Joedo Prihartono¹, Fitri Octaviana¹

Affiliation

¹ Department of Neurology (AB, IR, LA, DNL, FO) and Community Medicine Department (HH, JP), Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Abstract

Background and objectives: Major depressive disorder (MDD) is a common psychiatric disorder in patients with epilepsy (PWE). The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is one of the MDD screening tools used in PWE. This study aims to determine the accuracy of the valid and reliable NDDI-E Indonesian version as an MDD screening tool in PWE and investigate the prevalence and risk factors for the development of MDD in PWE.

Methods: A diagnostic cross-sectional study was conducted at Cipto Mangunkusumo National Referral Hospital, Indonesia. Patients were PWE aged 18 years or older who visited the epilepsy outpatient clinic. The valid and reliable NDDI-E Indonesian version and Mini International Neuropsychiatric Interview (MINI) International Classification of Disease, 10th Revision (ICD-10) were used to diagnose MDD. In phase II of the study, diagnostic accuracy was evaluated using the receiver operative characteristic (ROC) curve method to obtain the area under the curve (AUC) and diagnostic 2 x 2 table to determine the cutoff point, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). During phase III of the study, eligible individuals were screened for MDD using the NDDI-E Indonesian version. Demographic and clinical data were collected. Data analysis was performed using the χ² test, Mann-Whitney test, and multivariate logistic regression analysis.

Results: A total of 105 individuals were involved, and only 23 of them were found to experience MDD based on MINI ICD-10. The best cutoff point for the NDDI-E Indonesian version was ≥11, with a sensitivity of 91.3%, specificity 89%, PPV 70%, and NPV 97.3%. The AUC obtained from ROC analysis was 97.5% (95% CI 95-99%, p < 0.001). Then, the survey was completed by 79 individuals, predominantly male, mostly within the age range of 26-45 years. The prevalence of MDD in PWE was 50.6%, and the significant risk factors were seizure frequency ≥8 times a year and the presence of chronic diseases (p < 0.001).

Discussion: The NDDI-E Indonesian version was a screening tool with a high diagnostic accuracy to detect MDD in PWE at a cutoff point of 11. Poor seizure control and the presence of other chronic diseases were the risk factors correlated with MDD development in PWE.