Association of depression and epilepsy in rural northern Rwanda: a prospective longitudinal study with a patient-centered approach

Introduction Depression is the most frequent co-morbidity in persons living with epilepsy (PwE). In Rwanda, the prevalence of epilepsy ranges between 2.9 and 7.6% and the prevalence of any depression in PwE is more than 22%. This prospective interventional patient-centered study determined incidence and prevalence of depression in PwE and clinical outcomes of moderate to severe depression (MSD) in three rural sectors in Northern Rwanda. Methods PwE were enrolled between June 2018 and December 2018. At each three-monthly study visit, PwE were screened for depression with Patient Health Questionnaire-9 (PHQ-9). If positive, the Hamilton Depression Rating Scale (HDRS) was administered to quantify severity of depressive symptoms and confirm diagnosis of depression. PwE with MSD (PwED) were provided anti-depressants and followed for one year. Patient-centered interventions addressing social determinants of mental health were adopted. Results Of 304 PwE enrolled, 25 (8.2%) presented MSD during the study. At baseline. Prevalence of any depression and MSD was 27% and 4.3%. respectively. Incidence of any depression or MSD was 245 and 48/1.000 patient-years, respectively. Seizure frequency improvement was observed in both groups. HDRS scores for PwED were significantly reduced from 22.8 at baseline to 7.9 at 12-months follow-up. Access to dedicated epilepsy nursing staff and medication, psycho-education and income-generating initiatives proved beneficial. Conclusions Kinyarwanda PHQ-9 and HDRS versions were successfully deployed for screening and diagnosing depression symptoms in PwE in rural settings. Treatment of epilepsy and co-morbid depression improved clinical outcomes. Implementation of depression screening in routine health practice in Rwanda is warranted.