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.