Depression and anxiety diagnosis and treatment rates among subgroups of people with epilepsy.

BACKGROUND: People with epilepsy (PWE) experience higher rates of depression and anxiety than the general population, but racial and ethnic differences in mental health diagnoses and treatment within PWE are not well characterized. OBJECTIVE: To evaluate racial and ethnic disparities in depression and anxiety diagnoses, antidepressant use, and drug-resistant epilepsy (DRE) designation among adults with epilepsy compared to White, non-Hispanic PWE. METHODS: This retrospective cohort study from the All of Us database included 6,337 PWE. Multivariate logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs), using White, non-Hispanic PWE as the reference group. Chi-square tests were used for unadjusted comparisons among participants with DRE. RESULTS: Compared to White, non-Hispanic PWE, Black, non-Hispanic PWE were less likely to be diagnosed with depression (lifetime: aOR 0.84 [95% CI, 0.71-0.99]; within one year: aOR 0.77 [0.61-0.96]) or anxiety (lifetime: aOR 0.61 [0.51-0.74]; within one year: aOR 0.64 [0.54-0.75]). Hispanic PWE were less likely to be diagnosed with anxiety within one year of epilepsy diagnosis (aOR 0.82 [0.68-0.99]) and to receive antidepressant therapy (aOR 0.71 [0.56-0.89]). DRE was defined as more than two antiseizure medications prescribed each for at least six months after initial epilepsy diagnosis. Black, non-Hispanic (χ2 = 6.45; p = 0.011) and Hispanic PWE (χ2 = 17.4; p < 0.001) were less likely to meet our DRE criteria. DRE was associated with higher rates of depression, anxiety, and antidepressant use (all p < 0.001). CONCLUSIONS: Racial and ethnic disparities exist in mental health diagnoses, treatment, and DRE designation among PWE, highlighting the need for more equitable screening and care.