PEARLS depression treatment for individuals with epilepsy: A randomized controlled trial
Abstract
Objective Depression is associated with higher rates of suicide and lower levels of functioning and quality of life in individuals with epilepsy. The objective of this randomized controlled trial was to determine the effectiveness of PEARLS, a home-based program for managing depression in adult individuals with epilepsy and clinically significant acute and chronic depression.Methods Delivered by masters-level counselors, PEARLS is a collaborative care intervention consisting of problem solving treatment, behavioral activation, and psychiatric consultation. Patients were randomly assigned to the PEARLS intervention (N = 40) or usual care (N = 40), and assessed at baseline, 6 months, and 12 months.Results Compared with patients who received usual care, patients assigned to the PEARLS intervention achieved lower depression severity (P<0.005) (Hopkins Symptoms Checklist-20) and lower suicidal ideation (P = 0.025) over 12 months.Conclusions The PEARLS program, a community-integrated, home-based treatment for depression, effectively reduces depressive symptoms in adults with epilepsy and comorbid depression.
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Severity of depressive symptoms was used as an inclusion criterion in 5 studies (21%).
“Severity of depressive symptoms was used as an inclusion criterion in 5 studies (21%; see Table 1). 26,27,29 -32”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
The remaining 7 studies (29%) employed a usual care (UC)/treatment as usual (TAU) control group.
“The remaining 7 studies (29%) employed a usual care (UC)/treatment as usual (TAU) control group. 26,27,31,41,44,48 -50”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
Six interventions (25%) were delivered through individual sessions.
“6 interventions (25%) were delivered through individual sessions, 9,15,26,27,43,44,48”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
Four studies (17%) were rated as high ROB due to evidence of selective outcome reporting within the publications.
“Four studies (17%) 26,27,29,31,41 were rated as high ROB due to evidence of selective outcome reporting within the publications.”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
Eight studies (33%) were rated as low risk for attrition bias as there was only a small number of missing data, which were balanced across the groups with justifiable reasons.
“Eight studies (33%) 27,29,36,38,39,44,48,49 were rated as low risk as there was only a small number of missing data, which were balanced across the groups with justifiable reasons.”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
QOLIE-31/31-P/-89 was used in 17 studies (71%), of which 12 (70%) were considered for meta-analyses due to satisfactory methodological homogeneity.
“It was used in 17 studies (71%), of which 12 (70%) were considered for meta-analyses due to satisfactory methodological homogeneity. 26,27,29,30,33,36,37,41,46,47,49,50”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
Three studies (12%) provided details regarding the attempt to ensure fidelity to the intervention protocol by employing standard training protocols and supervision.
“Three studies (12%), however, provided details regarding the attempt to ensure fidelity to the intervention protocol by employing standard training protocols and supervision. 26 -28,31”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
The meta-analysis comprised data from 9 studies (37%) with a total of 468 participants.
“Consequently, the meta-analysis comprised data from 9 studies (37%) 26 -30,33,36,46,49,50 with a total of 468 participants (see studies highlighted in gray in Table 1).”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
The risk of infidelity to the intervention protocol was considered to be relatively low whenever the therapist delivering the intervention coincided with the developer of the intervention protocol (n = 6, 25%).
“Furthermore, the risk of infidelity to the intervention protocol was considered to be relatively low whenever the therapist delivering the intervention coincided with the developer of the intervention protocol (n = 6, 25%) 25 -27,34,46,48,49”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
Ciechanowski et al. reported a significantly smaller proportion of patients reporting suicidal ideation at follow-up (decreasing 24% in the intervention group and increasing 12% in the usual care group [P = .025]; posttreatment outcomes were not reported).
“Ciechanowski et al. 27 reported a significantly smaller proportion of patients reporting suicidal ideation at follow-up (decreasing 24% in the intervention group”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
Seven studies (64%) reported a significant postintervention difference between the intervention and the control groups for depressive symptoms.
“Seven studies (64%) reported a significant postintervention difference between the intervention and the control groups. 26 -29,31,32,36,46”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
Five studies (55%) found no significant differences between the treatment and control groups in seizure frequency.
“whereas the other 5 studies (55%) found no significant differences between the groups. 26,27,33,35,38,42”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [27]
Studies of treatment interventions using standard CBT protocols for depression and/or anxiety in LTCs report low levels of engagement.
“Studies of treatment interventions using standard CBT protocols for depression and/ or anxiety in LTCs report low levels of engagement with these interventions (Ciechanowski et al . 2010; Coventry et al . 2015).”
From Improving Distress in Dialysis (iDiD): A tailored CBT self-management treatment for patients undergoing dialysis. (2016) · cites this paper as Ciechanowski et al . 2010
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- Authors
- Ciechanowski, P., Chaytor, N., Miller, J., Fraser, R., Russo, J., Unutzer, J., & Gilliam, F.
- Affiliations
- University of Washington (US)
- Geisinger Health System (US)
- Corresponding author
- Ciechanowski, Paul
- Venue
- Epilepsy & Behavior
- Publisher
- Elsevier BV
- Published
- 2010-11
- Volume
- 19
- Issue
- 3
- Pages
- 225-231
- ISSN
- 1525-5050 (ISSN-L)
- OpenAlex
- W1998614246
- Cited by
- 130
- References
- 43
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 9 · 2021: 10 · 2020: 8 · 2019: 12 · 2018: 11 · 2017: 9 · 2016: 8 · 2015: 11 · 2014: 7 · 2013: 9 · 2012: 11
- FWCI
- 12.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Epilepsy & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Washington
- Centers for Disease Control and Prevention
- National Institute of Neurological Disorders and Stroke (K24NS047551, R01NS040808)
- National Center for Chronic Disease Prevention and Health Promotion (U48-DP000050)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, epilepsy, pearls, home-based therapy, collaborative care, problem-solving therapy, behavioral activation, psychiatric consultation, suicidal ideation, comorbid depression
- MeSH terms
- Adult, Antidepressive Agents, Community Health Services, Depression, Epilepsy, Female, Follow-Up Studies, Home Care Services, Humans, Male, Middle Aged, Time Factors, Treatment Outcome, Patient Satisfaction, Checklist
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