In the U.S., about one million people with active epilepsy are adults aged 55+. Older adults with epilepsy (OAWE) experience complex health conditions that compromise quality of life (QOL). The contribution of depressive symptom dimensions to health-related QOL remains underexplored in OAWE. We analyzed baseline data from 13 epilepsy self-management studies in the CDC-sponsored MEW-DB (Managing Epilepsy Well Database), including adults ages 55 and older (N = 198). The primary outcome was health-related QOL, assessed via the 10-item Quality of Life in Epilepsy scale (QOLIE-10), which was inverse rank normalized (mean = 0, SD = 1). Primary predictors included the Patient Health Questionnaire (PHQ-9) total score, cognitive and somatic symptom sub scores, and suicide ideation. Multivariable mixed-effects linear regression was used to assess associations. Models included a random intercept for originating study. Participants were x̄ = 60.8 years (range: 55-79); 60.6% female and 68.7% White. On average, participants had mild depressive symptoms (mean PHQ-9 = 8.3). Depressive symptom severity was significantly associated with worse QOL. Cognitive (β = 0.17 SD, 95% CI: 0.12-0.21, p = 5.6 × 10^-13), somatic (β = 0.19 SD, 95% CI: 0.14-0.23, p = 3.3 × 10^-17), and total depressive (PHQ-9 total) symptoms (β = 0.10 SD, 95% CI: 0.08-0.12, p = 3.8 × 10^-21) were associated with worse QOLIE-10 total scores when adjusting for likely confounders. Suicide ideation was not associated with QOLIE-10 (β = 0.07 SD, 95% CI: -0.15 to 0.29, p = 0.51). Past 30-day seizure occurrence was associated with worse total QOLIE-10 only when depressive terms were excluded from the multivariable model (β = 0.38 SD, 95% CI: 0.05-0.72, p = 0.024). Among OAWE, depressive symptoms are strongly linked to reduced QOL. These findings underscore the importance of integrated mental health screening and intervention for OAWE.

Objective: Smoking has been associated with psychiatric and somatic comorbidities in bipolar disorder (BD) populations. However, studies in older age BD (OABD) populations are sparse. We hypothesized that among individuals with OABD, current and former smokers would have worse psychiatric and somatic comorbidities parameters compared to never smokers. Method: Our study used baseline cross-sectional data from 27 international studies reporting data on adults 50 years old and older ( N = 984). Smoking status was categorized into current smokers, former smokers, and never smokers. The distribution of demographic and clinical variables was assessed. The associations between smoking status and the clinical variables were examined using multivariable models that adjusted for age, sex, and study. Multivariable models were repeated, restricting to individuals with and without cardiovascular or respiratory (cardiorespiratory) comorbidity. Results: Our study sample was 52.8% female with a mean age of 62 years and included 347 (35.3%) never smokers, 222 (22.6%) former smokers, and 415 (42.2%) current smokers. After controlling for age, sex, and study, current depression was more prevalent in former versus never smokers and current versus never smokers. Cardiovascular comorbidity was more prevalent among former than never smokers. More current versus never smokers were taking antipsychotic medications and more current versus never smokers having lifetime substance use disorders. When stratifying by the presence of cardiorespiratory comorbidity, the only statistically significant association was higher functioning in never versus current smokers in participants without cardiorespiratory comorbidity, though non-statistically significant relationships were present between lifetime smoking and depression across strata. Conclusions: The relationship of smoking with depression and substance use disorders is largely independent of age, sex, and, for the depression relationship, cardiorespiratory comorbidity. More smokers taking antipsychotic medications suggests that smoking is associated with a more severe BD course. Cardiovascular comorbidity may serve as a motivating factor for smoking cessation.

Objective: Few studies have simultaneously addressed self-management of cardiovascular disease and mental health in Black women at cardiovascular risk. This 24-week pilot prospective crossover randomized-controlled trial tested TEAM-Red, a 5-session, biweekly, nurse and peer-educator remotely delivered group self-management intervention for young Black women, compared to an enhanced waitlist control (eWL) group. Methods: The TEAM-Red intervention, adapted from an evidence-based program and culturally tailored based on stakeholder input, enrolled 50 depressed Black women ages 18-49 with at least one risk factor for hypertension. Participants were randomized to TEAM-Red (n = 25) or eWL (n = 24) and assessed at screening, baseline, 12 weeks, and 24 weeks. Those in eWL crossed over to receive TEAM-Red at 12 weeks and all participants were followed to 24 weeks. The primary goal was acceptability and feasibility. The primary outcome was change in depression severity from baseline to 12 weeks assessed by the 9-item Patient Health Questionnaire (PHQ-9). Secondary outcomes were perceived stress, mental health quality of life, diet quality, energy expended, social support, hypertension knowledge, and alcohol use. Results: Among women depressed at baseline (N = 31), TEAM-Red participants had 17.1 times higher odds of depression remission at week 12 (OR = 17.14, 95% CI: 1.78, 164.97; P = .014). At 12 weeks, TEAM-Red participants also showed significantly lower PHQ-9 scores ( P = .042), improved diet quality ( P = .025), higher mental health quality of life ( P = .032), and reduced perceived stress ( P = .038) compared to those in the eWL. Treatment satisfaction and engagement in the intervention group was high (89% found it useful), with 22% attrition. Conclusions: The TEAM-Red intervention demonstrated significant clinical benefits with a 17-fold higher odds of depression remission and meaningful improvements in mental health quality of life, diet quality, and perceived stress compared to controls. Despite limitations including small sample size and short follow-up period, this culturally tailored intervention showed promise for reducing cardiovascular risk and improving mental health outcomes in young Black women at risk for hypertension. These results need replication in a larger sample as part of a fully powered trial.

This report describes implementation of the SMART epilepsy self-management (ESM) program in a community setting. SMART was implemented by 3 epilepsy-focused social services agencies. Pre/Post outcomes included past 30-day seizure frequency, the 9-item Patient Health Questionnaire (PHQ-9), the 10-item Quality of Life in Epilepsy (QOLIE-10) and the 7-item Generalized Anxiety Disorder (GAD-7) scale. There have been 8 nurses (mean age 63.6, SD 9.1) and 14 peer educators trained (mean age 44.3, SD 15.8, having epilepsy a mean of 18.2, SD 11.1 years). Mean number of SMART sessions attended (out of a maximum of 8) was 5.7, SD 2.2. Sample means on PHQ-9 (pre 8.0 (SD 5.4) vs. post 7.3 (SD 5.0), p = 0.026) and on QOLIE-10 (pre = 2.9 (SD 0.9) vs. post 2.6 (SD 0.9), p < 0.007) significantly improved while change in GAD-7 and in past 30-day seizure frequency were not significant. Substantial proportions had social determinant of health distress with 30.3 % (n = 27) having housing insecurity, 44.9 % (n = 40) having food insecurity, 43.8 % (n = 39) transportation problems, 74.2 % (n = 66) with financial strain, 41.6 % (n = 37) with problems in activities of daily living and 23.6 % (n = 21) experiencing physical violence. Individuals who attended no sessions were more likely to be non-White (P = 0.017), have less than high school education (P = 0.061) and are less likely to have mental health diagnoses (P = 0.006) CONCLUSIONS: Epilepsy-focused social services agencies can successfully implement ESM. Agency experience could help other social services agencies in adopting ESMs to support clients with epilepsy.

Background: Comorbid substance use disorder (BD-SUD) is common among individuals with bipolar disorder (BD) and is associated with worse clinical outcomes. This study compares differences in medication adherence, adherence barriers, and symptom severity of individuals with BD-SUD based on diagnostic status (current, past, or none). Methods: This interim analysis utilized screening and baseline data from a 12-month randomized controlled trial comparing adherence interventions among poorly adherent individuals with BD. Patients were recruited from public mental health settings and met strict diagnostic and symptom criteria. Results: From the study sample ( N = 129; M _age = 42.18; SD _age = 13.04), no significant sociodemographic differences were found. Individuals with BD and current substance use disorder reported significantly higher rates of problematic substance use and motivation to reduce such use compared to the other groups. No other differences were found. Conclusions: Comorbid substance use disorder is common among individuals with bipolar disorder and often associated with poor outcomes. In this baseline, cross-sectional analysis, minimal differences were observed across varying BD-SUD status. Longitudinal analyses will be important for clarifying whether adherence and related outcomes differ over time across BD-SUD groups.

To examine longer-term outcomes following completion of the SMART self-management intervention among people with epilepsy (PWE), with a focus on whether seizure frequency and psychosocial outcomes remained stable beyond the initial 6-month randomized trial period. The sample comprised 63 PWE who were assigned to the SMART intervention group. The primary outcome was change in seizure count from 6 to 12- and 18-months post-intervention. Secondary outcomes included changes in depression, functional status, quality of life, epilepsy self-management competency, epilepsy stigma, social support and self-efficacy assessed respectively with the PHQ-9, SF-36, QOLIE-31, ESMS, ESS, MSPSS, and ESES. Associations between SMART session attendance and outcomes were also evaluated. Among PWE who received the SMART intervention (mean age 39.1 ± 11.6 years; mean epilepsy onset 25.1 ± 15.4 years; 11.1% rural), no significant changes were observed in seizure counts or psychosocial measures between 6 and 12 or 18 months (all p > 0.05), indicating descriptive consistency of outcomes during extended follow-up. Higher engagement in SMART groups (attending ≥7/8 sessions) was associated with higher ESMS and MSPSS scores at 6 months (p = 0.034), ESMS (p = 0.015) and MSPSS (p < 0.006) at 12 months, and ESMS at 18 months (p = 0.048) versus low session attendance (< 7/8 sessions). These findings provide preliminary evidence that improvements in clinical and psychosocial outcomes observed at the end of the SMART intervention did not measurably change 18 months post-intervention. Higher SMART session attendance was associated with greater improvements with self-management skills (ESMS) and social support (MSPSS). Conclusions regarding long-term benefit should be interpreted as descriptive and exploratory given the post hoc design, modest sample size, and non-randomized attendance. The results support further investigation of strategies to enhance engagement and to evaluate the long-term role of self-management interventions as part of comprehensive epilepsy care.