Innovative EHR-Based Strategy Enhances Anxiety and Depression Screening in Epilepsy Patients
In a groundbreaking study recently published in the Journal of Clinical and Translational Science, researchers at Wake Forest University School of Medicine have demonstrated a significant improvement in anxiety and depression screening rates among epilepsy patients through the implementation of an electronic health record (EHR)-based strategy. This advancement represents a critical step towards integrating mental health assessments into routine epilepsy care, addressing a long-standing gap in comprehensive clinical management.
Epilepsy, a complex neurological disorder characterized by recurrent seizures, frequently coexists with psychiatric comorbidities such as anxiety and depression. These mental health conditions are known to be underdiagnosed and undertreated in this population, despite their profound impact on quality of life and seizure control. Patients with epilepsy are estimated to have a two to fivefold increased risk of developing anxiety and depression compared to the general population, necessitating systematic screening protocols within epilepsy clinics.
The investigative team, led by Dr. Heidi Munger Clary, associate professor of neurology, harnessed the capabilities of the Atrium Health Wake Forest Baptist’s Comprehensive Epilepsy Center’s EHR system to integrate standardized screening tools that identify symptoms of anxiety and depression. By embedding these tools into the clinical workflow at patient check-in, support staff could administer and record screening instruments efficiently, with minimal disruption to clinic operations.
Quantitative analysis revealed that the screening rate for anxiety and depression nearly doubled, increasing from a baseline of 12.6% to 29.2% of total clinic visits following the intervention. This sizable improvement underscores the feasibility and effectiveness of leveraging existing health information technology systems and personnel to enhance mental health surveillance in a specialized neurological setting.
Further analysis uncovered demographic nuances influencing screening uptake. Younger patients, averaging 39.3 years of age, were more likely to complete the screening tools than their older counterparts, whose mean age was approximately 43.4 years. Moreover, patients identifying as white demonstrated higher screening completion rates relative to other racial and ethnic groups, highlighting crucial disparities that warrant targeted interventions to ensure equitable access to mental health assessment.
Dr. Munger Clary emphasized the practicality of this method, noting that the implementation required only three to four clicks by support staff within the EHR platform, making it a scalable model for other epilepsy centers. Notably, the investigators employed the RE-AIM framework—encompassing Reach, Effectiveness, Adoption, Implementation, and Maintenance—to guide and evaluate the implementation process rigorously and systematically.
Despite these advancements, challenges remain. The clinic workflow can be interrupted by the screening process, and time constraints continue to hinder universal completion rates. The research team suggests exploring abbreviated screening instruments and facilitating pre-visit questionnaire completion through patient portals or mobile applications as promising approaches to mitigate these barriers.
The study’s technical import is enhanced by its grounding in theory-based implementation science, combining both behavioral and organizational change methodologies. This approach enables a nuanced understanding of the interplay between clinical staff behaviors, technology integration, and patient engagement, fostering sustainable improvements in clinical practice.
Financial and infrastructural support for this project was robust, with funding from the National Institutes of Health and the Agency for Healthcare Research and Quality, which helped develop specific EHR tools tailored to the epilepsy clinic’s requirements. These resources were instrumental in transforming screening from a sporadic, clinician-dependent task into a structured, technologically facilitated process.
Furthermore, this research adds to a growing body of evidence asserting the critical need for integrated care models in neurology that competently address not only physiological markers like seizures but also the psychological well-being of patients. The results represent a paradigm shift in epilepsy care, encouraging multidisciplinary collaboration and leveraging digital health technologies to optimize patient outcomes.
Looking ahead, the research team is poised to investigate targeted strategies to eliminate demographic disparities in screening and to evaluate the longitudinal impact of improved mental health detection on seizure management and overall patient prognosis. They envision a future where EHR systems not only support efficient data capture but also provide decision support to clinicians for timely intervention.
The clinical implications of this study resonate widely in the fields of neurology and psychiatry, advocating for policy changes that endorse routine mental health screening as a standard of care in epilepsy clinics. Given that anxiety and depression substantially contribute to morbidity and healthcare utilization in epilepsy, their systematic detection and treatment could ultimately reduce the disease burden.
This pioneering research encapsulates the dynamic potential of marrying technology with clinical insight to innovate patient care pathways. By enhancing screening rates through a pragmatic, scalable approach, Wake Forest University researchers have set a new benchmark for epilepsy centers striving to provide holistic and equitable healthcare services.
Subject of Research:
Screening for anxiety and depression in epilepsy patients using an electronic health record-based implementation strategy.
Article Title:
Implementing electronic health record-based anxiety and depression screening in an epilepsy clinic: Theory-based implementation strategy and pre-post quantitative outcomes using Reach, Effectiveness, Adoption, Implementation, and Maintenance
News Publication Date:
May 21, 2025
Web References:
Wake Forest University School of Medicine: https://school.wakehealth.edu/
Journal of Clinical and Translational Science article: https://www.cambridge.org/core/journals/journal-of-clinical-and-translational-science/article/implementing-electronic-health-recordbased-anxiety-and-depression-screening-in-an-epilepsy-clinic-theorybased-implementation-strategy-and-prepost-quantitative-outcomes-using-reach-effectiveness-adoption-implementation-and-maintenance/DC7330DE4AC9D79B11415359C7667105
DOI link: http://dx.doi.org/10.1017/cts.2025.74
Keywords:
Epilepsy, neurological disorders, anxiety, depression, mental health, seizures, electronic health records, implementation science, screening, integrated care
Tags: anxiety and depression in epilepsy patientscomprehensive epilepsy managementEHR-based mental health screeningimpact of anxiety on seizure controlimproving quality of life for epilepsy patientsinnovative approaches in epilepsy careintegration of mental health assessmentsneurology and mental health integrationpsychiatric comorbidities in epilepsysystematic screening protocols for epilepsyunderdiagnosed mental health conditionsWake Forest University epilepsy research
