Adaptive mental health screening in Veterans admitted to an epilepsy monitoring unit

Abstract: OBJECTIVE: To describe and characterize results from Computer Adaptive Testing (CAT) and Computer Adaptive Diagnosis (CAD) mental health instruments administered to a sample of Veterans admitted to an Epilepsy Monitoring Unit (EMU). METHOD: Forty-two Veterans admitted to a large urban VA Medical Center in the Pacific Northwest for overnight epilepsy monitoring completed tablet-administered CAT measures for depression, anxiety, posttraumatic stress, mania/hypomania, psychosis, substance use disorder risk, and suicide risk, along with CAD screenings for Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD). The Minnesota Multiphasic Personality Inventory-2-Restructuered Form (MMPI-2-RF) was also administered to assess symptom validity. Patients were diagnosed with epileptic seizures (ES), psychogenic nonepileptic seizures (PNES), mixed ES/PNES, other seizure-related disorder, or had a non-diagnostic evaluation. RESULTS: Most patients reported at least mild symptoms of depression (73.8%), anxiety (61.9%), and/or posttraumatic stress (64.1%). More than half (57.1%) screened positive for MDD, and 23% screened positive for PTSD. Approximately 41% endorsed mild or greater psychotic symptoms. About 36% of patients were at intermediate or high risk for substance use disorder, and 56.3% were at intermediate or high risk for suicide. Analysis of symptom validity suggested 7-24% of patients demonstrated likely noncredible responding on the MMPI-2-RF. CONCLUSIONS: Veterans undergoing EMU evaluation demonstrate a high prevalence of mental health symptoms. Tablet-administered CAT and CAD instruments provide an efficient screening method for psychiatric distress. Findings highlight the importance of routine mental health assessment, appropriate treatment planning, and safety monitoring for patients in the EMU.