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UCL Great Ormond Street Institute of Child Health

Great Ormond Street Institute of Child Health

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PhD Studentship in Paediatric Mental Health

Mental health treatment for children with epilepsy: outcomes for education, health and parents

Hypothesis and/or Aims:

The aim of the research is to investigate the wider outcomes of intervention for mental health disorders in children with epilepsy compared to usual care. Specifically, we will investigate the impact of the intervention being investigated in the NIHR funded Mental Health Intervention for Children with Epilepsy (MICE) trial on school attainment, parental mental health and health outcomes in later life.

We hypothesise that treating mental health conditions in children with epilepsy will have a positive impact on:

  1. Educational attainment
  2. Parental mental health
  3. Longer-term physical health outcomes indexed by fewer hospital admissions

6-12 month plan (eg experimental approaches, data collection, preliminary analyses):

We aim to recruit 334 children and young people to the MICE trial. Participants consent to data linkage during the informed consent process prior to trial randomisation. Working with the leading centre for data science and linked administrative data analysis for child health in the UK, the student will link and analyse the MICE trial outcome data on child and parent mental health with national databases. Parental mental health data are being collected at baseline, 6 months and 12 months post-randomisation.

Databases

Hospital Episode Statistics (HES) - HES is the national hospital database for England. It contains longitudinal data on all admissions to NHS hospitals, Accident and Emergency (A&E) attendances and outpatient bookings.

National Pupil Database (NPD) - The NPD holds data on all children in state primary and secondary schools (93% of all school children in England). The NPD contains pupil-level information on school test results (early years foundation stage (EYFS) profiles, key stages (KS) and phonics), special educational needs (SEN) provision, and school-level information including religious character and size.

Data linkage

Trial outcome data will be linked to: education data (NPD; Aim 1) using name, date of birth, sex and postcode; parental mental health data (Aim 2) using trial participant number; and to health data (HES; Aim 3) using NHS number.

Hypothesis 1: We will compare educational outcomes from the NPD for those undertaking the MICE intervention compared to those randomised to receive usual care alone. We will investigate the extent to which their mental health outcome is associated with educational outcomes.

Hypothesis 2: The primary outcome is the difference in the total score on the Patient Health Questionnaire-9 (PHQ9 - a 9-item measure of depression severity) and Generalised Anxiety Disorder 7-item (GAD7 – a 7-item measure of anxiety severity) at 6-months post-randomisation between the intervention group and the control group. If the intervention is effective, we would expect to see a reduction in the total scores (higher total difficulties score indicates greater symptoms of depression or anxiety).

Hypothesis 3: Our outcomes will be A&E attendance and emergency hospital admission rates from HES. We will use appropriate statistical models, such as proportional hazard regression models, to examine whether children who have completed the MICE intervention are less likely to experience hospital admission or A&E attendance compared to other children.

Timeline:

Apr 2021:                              Final participants recruited to trial.

Apr 2021 - Apr 2022:       Ph.D. student attends courses on data linkage, Development of Statistical Analysis Plan (SAP), Ethics, preliminary cleaning and preparation of data and databases; systematic reviews of literature relating to outcomes, application for data linkage.

Apr 2022:                              Final follow-up data collected for all trial participants.

Apr 2022 – Oct 2022:            Data cleaned and databases prepared

Oct 2022 – Oct 2023:            Statistical analysis (4 months for each hypothesis)

Oct 2023 – Apr 2024:            Write-up and dissemination

Ethics Approval:

The MICE trial has received ethical approval from the South Central - Oxford A Research Ethics Committee (REC Reference: 18/SC/0250). This includes specific approval for linkage with national datasets.

References:

  1. Shafran, R., Bennett, S., Coughtrey, A., Welch, A., Walji, F., Cross, J. H., ... & Dalrymple, E. (2020). Optimising Evidence-Based Psychological Treatment for the Mental Health Needs of Children with Epilepsy: Principles and Methods. Clinical Child and Family Psychology Review, 1-12.
  2. Asato, M. R., Caplan, R., & Hermann, B. P. (2014). Epilepsy and comorbidities—what are we waiting for? Epilepsy & Behavior, 31:127-8.
  3. Ott, D., Siddarth, P., Gurbani, S., Koh, S., Tournay, A., Shields, W. D., & Caplan, R. (2003). Behavioral disorders in pediatric epilepsy: unmet psychiatric need. Epilepsia, 44(4), 591-597.
  4. Reilly, C., & Neville, B. G. (2011). Academic achievement in children with epilepsy: a review. Epilepsy Research, 97(1-2), 112-123.
  5. Jones, C., & Reilly, C. (2016). Parental anxiety in childhood epilepsy: a systematic review. Epilepsia, 57(4), 529-537.