Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs

Abstract

A screening programme designed to identify cases of Major Depressive Disorder (MDD) in patients attending a Regional Cancer Centre outpatient department was established. It comprised two stages: (1) The Hospital Anxiety and Depression Scale (HADS) selfrating questionnaire administered by a touch-screen computer; (2) we interviewed patients with high scores on the HADS (15 or more total score) over the telephone using the depression section of the Structured Clinical Interview for DSMIV (SCID). A large consecutive sample (5613) of oncology clinic attenders was screened, and practical difficulties in the screening process were identified. The estimated prevalence of major depressive disorder (MDD) in the sample surveyed was approximately 8% (7.8%; 95% confidence intervals 6.9 -8.5%). We assessed a consecutive series of 150 patients identified as having MDD to determine how many had received evidence-based treatment for MDD. Only half had discussed their low mood with their general practitioner, only onethird had been prescribed any antidepressant medication, and very few had taken a therapeutic dose for an adequate period. Very few had received psychological treatment or had been referred to mental health services. Most were receiving no potentially effective therapy.

Evaluation of screening instruments for depression and anxiety in breast cancer survivors

“…The point prevalence of depression among this group of breast cancer survivors is much lower than reported in some previous studies [20], but at 9%, it is in line with rates in primary care settings of 5-10% [21] and rates reported in some studies of cancer outpatients [3,22]. There is some evidence that after an initial rise, the prevalence of depression decreases over time following the diagnosis of breast cancer [1].…”

“…The EDS has not yet been validated as a screen for psychological distress and there are limited studies on HADS-T. Where studies on the use of HADS-T to screen for anxiety and depression exist, there is no consistent definition for 'psychological distress', with some studies incorporating all psychiatric disorders and others taking a narrower view. In practice [3], tests which screen for a variety of psychiatric problems are likely to be more useful in follow-up patient care. On this basis, the use of the HADS-T and the EDS to screen for psychological distress can be recommended above their use to screen for depression alone, although the appropriate cut-off scores would need to be validated with a consistent definition of psychological distress in a larger population.…”

“…Depression is more than three times as likely to occur in women when first diagnosed than in the general population, but levels among women in remission from breast cancer have been found to be comparable to those of the general female population [1,2]. As the likelihood a patient will suffer from depression decreases, efforts to identify new cases can move down the agenda of patient care and it has been suggested that in focusing on the medical management of a patient's cancer, the psychological aspects may be neglected [3]. There is evidence that the relative risk of suicide is significantly raised even years after the disease has been treated [4].…”

Antidepressant use and risk of central nervous system metastasis

“…Interestingly, a study by Sharpe et al [245] found only 49% of patients identified as having major depressive disorder reported speaking to their doctors about depression, and only 15% of all patients identified as having major depressive disorder received a potentially effective evidence-based treatment such as a therapeutic dose of antidepressants or formal psychological treatment.…”

Management of major depression in outpatients attending a cancer centre: a preliminary evaluation of a multicomponent cancer nurse-delivered intervention

“…Hospital Anxiety and Depression Scale (HADS) (Zigmond and Snaith, 1983): Anxiety and depressive symptoms were assessed with this 14-item self-rated scale designed for use in the medically ill (see companion paper Sharpe et al, 2003). (Harrison et al, 1994): Patient's concerns were rated using this 14-item checklist, each concern being rated on a five-point scale from 'not a worry' to 'extremely worried'.…”