The Phenomenology and Screening of Clinical Depression in Cancer Patients

Abstract

Clinical depression is the most common psychiatric disorder among cancer patients and is associated with significant functional impairment. Unfortunately, depression in cancer patients is often under- diagnosed and untreated, and studies examining the predictive utility of assessment instruments in detecting clinically depressed cancer patients are sparse. Using a structured interview, thirty-three patients with various cancer types were diagnosed as having major depression (n = 24) or no psychiatric diagnosis (n = 9). All patients were administered the Beck Depression Inventory-II (BDI-II), the Center for Epidemiological Studies in Depression Scale (CES-D), Hamilton Rating Scale for Depression (HRSD), Quality of Life Inventory (QOLI), a medical and psychosocial functioning questionnaire (SF-36), and given co-morbidity of depression with anxiety disorders, the Beck Anxiety Inventory (BAI). Depressed and non-depressed cancer patients were compared and contrasted across all assessment measures and accuracy of instruments was based on evaluating their sensitivity, specificity, and positive predictive values. Depressed cancer patients exhibited more severe depressive symptoms and poorer quality of life, increased anxiety and bodily pain, and decreased vitality and social functioning. All instruments exhibited strong predictive properties, with the CES-D and BDI-II considered most feasible given their time efficiency, administrative simplicity, and strong psychometric properties.

A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses

“…However, its criterion validity has been evaluated in only two, smallscale studies focusing exclusively on major depression [34,56]; in one of these, its specificity was inferior to that of the HADS-T (see Table 10 above). Future studies are needed to evaluate the validity of items assessing problems with sleep, appetite and concentration in samples on active treatment.…”

The Impact of Cognitive Interventions in Treating Depressed Breast Cancer Patients

“…The scale is a valid and reliable measure of life satisfaction (Frisch, 1999) and is sensitive to change following cognitive-behavioral therapy for depression (Hopko et al, 2008b). The measure also has been shown to effectively discriminate depressed (M = -1.0, SD = 1.3) from nondepressed (M = 2.3, SD = 1.6) cancer patients (Hopko et al, 2008a).…”

“…The instrument has adequate psychometric properties in clinical and nonclinical samples of adults (Stanley, Beck, & Zebb, 1998;Zimet et al, 1988) and has been shown to effectively discriminate depressed (M = 36.0, SD = 18.6) from nondepressed (M = 24.2, SD = 19.4) cancer patients (Hopko et al, 2008a).…”

“…Depression has a tremendous impact on the lives of cancer patients, and may include exacerbation of medical illness, increased anxiety and substance use (Baum & Andersen, 2001;Evans et al, 2005), and decreased quality of life, including recreational activities, social life, family relationships, self-care skills, physical activities, and sleep (Baum & Andersen, 2001;Ciaramella & Poli, 2001). Depressed cancer patients also may experience decreased immune system functioning, a more rapid progression of cancer symptoms, more metastasis and pain, and possibly increased mortality relative to non-depressed patients (Ciaramella & Poli, 2001;Hopko, 2008a;Spiegel & Giese-Davis, 2003).…”

Evaluación de la depresión en pacientes con cáncer terminal y su aplicación en el contexto mexicano: Una revisión

“…Sin embargo, al compararla con otros instrumentos, como el HADS, obtiene menores propiedades psicométricas, por lo que su uso se recomienda sólo parcialmente. 26,27 Otro instrumento utilizado es la escala de depresión posnatal de Edimburgo (EPDS) que está formada por 10 reactivos, los cuales se enfocan primordialmente a síntomas no físicos relacionados con la depresión post parto, por tal razón, se ha aplicado a población con cáncer terminal y ha mostrado en tres estudios una especificidad, sensibilidad, confiabilidad inclusive mayor que las reportadas en algunos trabajos que utilizan el HADS. No obstante los buenos resultados, son necesarios más estudios para recomendar ampliamente su uso.…”