Primary care practice characteristics associated with the quality of care received by patients with depression and comorbid chronic conditions

Objective

This study aimed to identify primary care practice characteristics associated with the quality of depression care in patients with comorbid chronic medical and/or psychiatric conditions.

Method

Using data from cross-sectional organizational and patient surveys conducted within 61 primary care clinics in Quebec, Canada, the relationships between primary care practice characteristics, comorbidity profile, and the recognition and minimally adequate treatment of depression were assessed using multilevel logistic regression analysis with 824 adults with past-year depression and comorbid chronic conditions.

Results

Likelihood of depression recognition was higher in clinics where accessibility of mental health professionals was not viewed to be a major barrier to depression care [odds ratio (OR)=1.61; 95% confidence interval (CI) 1.13–2.30]. Four practice characteristics were associated with minimal treatment adequacy: greater use of treatment algorithms for depression (OR=1.77; 95% CI=1.18–2.65), high value given to teamwork (OR=2.48; 95% CI=1.40–4.38), having at least one general practitioner at the clinic devote significant time in practice to mental health (OR=1.54; 95% CI=1.07–2.21) and low perceived barriers to depression care due to inadequate payment models (OR=2.12; 95% CI=1.30–3.46).

Conclusions

Several primary care practice characteristics significantly influence the quality of care provided to patients with depression and comorbid chronic conditions and should be targeted in quality improvement efforts.     

Correlates of depressive symptoms among at-risk youth presenting to the emergency department

Objective

The study's objective was to identify correlates of depressive symptoms among at-risk youth in an urban emergency department (ED).

Method

A systematic sample of adolescents (ages 14–18) in the ED were recruited as part of a larger study. Participants reporting past-year alcohol use and peer aggression self-administered a survey assessing: demographics, depressive symptoms and risk/protective factors. Logistic regression identified factors associated with depressive symptoms.

Results

Among 624 adolescents (88% response rate) meeting eligibility criteria, 22.8% (n=142) screened positive for depressive symptoms. In logistic regression, depressive symptoms were positively associated with female gender [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.78–4.51], poor academic performance (OR: 1.57, 95% CI: 1.01–2.44), binge drinking (OR: 1.88, 95% CI: 1.21–2.91), community violence exposure (OR: 2.25, 95% CI: 1.59–3.18) and dating violence (OR: 2.14, 95% CI: 1.36–3.38) and were negatively associated with same-sex mentorship (OR: 0.52, 95% CI: 0.29–0.91) and older age (OR: 0.55, 95% CI 0.34–0.89). Including gender interaction terms did not significantly change findings.

Conclusions

Screening and intervention approaches for youth in the urban ED should address the co-occurrence of depressive symptoms with peer and dating violence, alcohol and nonmarijuana illicit drug use.     

Hospitalization,depression and dementia in community-dwelling older Americans: findings from the National Health and Aging Trends Study

Objective

The objective was to estimate the prevalence of both dementia and depression among community-dwelling older Americans and to determine if hospitalization is independently associated with dementia or depression in this population.

Method

This cross-sectional study utilized data from a nationally representative, population-based sample of 7197 community-dwelling adults ≥ 65 years old interviewed in 2011 as part of the National Health and Aging Trends Study. Information on hospitalizations was obtained from self- or proxy-report. Possible and probable dementia was assessed according to a validated algorithm. Depressive symptoms were assessed with the Patient Health Questionnaire-2.

Results

An estimated 3.1 million community-dwelling older Americans may have dementia, and approximately 5.3 million may have substantial depressive symptoms. After adjusting for demographic and social characteristics, medical diagnoses, smoking history, serious falls and pain symptoms, being hospitalized in the previous year was independently associated with greater odds of probable dementia (odds ratio [OR]: 1.42, 95% confidence interval [95% CI]: 1.16–1.73) and substantial depressive symptoms (OR: 1.60, 95% CI: 1.29–1.99).

Conclusions

Dementia and depression are common in community-dwelling older Americans, and hospitalization is associated with these conditions. Additional research increasing understanding of the bidirectional relationship between hospitalizations, dementia and depression, along with targeted interventions to reduce hospitalizations, is needed.     

Self-reported family history in estimating the risk of hormone,surgery and cast related VTE in women

Background

Combined hormonal contraceptives, menopause hormone treatment and surgery/cast in orthopedic patients are important risk factors for venous thromboembolism (VTE) in women.

Objectives

To evaluate whether self-reported family history can be used for risk assessment concerning hormone and surgery /cast related VTE in women.

Patients/methods

1288 women 18–64 years with a first event of VTE and 1327 age-matched controls were included in a nation-wide population-based case–control study in Sweden. Odds ratios were calculated by comparing occurrence of VTE in women with and without a positive family history in combination with hormones or surgery/cast.

Results

The risk of hormone-associated VTE was doubled in women with a family history of VTE as compared to women with hormones and negative family history. The risk was more than tripled in women with surgery/cast and a positive family history, as compared to surgery/cast patients with negative family history. Women with a positive family history and combined hormonal contraceptive or menopause hormone treatment had an OR of 15.3 (95% CI 6.1–38) and 5.9 (95% CI 3.3–11) respectively compared to women without hormones or family history. The corresponding OR in women with surgery/cast and a positive family history was 67 (95% CI 21–213) compared to women without surgery/cast treatment and a negative family history.

Conclusion

Self-reported family history is associated with increased odds of developing VTE on combined hormonal contraceptives, menopause hormone treatment and in connection with surgery or plaster. We believe that assessing family history of VTE can be helpful in identifying high risk patients.     

Peptic ulcer disease and mental illnesses

Objective

We evaluated the association between self-reported doctor-diagnosed peptic ulcer disease (PUD) and mental disorders in a representative cross-sectional study conducted in 2010 in Singapore.

Method

The sample comprised 6616 community-dwelling individuals. Participants were asked about a previous history of doctor-diagnosed PUD. Assessment of mental disorders was performed using the World Mental Health Composite International Diagnostic Interview version 3.0. Quality of life was assessed using the EuroQoL 5D.

Results

The weighted prevalence of PUD was 1.58% (95% CI=1.13–2.02). In adjusted analyses, PUD was more common among people with anxiety disorders [obsessive compulsive disorders (OR 4.22, 95% CI 1.59–11.21), Generalized Anxiety Disorders (OR 9.25, 95% CI 2.43-35.17), any anxiety disorders (OR 4.41, 95% CI 1.82-10.61)] and with any mood disorders (OR 2.66, 95% CI 1.08-6.53). PUD was associated with alcohol abuse and alcohol dependence, but not with smoking or nicotine dependence. Adjustment for nicotine and alcohol use attenuated the association of mood disorders with PUD, but not that of anxiety disorders. PUD was associated with reduced quality of life as measured on EuroQoL 5D, with further reduction in those with concomitant mental disorders.

Conclusion

PUD was associated with anxiety disorders, and this association is not attenuated with adjustment for nicotine dependence or alcohol use disorder.     

Diabetes and psychiatric illness in the total population of Stockholm

Objective

Concomitant psychiatric disorders in people with diabetes affect morbidity and mortality. We aimed to study psychiatric morbidity in people with diabetes and the general population using administrative health care data in Stockholm County.

Methods

The study population included all living persons who resided in Stockholm County, Sweden, on January 1, 2011 (N = 2,058,408). Subjects with a diagnosis of diabetes were identified with data from all consultations in primary health care, specialist outpatient care and inpatient care during the time span 2009–2013. As outcome, information was obtained on all consultations due to any psychiatric diagnosis as well as, specifically, schizophrenia, bipolar disorders, depression, and anxiety disorders, in 2011–2013. Analyses were performed by age group and gender. Age-adjusted odds ratios (ORs) with 95% confidence intervals (95% CI) for women and men with diabetes, using individuals without diabetes as referents, were calculated.

Results

Age-adjusted OR for all psychiatric diagnoses among people with diabetes was 1.296 (95% CI 1.267–1.326) for women and 1.399 (95% CI 1.368–1.432) for men. The greatest excess risk was found for schizophrenia, with OR 3.439 (95% CI 3.057–3.868) in women and 2.787 (95% CI 2.514–3.089) in men, with ORs between 1.276 (95% CI 1.227–1.327) and 1.714 (95% CI 1.540–1.905) for the remaining diagnoses.

Conclusion

The prevalence of psychiatric disorders is elevated in people with diabetes, which calls for preventive action to be taken to minimize suffering and costs to society.     

Determinants of mental health service use among depressed adolescents

Objective

Evaluate determinants of mental health service use among depressed adolescents.

Method

We assessed mental health services use over the 12 months following screening among 113 adolescents (34 males, 79 females) from an integrated healthcare system who screened positive for depression (Patient Health Questionnaire-9 score ≥ 11). Youth characteristics (demographics, depression severity, and co-morbidity) and parent characteristics (parent history of depression, parent-report of youth externalizing and internalizing problems) were compared among youth who had received mental health services and those who had not. Multivariate regression was used to evaluate the strongest factors associated with mental health service use.

Results

Overall, 52% of adolescents who screened positive for depression received mental health service in the year following screening. Higher parent-reported youth internalizing problems (OR 5.37, CI 1.77–16.35), parental history of depression/anxiety (OR 4.12, CI 1.36–12.48) were significant factors associated with mental health service use. Suicidality and functional impairment were not associated with increased mental health services use.

Conclusion

Parental factors including recognition of the adolescent's internalizing symptoms and parental experience with depression/anxiety are strongly associated with mental health service use for depressed adolescents. This highlights the importance of educating parents about depression and developing systems to actively screen and engage youth in treatment for depression.     

Prevalence and associated factors of comorbid skin diseases in patients with schizophrenia: a clinical survey and national health database study

Objectives

To examine the epidemiology of and possible risk factors for skin diseases in patients with schizophrenia.

Methods

All of 337 patients with schizophrenia were recruited from the therapeutic community of a psychiatric hospital and underwent a detailed skin examination. The National Health Insurance Research Database (NHIRD) was used to compare the prevalence of skin diseases between patients with schizophrenia and those without.

Results

In the clinical survey, fungal infection (61.4%) and dermatitis (46.9%) were the most common skin diseases. Clozapine users had a lower risk of fungal infection than those on typical antipsychotics [odds ratio (OR)=0.49, 95% confidence interval (CI)=0.30–0.81]. Obese patients were more likely to have fungal infections than those without (OR=1.93, 95% CI=1.20–3.09), and those with diabetes had an increased risk of bacterial infection than those without (OR=2.0, 95% CI=1.06–3.75). NHIRD revealed that the overall prevalence of skin diseases, including infections, dermatitis, hyperkeratosis, pilosebaceous disease, androgenic alopecia, xerosis and stasis, were higher in patients with schizophrenia than in those without (75.1% vs. 72.6%, P= .01).

Conclusions

The prevalence of skin diseases is high in patients with schizophrenia, for whom proper skin care is necessary to improve their life quality.     

Restoring professionalism: the physician fitness-for-duty evaluation

Objectives

We compare findings from 10 years of experience evaluating physicians referred for fitness-to-practice assessment to determine whether those referred for disruptive behavior are more or less likely to be declared fit for duty than those referred for mental health, substance abuse or sexual misconduct.

Method

Deidentified data from 381 physicians evaluated by the Vanderbilt Comprehensive Assessment Program (2001–2012) were analyzed and compared to general physician population data and also to previous reports of physician psychiatric diagnosis found by MEDLINE search.

Results

Compared to the physicians referred for disruptive behavior (37.5% of evaluations), each of the other groups was statistically significantly less likely to be assessed as fit for practice [substance use, %: odds ratio (OR)=0.22, 95% confidence interval (CI)=0.10–0.47, P< .001; mental health, %: OR=0.14, 95% CI=0.06–0.31, P< .001; sexual boundaries, %: OR=0.27, 95% CI=0.13–0.58, P= .001].

Conclusions

The number of referrals to evaluate physicians presenting with behavior alleged to be disruptive to clinical care increased following the 2008 Joint Commission guidelines that extended responsibility for professional conduct outside the profession itself to the institutions wherein physicians work. Better strategies to identify and manage disruptive physician behavior may allow those physicians to return to practice safely in the workplace.     

A single question to screen for major depression in the general population

Purpose

Major depression is frequent but underrecognized. Our objective was to investigate the usefulness of a single question as a clinical indicator for current major depressive disorder in the general population.

Methods

Data were drawn from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The NESARC is a survey of 43,093 adults aged 18 years and older residing in households in the United States. Odds ratios (OR), 95% confidence intervals (CIs), and test characteristics (sensitivity, specificity, positive and negative predictive values and positive likelihood ratio) of the question “During the past 4 weeks, how often did you felt downhearted and depressed?” for the detection of current DSM-IV major depressive disorder were determined.

Results

Participants who reported having felt downhearted and depressed “a little of the time,” “some of the time,” “most of the time” or “all the time” were more likely than participants reporting those feeling “none of the time” during the last 4 weeks to be diagnosed with current major depressive disorder (OR 4.15 [95% CI, 3.57–4.83]; OR, 9.23 [95% CI, 7.93–10.74]; OR, 23.97 [95% CI, 20.21–28.44]; and OR, 24.00 [95% CI, 19.08–30.18], respectively).The likelihood ratio for a positive test ranged between 6.49 (5.89–7.14) and 8.07 (7.18–9.07), going from a 7.1% pretest probability of major depression up to 31.9% if the participant report having felt downhearted and depressed “most of the time” or “all the time” during the past 4 weeks.

Conclusion

The single screening question has potential for use in primary care settings.     

Association of gender disadvantage factors and gender preference with antenatal depression in women: a cross-sectional study from rural Maharashtra

Purpose

Maternal depression is a major public health problem in low- and middle-income countries including India. Very few studies have assessed association of various risk factors with antenatal depression in rural Indian women, especially the effect of marital conflict, gender disadvantage and gender preference on antenatal depression. This paper describes the prevalence of probable antenatal depression in rural Maharashtra, a state in the western part of India and specifically assesses the association of marital and gender disadvantage factors and gender preference for a male child with antenatal depression.

Methods

Primary Health Centre-based cross-sectional survey of antenatal women in rural Maharashtra was carried out. The outcome of interest was a probable diagnosis of depression in antenatal women which was measured using the Edinburgh postnatal depression scale (EPDS). Data were analyzed using simple and multiple logistic regression.

Results

302 women in their antenatal period were included in this study. The outcome of antenatal depression (EPDS?>?12) was found in 51 women (16.9%, 95% CI 12.6–21.1%). Feeling pressurized to deliver a male child was strongly associated with the outcome of antenatal depression (adjusted odds ratio (OR): 3.0; 95% CI 1.4–6.5). Unsatisfactory reaction of in-laws to dowry (adjusted OR 11.2; 95% CI 2.4–52.9) and difficult relationship with in-laws (adjusted OR 5.3; 95% CI 2.4–11.6) were also significantly associated with antenatal depression.

Conclusions

Our findings demonstrate that antenatal depression in rural women of Western Maharashtra is associated with gender disadvantage factors, especially related to preference for a male child. The agenda to improve maternal mental health should be ultimately linked to address the broader social development goals and gender empowerment.

     

Determinants of a hopeful attitude among family caregivers in a palliative care setting

Objective

This study investigated the determinants of a hopeful attitude among family caregivers involved with palliative care.

Method

We investigated a broad range of factors for the patient–family dyad in a palliative care setting using a cross-sectional design. The patients' sociodemographic, clinical and psychological factors were evaluated, as well as caregiver-related sociodemographic and psychological factors, including depressive symptoms, burden, coping style and religiosity. Caregivers were divided into two groups based on a hopeful or nonhopeful attitude and assessed using the abbreviated version of the seven-item Beck Hopelessness Scale (BHS-7).

Results

Of 304 analyzed dyads, 210 (69.1%) caregivers showed a hopeful attitude, with a BHS-7 score of 0. The adjusted logistic regression analyses showed that caregivers' hopeful attitude was determined by only their psychological status: less depressive symptoms [odds ratio (OR), 0.86; 95% confidence interval (CI), 0.83–0.90], active coping strategy (OR, 1.12; 95% CI, 1.07–1.18) and lower burden (OR, 0.93; 95% CI, 0.88–0.99). In a subpopulation analysis (n= 200), higher religiosity was a significantly associated factor.

Conclusion

Healthcare providers need to pay attention to the psychological vulnerability of caregivers to encourage a hopeful attitude. Additional studies of longitudinal design for hopeful attitude throughout the trajectory of palliative care are necessary.     

The presence of a depressive episode predicts lower return to work rate after myocardial infarction

Context

No studies have evaluated whether the presence of a depressive episode is associated with an increased risk of not returning to work following myocardial infarction (MI).

Objectives

To examine the prospective associations between depressive episode and anxiety disorders with return to work (RTW) after MI at 3 and 12 months based on International Classification of Diseases, 10th Revision.

Design

Prospective cohort study.

Setting

Four hospitals in the North of The Netherlands.

Participants

From a sample of patients hospitalized for MI (n= 487), we selected those who had a paid job at the time of the MI (N= 200).

Main exposure measures

Presence of a depressive episode and presence of any anxiety disorder during the first 3 months post-MI.

Main outcome measures

RTW at 12 months post-MI.

Results

Of the patients with work prior to MI, 75% had returned to work at 12 months. The presence of a depressive episode during the first 3 months (prevalence: 19.4%) was a significant predictor of no RTW at 12 months post-MI, also after controlling for confounders [odds ratio (OR) 3.48; 95% confidence interval (CI): 1.45–8.37]. The presence of an anxiety disorder (prevalence: 11.9%) had a borderline significant association with no RTW as well. This association remained after controlling for confounders (OR 2.90; 95% CI: 1.00–6.38) but diminished when controlling for depression.

Conclusions

The presence of a depressive episode was associated with an increased risk of no RTW in MI patients. The association between anxiety and risk of no RTW could in part be explained by the presence of depression. Further studies may address the possibility of countering the effect of depression by effective treatment.     

Respiratory tract rather than cutaneous atopic allergy inversely associate with multiple sclerosis: A case–control study

Background

It has been previously shown that genetic or environmental factors, which promote susceptibility to allergic conditions, prevent the development of Th1-mediated inflammatory disease of multiple sclerosis (MS). To investigate the prediction value of lifetime atopic allergy in development of the future MS, a case–control study was designed.

Methods

Cases and controls were interviewed between December 2007 and April 2008 and they were asked if they had symptoms or diagnosis of allergies (including respiratory tract allergy, RTA; coetaneous allergy, CA; food/drug allergy, FDA) before MS diagnosis.

Results

Of 390 participants (195 controls and 195 cases), 125 healthy controls (64.1%) and 105 cases (53.8%) reported history of at least one type of atopic allergy (P = 0.04). A positive history of RTA (OR 0.43; 95% CI 0.28–0.66) or FDA (OR 0.24; 95% CI 0.13–0.43) was inversely associated with the risk of MS. No statistically significant association was found between the history of CA and MS.

Conclusions

There is a significant inverse association between RTA and MS that is compatible with a Th1/Th2 imbalance. History of RTA can be considered as a clinically useful risk reducing factor of MS.     

Parents’ traumatic brain injury increases their children’s risk for use of psychiatric care: the 1987 Finnish Birth Cohort study

Objective

Traumatic brain injury (TBI) of a parent causes significant changes in their family life and parent–children relationships. However, the number of children affected by parental TBI and the long-term consequences for these children remain unknown. We estimated the prevalence of children affected by parental TBI and investigated whether these children had greater use of psychiatric services than their peers.

Methods

This a retrospective population-based register study. All 60,069 children born in Finland in 1987 were followed up through national health and social registers from 1987 to 2008.

Results

During the 21-year follow-up, 1532 (2.6%) children had a parent with TBI. Overall, 22.5% of those having a parent with TBI were treated in specialized psychiatric care. Use of psychiatric care was significantly increased among those cohort members with a parent with mild [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.37–2.38] or severe (OR 1.49, 95% CI 1.12–1.98) TBI compared to their peers.

Conclusions

Parental TBI is associated with increased use of specialized psychiatric services by children. Adult health care services must have appropriate systems in place to address the psychosocial needs and support the welfare and development of children of patients with TBI.     

Hospital costs associated with depression in a cohort of older men living in Western Australia

Background

There is lack of information of the hospital costs related to depression. Here, we compare the costs associated with general hospital admissions over 2 years between older men with and without a documented past history of depression.

Methods

A community-based cohort of older men living in Perth, Western Australia, was assessed at baseline between 2001 and 2004 and followed up for 2 years by prospective data linkage. The participants were selected randomly from the Australia electoral roll. Two-year hospital costs were estimated.

Results

Among 5411 patients, 75% of 339 men with depressive symptoms had at least one hospital admission compared with 61% of 5072 men without depression (P< .001). Two-year median hospital costs in the depressed group were A$4153 compared with A$1671 in participants free from depression (P< .001). In multivariate analysis, the presence of clinically significant depressive symptoms remained an independent predictor of higher cost [incident rate ratios (RR)=1.44, 95% confidence interval (CI): 1.23–1.68] and was associated with being a high-cost user of health services (RR=2.04, 95% CI: 1.43–2.92).

Limitations

The estimation of costs was solely based on the main diagnosis, potentially leading to underestimates of the real cost differences.

Conclusions

Hospital care cost was higher for older men with documented evidence of past depression than those without. The issue of depression in later life must be tackled if we want to optimize the use of limited hospital resources available.     

Recent medical service utilization and health conditions associated with a history of suicide attempts

Objectives

Suicide is a leading cause of death; unfortunately most individuals at risk for suicide are not identified, assessed or treated by the mental health system. Investigating medical healthcare utilization among individuals with a history of suicide attempt may identify alternative settings for case finding and brief intervention.

Methods

The study sample (n= 1422, 58% female, 72% African-American) is from a prospective cohort of adults (27–31 years) who participated in a randomized trial of school-based interventions. Logistic regression evaluated the relationship between lifetime history of suicide attempt with past year medical service utilization and selected self- reported health conditions, controlling for lifetime Major Depressive Disorder (MDD), demographic factors, health insurance status and employment.

Results

A suicide attempt history was associated with past year emergency department medical visits [aOR 1.51, 95% CI 1.04–2.18, P= .03], but not primary care visits or inpatient hospitalization, when controlling for MDD and other covariates. Severe headaches and chronic gastrointestinal conditions were also associated with lifetime suicide attempt [aOR 1.50, 95% CI 1.03–2.17 and aOR 1.67, 95% CI 1.06–2.63, respectively].

Conclusions

Suicide prevention, including universal screening and brief intervention, is indicated in emergency department settings. Restricting screening to subgroups, such as those individuals presenting with depression, may miss at-risk individuals with somatic concerns.     

Sleep disturbances and reduced work functioning in depressive or anxiety disorders

Objectives

We aimed to examine the associations between sleep disturbances and work functioning in an epidemiologic cohort study in subjects with or without depressive or anxiety disorders.

Methods

There were 707 subjects included in our analyses with depressive or anxiety disorders and 728 subjects without current depressive or anxiety disorders. Insomnia was defined as a score ?9 using the Insomnia Rating Scale. Self-reported sleep duration was categorized in short, normal, and long (?6, 7–9, and ?10 h, respectively). Work absenteeism was defined as none, short (?2 weeks), or long (>2 weeks). Work performance was defined as not impaired, reduced, or impaired. Logistic regression analyses were performed to examine the associations of sleep disturbances with work functioning.

Results

In subjects with psychopathology, insomnia and short sleep duration were significantly associated with impaired work performance (odds ratio [OR] for insomnia, 2.20; [95% confidence interval {CI}, 1.50–3.22]; OR for short sleep, 2.54 [95% CI, 1.66–3.88] compared to normal sleep duration). Insomnia (OR, 2.48 [95% CI, 1.67–3.69]) and short sleep duration (OR, 1.85 [95% CI, 1.23–2.78]) also were associated with long-term absenteeism. These findings remained the same after considering clinical characteristics including medication use and symptom severity.In subjects without psychopathology, no significant associations were found between insomnia and short sleep duration on work functioning after considering subthreshold depression symptoms.

Conclusions

In subjects with psychopathology, sleep disturbances were negatively associated with work functioning, independent of disorder severity and use of psychotropic medication. Further research is needed to determine if treatment of sleep disturbances in subjects with psychopathology improves work functioning.     

Prevalence,correlates and recognition of depression in Chinese inpatients with cancer

Objective

To determine the prevalence, correlates and recognition rates of depressive disorders (DDs) in Chinese inpatients with cancer.

Methods

Four hundred and sixty cancer inpatients were recruited from the oncology ward of a university hospital in Beijing, China. Patients were interviewed with a Chinese version of the Mini International Neuropsychiatric Interview 5.0 by eight trained psychiatrists. Case records of inpatients with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) DDs were reviewed to determine whether treating oncologists made a diagnosis of depression, prescribed antidepressant medications and/or recommended psychiatric consultation/referral.

Results

The 1-month prevalence rates (95% confidence intervals) of DDs and major depressive disorder (MDD) were 25.9% (21.9%–29.9%) and 12.6% (9.6%–15.6%), respectively. In our multiple logistic regression analysis, being unmarried [odds ratio (OR)=1.41], cancer stage of metastasis (OR=2.35), time since cancer diagnosis ≤ 20 months (OR=2.05), frequent pain (OR=1.99~6.83) and being scored between two and four on the Eastern Cooperative Oncology Group Scale (OR=2.25~4.97) were independently associated with depression. Only 6.9% of patients with MDD were recognized by treating oncologists.

Conclusions

DDs are very common among Chinese inpatients with cancer. The high prevalence rate and low recognition rate of depression in cancer patients indicate a pressing need for routine screening, evaluation and treatment of depression in this patient population.     

Reevaluating the role of antidepressants in cancer-related depression: a systematic review and meta-analysis

Objective

Prior reviews evaluating the role of antidepressants in cancer-related depression have drawn conflicting conclusions. These reviews have also not explored differences in efficacy and tolerability between antidepressants. We conducted a meta-analysis to address these limitations.

Method

We searched Medline (1948–2013), the Cochrane Library (1800–2013), the Cumulative Index to Nursing and Allied Health Literature (1986–2013), ClinicalTrials.gov (2013) and meeting abstracts. We included randomized trials comparing antidepressants to placebo or no treatment for cancer-related depression. We used random effects to calculate standardized mean differences (SMD).

Results

Of 5178 potentially eligible citations, 9 trials (1169 subjects) met inclusion criteria. Trials of mianserin found a robust reduction in depression scores at ≥ 4 weeks of treatment (SMD: 0.60, 95% confidence interval (CI): 0.24–0.95). Similar, but less robust, results were observed with paroxetine (SMD: 0.22, 95% CI: 0.01–0.42) and fluoxetine (SMD 0.34, 95% CI: 0.02–0.66). Conversely, there was no advantage with amitriptyline or desipramine. Compared to placebo, the odds of dropping out due to side effect were higher with fluoxetine and paroxetine and lower with mianserin. Methodological quality was moderate.

Conclusions

Paroxetine, fluoxetine and mianserin improve cancer-related depression but may vary in efficacy and tolerability. High-quality, randomized trials of newer antidepressant agents are needed to identify optimal treatments for managing cancer-related depression.