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.