Depression in advanced disease |
||
|
|
Depression prevalence
This systematic review [1] set out to find all studies examining the prevalence of depression in advanced disease. The problems were two: defining depression and defining advanced disease. For the first, the aim was to examine different methods of detecting depression, from clinical recognition to using different depression scales. For the second, reviewers had a target population of patients in palliative care settings, excluding studies focusing on non-cancer conditions like heart failure or AIDS. At least 50% of patients had to have cancer, and oncology studies were included if expected or real survival was less than six months.
A very extensive search strategy was used, examining many electronic databases, the St. Christopher's Hospice database, the Cochrane Library, and with handsearching selected journals.
Results
The review performs no meta-analysis to give an overall figure for depression, because there was real clinical heterogeneity between studies. The six main diagnostic criteria were clinical recognition, single-item scales, the Hospital Anxiety and Depression Scale (HADS), other questionnaires, use of diagnostic criteria and case-finding studies.
Figure 1 shows an abacus plot of the prevalence rates found for the first five of these methods in just under 6,700 patients in which the overall rate of depression was about 30%. For HADS and others reporting degrees of depression, only severe depression was included for Figure 1. Many studies were very small, and this also contributed to the wide variation, which was from under 10% to over 60%.
Figure 1: Prevalence of depression in patients with advanced disease according to different diagnostic methods
|