Diagnosis of major depression according to 4 sets of criteria
Department of Psychiatry, University of Iowa, Iowa City 55242. American Journal of Psychiatry
(Impact Factor: 12.3).
09/1990; 147(8):1021-4. DOI: 10.1176/ajp.147.8.1021
Diagnoses of major depression in 152 cancer patients differed as much as 13% depending on the diagnostic system used. The Beck Depression Inventory and the Hamilton Rating Scale for Depression were useful tools for screening patients with depressive symptoms but frequently misclassified those who had no major depression according to one or more of the criteria-based diagnostic systems.
Available from: Ana Duarte
- "The trial included 500 adults (aged ≥ 18 years) with a diagnosis of cancer , a good cancer prognosis (predicted survival ≥ 12 months estimated by their cancer specialist) and major depression (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV] criteria using the inclusive approach to diagnosis) of at least four weeks' duration   . Patients were excluded if they were unable to participate in DCPC (those with substantial cognitive or communication difficulties, or who could not attend regular sessions), or if DCPC was inappropriate to their needs (those with continuous depression for ≥2 years, a psychiatric or medical condition requiring alternative treatment, known cerebral metastases, or those already regularly seeing a mental health specialist). "
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Comorbid major depression is associated with reduced quality of life and greater use of healthcare resources. A recent randomised trial (SMaRT, Symptom Management Research Trials, Oncology-2) found that a collaborative care treatment programme (Depression Care for People with Cancer, DCPC) was highly effective in treating depression in patients with cancer. This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective.
Costs were estimated using UK national unit cost estimates and health outcomes measured using quality-adjusted life-years (QALYs). Incremental cost-effectiveness of DCPC compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data. Uncertainty was characterised using cost-effectiveness acceptability curves. The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence's (NICE) cost-effectiveness threshold range of £20,000 to £30,000 per QALY gained.
DCPC cost on average £631 more than usual care per patient, and resulted in a mean gain of 0.066 QALYs, yielding an incremental cost-effectiveness ratio of £9549 per QALY. The probability of DCPC being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £20,000 per QALY for the base case and scenario analyses.
Compared with usual care, DCPC is likely to be cost-effective at the current thresholds used by NICE. This study adds to the weight of evidence that collaborative care treatment models are cost-effective for depression, and provides new evidence regarding their use in specialist medical settings.
Available from: Zahra Zakeri
- "One study reported the prevalence of depression as 43% in which 19% had major depression and 24% had mild to moderate depression . Another study revealed the overall depression of 46% in which 20% of the patients had severe and clinical depression . However, in our study, the overall prevalence of depression according to BDI was 26.5% and all of them had mild to moderate scores (11-17), and we did not observe any patients with severe depression. "
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The symptoms related to depression in patients with cancer are amajor problem and could influence the treatment and survival of patients. This disorder is varied in different populations and in different studies.
We evaluated the prevalence of depression with Beck Depression Inventory (BDI) scale in 400 patients with cancer. This measurement was after the diagnosis of malignancy and before chemotherapy or radiotherapy.
The mean age of patients was 45 ±8.5 years, and female to male ratio was 45/55. The prevalence of depression was 24.8 % and 28% in males and females. All patients with depression had mild to moderate depression. Prevalence of depression was significantly higher in younger cases (P<0.0001). According to the site of malignancy, prevalence of depression was significantly highest in patients with breast cancer, following metastatic of unknown origin and gastrointestinal cancer and the lowest prevalence was observed in patients with hematologic malignancy (p <0.0001). Also, we observed a significant higherprevalence of depression in single versus married patients (p <0.0001), in patients with higher education (p <0.0001) and patients who had knowledge about their disease in comparison with those who had no knowledge (p <0.0001).
The prevalence of depression and its severity in cancer patients in South east of Iran was lower than other studies and it seems that this situation may be related to high religious beliefs in this region, high prevalence of illiteracy and lack of knowledge about their underlying disease.
Available from: sciencedirect.com
- "Cela était essentiellement dû aux diverses conceptualisations de la dépression et en particulier aux critères pour la définir, aux approches méthodologiques pour la mesurer et à la diversité des populations de patients étudiés (ambulatoire, hospitalisé) et des tumeurs considérées (localisation et stade). Ainsi, deux biais majeurs ont pu être relevés : • soit considérer les symptômes dépressifs comme un phénomène général (confondre symptômes dépressifs et syndrome dépressif majeur) ; • soit considérer les troubles dépressifs spécifiques définis par des critères diagnostiques selon une nosographie bien précise dans une perspective de recherche  . "
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ABSTRACT: The purpose of this paper was to make a brief review of the main problematics raised by depression in oncology in terms of prevalence, semiology, screening, risk, prognosis factors and treatment. This reflection was based on recent literature data obtained through a PubMed search. Depressive disorders have frequently been encountered in cancer patients. During routine oncology daily care, depression screening, assessment and treatment are of paramount importance regarding psychosocial management. Depressive elements have a tremendous impact on the quality of life, tolerance and compliance with anticancer treatment. Moreover, depression morbidity and its possible influence on prognosis represent an important challenge in terms of prevention. A specific semiology for depressive disorders in the oncologic field might be more relevant with practical clinical implications. Optimal care of these mood disorders have to be implemented as soon as possible and be supported by the association of pharmacological treatment and psychotherapy.
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