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Social frailty as a risk factor for new-onset depressive symptoms at one year post-surgery in older patients with gastrointestinal cancer
... Tables A1 and A2 show the characteristics of the studies included in the review. Of the 14 original studies, 9 are cross-sectional studies [4,11,[18][19][20][21][22][23][24], 3 are prospective cohort studies [8,25,26], and 1 is a retrospective cohort study [27]. One analyzed both crosssectional data and data from prospective cohort studies [10]. ...
... However, of the nine studies applying the GDS-15, researchers judged the cutoff at different points, even in the same country. For example, Maho Okumura classified scores ≥5 on the GDS-15 as "new-onset of depression", while Kota Tsutsumimoto PhD regarded this category as ≥6 for Japanese older adults [8,27]. Additionally, ZeKun Chen equated scores ≥6 on the GDS-15 with showing depressive symptoms, but Wenya Zhang considered this marker as scores ≥8 in Chinese older adults [10,22]. ...
... The dependent variable was depressive symptoms. Notably, the shortest follow-up period was only 1 year [27], which is likely to limit the ability to identify temporal changes in the incidence rate of depressive symptoms. However, there were positive relationships between social frailty and depressive symptoms in all of the findings, even though the shortest follow-up time was only 1 year. ...
Background:
Various studies have highlighted the correlation between social frailty and depressive symptoms in the elderly. However, evidence of how these two domains influence each other is not clear. The purpose of this scoping review is to summarize the current literature examining social frailty and depressive symptoms.
Method:
We conducted a scoping review allowing for the inclusion of multiple methodologies to examine the extent and range of this research topic.
Result:
The search initially yielded 617 results, 14 of which met the inclusion criteria. Five studies were identified from China, six were identified from Japan, two were identified from Korea, one was identified from Ghana, and one was from Asia. The evidence reviewed indicated that five studies met category 5 criteria, and the others met level 3 criteria. The findings from these studies showed that there is a significant relationship between social frailty and depressive symptoms.
Conclusion:
This scoping review shows that worse social frailty contributes to a significant degree of depression. Further research on screening social frailty and possible interventions in community and medical settings to prevent the elderly from developing depressive symptoms is needed.
... The type of cancer present in each sample was highly variable, with some studies selecting people with a specific diagnosis: hematological [28], gynecologic [30], non-Hodgkin s lymphoma [26], colorectal [41], gastrointinal [45], and bladder [46]; and others including any type of cancer [27,29,[32][33][34][37][38][39][40][42][43][44]. Despite this variability, breast/gynecological, gastrointestinal, and colorectal cancers were the most represented, with 20.9%, 17.7% and 16.4%, respectively. ...
... Another variability present in the samples from different studies concerned the phase of the oncological disease in which participants were at the time of data collection. In most studies, participants were in the active phase of the disease and/or in treatment [26,27,29,[32][33][34][35]39,40,[43][44][45]. However, some studies included individuals who were diagnosed up to 5 years prior [28], while others included individuals diagnosed 5 years or more prior [36,38]. ...
... The measures used to assess anxiety and depression were very heterogeneous. Regarding the measures used for depression, six studies used the geriatric depression scale (GDS) or a reduced version of it [32,34,37,[43][44][45], three used the Veterans RAND 12-item Health Survey (VR-12) [30,41,46], three used the Hospital Anxiety and Depression Scale (HADS) [29,35,39] and two used the Center for Epidemiological Studies Depression Scale (CES-D) [36,38]. The Patient Health Questionnaire-9 (PHQ-9) [28], Mini International Neuropsychiatric Interview (MINI) [26] and Edmonton Symptom Assessment System Revised (ESAS-r) [42] were three other measures used to assess depression. ...
This study presents a systematic review of the sociodemographic, clinical, and psychosocial factors associated with distress in elderly cancer patients. Relevant studies were identified using four electronic databases: PubMed, Scopus, Web of Science and ProQuest. Cross-sectional and longitudinal studies exploring factors associated with distress in people over 60 years of age were included and independently assessed using the Joanna Briggs Institute Critical Assessment Checklists. A total of 20 studies met the inclusion criteria. Research showed that being a woman, being single, divorced or widowed, having low income, having an advanced diagnosis, having functional limitations, having comorbidities, and having little social support were factors consistently associated with emotional distress. Data further showed that the impact of age, cancer type, and cancer treatment on symptoms of anxiety and/or depression in elderly patients is not yet well established. The findings of this review suggest that the emotional distress of elderly cancer patients depends on a myriad of factors that are not exclusive, but coexisting determinants of health. Future research is still needed to better understand risk factors for distress in this patient population, providing the resources for healthcare providers to better meet their needs.
... Overall, 35 studies involved community-dwelling older people, 6,11e15,19,20,22,26e33,36e45,48e52,55e57 and 8 studies involved hospitalized older people. 21,25,34,35,46,47,53,54 Methodological Quality ...
Abstract:
Objective: To report the overall prevalence of social frailty among older people and provide information for policymakers and authorities to use in developing policies and social care.
Design: A systematic review and meta-analysis.
Setting and participants: We searched four databases (PubMed, Embase, Web of Science and Google Scholar) to find articles from inception to July 30, 2022. We included cross-sectional and cohort studies that provided the prevalence of social frailty among older adults aged 60 years or more, in any setting.
Methods: Three researchers independently reviewed the literature and retrieved the data. A risk of bias tool was used to assess each study’s quality. A random-effect meta-analysis was performed to pool the data, followed by subgroup analysis, sensitivity analysis and meta-regression.
Results: From 761 records, we extracted 43 studies with 83,907 participants for meta-analysis. The pooled prevalence of social frailty in hospital settings was 47.3% (95% CI:32.2%–62.4%); among studies in community settings the pooled prevalence was 18.8% (95% CI:14.9%–22.7%; P< 0.001). The prevalence of social frailty was higher when assessed using the Tilburg Frailty Indicator (32.3%, 95% CI: 23.1%–26 41.5%) than the Makizako Social Frailty Index (27.7%, 95% CI: 21.6%–33.8%) or Social Frailty Screening Index (13.4%, 95% CI: 8.4%–18.4%). Based on limited community studies in individual countries using various instruments, social frailty was lowest in China (4.9%, 95%CI:4.2%-5.7%), followed by Spain (11.6%,95%CI:9.9%-13.3%), Japan (16.2%,95%CI:12.2%-20.3%), Korea (26.6%,95%CI:7.1%-46.1%), European urban centers (29.2%,95%CI:27.9%-30.5%) and the Netherlands (27.2%,95%CI:16.9%-37.5%). No other subgroup analyses showed any statistically significant prevalence difference between groups.
Conclusion and Implications: The prevalence of social frailty among older adults is high. Settings, country and method for assessing social frailty affected the prevalence. More valid comparisons will await consensus on measurement tools and more research on geographically representative populations. Nevertheless, these results suggest that public health professionals and policymakers should seriously consider social frailty in research and program planning involving older adults.
Frailty is one of the notable health problems of the elderly. Frailty has been proposed as a multidimensional concept with multiple domains, including physical frailty, cognitive frailty, and social frailty. Previous studies have shown that frailty in elderly cancer patients affects treatment efficacy, prognosis, and quality of life (QOL). Therefore, frailty is also considered important in the field of oncology. However, at present, there is no internationally unified concept and evaluation method for frailty and the domains that comprise it. Cancer has become a disease for which long-term survival is expected due to widespread screening and improved treatment techniques. Physical therapists involved in the treatment of elderly cancer patients need an understanding of the multidimensional concept of frailty and the viewpoint of a long-term perspective that focuses on the life course. We hope that further research and discussion will lead to the realization of a seamless and comprehensive physical therapy intervention focusing on multiple frailty in elderly cancer patients.
Frailty is highly prevalent in gastrointestinal cancer patients due to decreased food intake and gastrointestinal symptoms. Frailty is associated with postoperative complications, emergency room visits, and mortality, making preoperative screening important. Gastrointestinal cancer patients also have a high prevalence of postoperative psychiatric disorders due to postoperative complications, poor prognosis, and negative body image. Since psychiatric symptoms affect activities of daily living and quality of life, rehabilitation plays a significant role in treatment. Rehabilitation for gastrointestinal cancer patients is aimed at prevention of postoperative complications and improvement of physical function, and in recent years, pre-rehabilitation has been the focus of attention. The effects of exercise on mental health have been reported in several studies, and exercise is a low-cost and safe method for improving mental health. Finally, we discuss the association between social frailty and mental health, which is the topic of our research.
Social frailty is a geriatric public health problem that deeply affects healthy aging. Currently, evidence on the prevalence and factors associated with social frailty in older adults remains unclear. Our study aims to estimate the prevalence and related factors of social frailty in older adults. This study retrieved nine electronic databases searched through July 5th, 2022. The prevalence of social frailty was pooled using Stata software. It was found that older adults suffered from a “moderate” level of social frailty. We found a higher prevalence of social frailty in the United Kingdom, Greece, Croatia, The Netherlands, and Spain, in people over 75 years, in hospitals, and during the Coronavirus Disease 2019 (COVID-19). We believed that countries, age, research sites, and the pandemic of COVID-19 were influencing factors of social frailty among older adults. These findings may provide a theoretical basis for the development of ameliorating social frailty among older adults.
Objective:
To report the overall prevalence of social frailty among older people and provide information for policymakers and authorities to use in developing policies and social care.
Design:
A systematic review and meta-analysis.
Setting and participants:
We searched 4 databases (PubMed, Embase, Web of Science, and Google Scholar) to find articles from inception to July 30, 2022. We included cross-sectional and cohort studies that provided the prevalence of social frailty among adults aged 60 years or older, in any setting.
Methods:
Three researchers independently reviewed the literature and retrieved the data. A risk of bias tool was used to assess each study's quality. A random-effect meta-analysis was performed to pool the data, followed by subgroup analysis, sensitivity analysis, and meta-regression.
Results:
From 761 records, we extracted 43 studies with 83,907 participants for meta-analysis. The pooled prevalence of social frailty in hospital settings was 47.3% (95% CI: 32.2%-62.4%); among studies in community settings, the pooled prevalence was 18.8% (95% CI: 14.9%-22.7%; P < .001). The prevalence of social frailty was higher when assessed using the Tilburg Frailty Indicator (32.3%; 95% CI: 23.1%-41.5%) than the Makizako Social Frailty Index (27.7%; 95% CI: 21.6%-33.8%) or Social Frailty Screening Index (13.4%; 95% CI: 8.4%-18.4%). Based on limited community studies in individual countries using various instruments, social frailty was lowest in China (4.9%; 95% CI: 4.2%-5.7%), followed by Spain (11.6%; 95% CI: 9.9%-13.3%), Japan (16.2%; 95% CI: 12.2%-20.3%), Korea (26.6%; 95% CI: 7.1%-46.1%), European urban centers (29.2%; 95% CI: 27.9%-30.5%), and the Netherlands (27.2%; 95% CI: 16.9%-37.5%). No other subgroup analyses showed any statistically significant prevalence difference between groups.
Conclusion and implications:
The prevalence of social frailty among older adults is high. Settings, country, and method for assessing social frailty affected the prevalence. More valid comparisons will await consensus on measurement tools and more research on geographically representative populations. Nevertheless, these results suggest that public health professionals and policymakers should seriously consider social frailty in research and program planning involving older adults.
Objectives
Frailty is a multidimensional syndrome. However, typical frailty scales used in oncology clinics assess physical impairment and/or malnutrition but do not consider the social domain. Our study aimed to clarify the relationship between preoperative social frailty and overall survival (OS) and cancer-specific survival (CSS) among older patients with gastrointestinal cancer.
Design
This was a prospective cohort study.
Setting and Participants
This single-center study recruited 195 patients with gastrointestinal cancer scheduled for curative surgery and aged >60 years.
Methods
The outcomes considered were the OS and CSS of surgery. Primary associated factors included frailty defined as a Geriatric 8 score ≤14; social frailty defined as 2 or more of the following—going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone, and not talking with someone daily, and combinations therein [no frailty without social frailty (−/−), frailty without social frailty (+/−), no frailty with social frailty (−/+), and frailty with social frailty (+/+)]. We used the Cox proportional hazards model and the Fine and Gray proportional subdistribution hazard model adjusting for confounding factors.
Results
Of the 195 patients, 181 (mean age, 72.0 years) were included for analysis. The median follow-up time was 994 days. Social frailty (hazard ratio 3.10) and their combinations [6.35; frailty with social frailty (+/+) vs no frailty without social frailty (−/−)] were significant predictors of OS. Social frailty (subdistribution hazard ratio 3.23) and their combinations (7.57) were significant predictors of CSS.
Conclusions and Implications
Preoperative social frailty is a predictor of OS and CSS in older patients with gastrointestinal cancer. Screening for social frailty, frailty, and their combinations in older patients with cancer is important.
Social frailty domains may play an important role in preventing physical decline and disability. The aim of this study is to examine the impact of social frailty as a risk factor for the future development of physical frailty among community-dwelling older adults who are not yet physically frail. A total of 1226 physically non-frail older adults were analyzed to provide a baseline. Participants completed a longitudinal assessment of their physical frailty 48 months later. Their baseline social frailty was determined based on their responses to five questions, which identified participants who went out less frequently, rarely visited friends, felt less like helping friends or family, lived alone and did not talk to another person every day. Participants with none of these characteristics were considered not to be socially frail; those with one characteristic were considered socially pre-frail; and those with two or more characteristics were considered socially frail. At the four-year follow-up assessment, 24 participants (2.0%) had developed physical frailty and 440 (35.9%) had developed physical pre-frailty. The rates of developing physical frailty and pre-frailty were 1.6% and 34.2%, respectively, in the socially non-frail group; 2.4% and 38.8%, respectively, in the socially pre-frail group; and 6.8% and 54.5%, respectively, in the socially frail group. Participants classified as socially frail at the baseline had an increased risk of developing physical frailty, compared with participants who were not socially frail (OR = 3.93, 95% CI = 1.02-15.15). Participants who were socially frail at the baseline also had an increased risk of developing physical pre-frailty (OR = 2.50, 95% CI = 1.30-4.80). Among independent community-dwelling older adults who are not physically frail, those who are socially frail may be at greater risk of developing physical frailty in the near future. Social frailty may precede (and lead to the development of) physical frailty.
Social frailty is a rather unexplored concept. In this paper, the concept of social frailty among older people is explored utilizing a scoping review. In the first stage, 42 studies related to social frailty of older people were compiled from scientific databases and analyzed. In the second stage, the findings of this literature were structured using the social needs concept of Social Production Function theory. As a result, it was concluded that social frailty can be defined as a continuum of being at risk of losing, or having lost, resources that are important for fulfilling one or more basic social needs during the life span. Moreover, the results of this scoping review indicate that not only the (threat of) absence of social resources to fulfill basic social needs should be a component of the concept of social frailty, but also the (threat of) absence of social behaviors and social activities, as well as (threat of) the absence of self-management abilities. This conception of social frailty provides opportunities for future research, and guidelines for practice and policy
Purpose Depression symptoms are common among patients with lung cancer patients; however, longitudinal changes and their impact on survival are understudied.
Methods This was a prospective, observational study from the Cancer Care Outcomes Research and Surveillance Consortium from five US geographically defined regions from September 2003 through December 2005. Patients enrolled within 3 months of their lung cancer diagnosis were eligible. The eight-item Center for Epidemiologic Studies Depression scale was administered at diagnosis and 12 months’ follow-up. The main outcome was survival, which was evaluated using Kaplan-Meier curves and adjusted Cox proportional hazards modeling.
Results Among 1,790 participants, 681 (38%) had depression symptoms at baseline and an additional 105 (14%) developed new-onset depression symptoms during treatment. At baseline, depression symptoms were associated with increased mortality (hazard ratio [HR], 1.17; 95% CI, 1.03 to 1.32; P = .01). Participants were classified into the following four groups based on longitudinal changes in depression symptoms from baseline to follow-up: never depression symptoms (n = 640), new-onset depression symptoms (n = 105), depression symptom remission (n = 156), and persistent depression symptoms (n = 254) and HRs were calculated. Using the never-depression symptoms group as a reference group, HRs were as follows: new-onset depression symptoms, 1.50 (95% CI, 1.12 to 2.01; P = .006); depression symptom remission, 1.02 (95% CI, 0.79 to 1.31; P = .89), and persistent depression symptoms, 1.42 (95% CI, 1.15 to 1.75; P = .001). At baseline, depression symptoms were associated with increased mortality among participants with early-stage disease (stages I and II; HR, 1.61; 95% CI, 1.26 to 2.04), but not late-stage disease (stages III and IV; HR, 1.05; 95% CI, 0.91 to 1.22). At follow-up, depression symptoms were associated with increased mortality among participants with early-stage disease (HR, 1.71; 95% CI, 1.27 to 2.31) and those with late-stage disease (HR, 1.32; 95% CI, 1.04 to 1.69).
Conclusion Among patients with lung cancer, longitudinal changes in depression symptoms are associated with differences in mortality, particularly among patients with early-stage disease. Symptom remission is associated with a similar mortality rate as never having had depression
Objective
In older men with prostate cancer, aging is associated with reduced anxiety and increased depression. The purpose of this study was to examine the association among age, anxiety, and depression in a cohort of older adults receiving chemotherapy.Methods
This is a secondary analysis of a prospective longitudinal study investigating chemotherapy toxicity in older adults with cancer. Baseline data (pre-chemotherapy) included: age, sociodemographics, tumor and treatment factors, functional status, comorbidities, psychological state (measured by the Hospital Anxiety and Depression Scale), and social support. Univariate and multiple regression analyses were conducted to test the relationship between age, anxiety, and depression.ResultsThe average age of the 500 patients (56% females) was 73.1. The majority had late stage disease: 22% Stage III and 61% stage IV. Clinically significant depression was reported in 12.6%. Clinically significant anxiety was reported in 20.9%. In univariate analyses, there was no association between anxiety and age, or depression and age. In multivariable analyses, older age (p=0.05) was associated with decreased anxiety, as well as lack of social support (p<0.01) and increased number of comorbidities (p<0.01). In multivariable analysis, depression was associated with lack of social support (p<0.01), increased number of comorbidities (p<0.01), and advanced stage (p<0.01).Conclusions
This study supports previous research that anxiety decreases with age in older adults with cancer. However, depression remained constant with increasing age. Greater resources and attention to identifying and treating the psychological sequelae of cancer in older adults are warranted.
Cancer patients experience several stressors and emotional upheavals. Fear of death, interruption of life plans, changes in body image and self-esteem, changes in social role and lifestyle are all important issues to be faced. Moreover, Depressive Disorders may impact the course of the disease and compliance. The cost and prevalence, the impairment caused, and the diagnostic and therapeutic uncertainty surrounding depressive symptoms among cancer patients make these conditions a priority for research. In this article we discuss recent data, focusing on detection of Depressive Disorders, biological correlates, treatments and unmet needs of depressed cancer patients.
Objectives:
To examine the association between each type of frailty status and the incidence rate of depressive symptoms among community-dwelling older adults.
Design:
Prospective cohort study.
Setting:
General communities in Japan.
Participants:
Participants comprised 3538 older Japanese adults.
Measurements:
We assessed our participants in terms of frailty status (physical frailty, cognitive impairment, and social frailty), depressive symptoms (geriatric depression scale ≥6), and other covariates, and excluded those who showed evidence of depression. Then, after a 4-year interval, we again assessed the participants for depressive symptoms. Physical frailty was defined by the Fried criteria, showing 1 or more of these were physical frailty. To screen for cognitive impairment, receiving a score below an age-education adjusted reference threshold in 1 or more tests was cognitive impairment. Finally, social frailty was defined using 5 questions, and those who answered positively to 1 or more of these were considered to have social frailty.
Results:
After multiple imputations, the incidence rate of depressive symptoms after 4 years of follow-up was 7.2%. The incidence rates of depressive symptoms for each frailty status were as follows: 9.6% for physical frailty vs 4.6% without, 9.3% for cognitive impairment vs 6.5% without, and 12.0% for social frailty vs 5.1% without. Finally, through the application of multivariable logistic regression analysis, the incidence of depressive symptoms was found to have a significant association with social frailty (odds ratio 1.55; 95% confidence interval 1.10-2.20) but not with physical frailty or cognitive impairment.
Conclusions:
This study revealed that social frailty, in comparison with physical frailty and cognitive impairment, is more strongly associated with incidences of depressive symptoms among elderly.
Background: Psychological distress is common among patients with oesophageal cancer. However, little is known about the course and predictors of psychological distress among patients treated with curative intent. Therefore, the aim of this study was to explore the prevalence, course and predictors of anxiety and depression in patients operated for oesophageal cancer, from prior to surgery to 12 months post-operatively.
Methods: A prospective cohort of patients with oesophageal cancer (n = 218) were recruited from one high-volume specialist oesophago-gastric treatment centre (St Thomas’ Hospital, London, UK). Anxiety and depression were assessed prior to surgery, 6 and 12 months post-operatively. Mixed-effects modelling was performed to investigate changes over time and to estimate the association between clinical and socio-demographic predictor variables and anxiety and depression symptoms.
Results: The proportion of patients with anxiety was 33% prior to surgery, 28% at 6 months, and 37% at 12 months. Prior to surgery, 20% reported depression, 27% at 6 months, and 32% at 12-month follow-up. Anxiety symptoms remained stable over time whereas depression symptoms appeared to increase from pre-surgery to 6 months, levelling off between 6 and 12 months. Younger age, female sex, living alone and more severe self-reported dysphagia (i.e., difficulty swallowing) predicted higher anxiety symptoms. In-hospital complications, greater limitations in activity status and more severe self-reported dysphagia were predictive of higher depression.
Conclusions: Many patients report psychological distress during the first year following oesophageal cancer surgery. Whether improving the experience of swallowing difficulties may also reduce distress among these patients warrants further study.
Background:
Up to 37% of colorectal cancer (CRC) survivors report depressive and anxiety symptoms. The identification of risk factors for depressive or anxiety symptoms might help focus supportive care resources on those patients most in need. The present study aims to explore which factors are associated with heightened anxiety or depression symptom severity.
Methods:
In this cross-sectional study, individuals diagnosed with CRC 3.5 to 6 years ago completed questionnaires on sociodemographic information, medical comorbidities, anxiety symptoms (Beck Anxiety Inventory), and depressive symptoms (Inventory of Depressive Symptomatology). The general linear model analysis of covariance was used to identify factors associated with heightened anxiety or depressive symptom severity.
Results:
The sample included 91 CRC survivors, 40.7% women, mean age 69.1 years. A minority of CRC survivors had moderate (3.4%) or severe (2.3%) anxiety symptoms, and moderate (7.7%) or severe (0%) depressive symptoms. Shorter time since diagnosis and higher number of comorbid diseases were associated with higher anxiety symptom severity. Female sex and higher number of comorbid diseases were associated with higher depressive symptom severity.
Conclusion:
From this explorative study, it follows that survivors with multiple comorbid diseases, shorter time since diagnosis, and female survivors might be at risk for higher anxiety and/or depressive symptom severity. Survivors with these characteristics might need extra monitoring.
Objective:
To determine social frailty status using simple questions and to examine the association between social frailty and disability onset among community-dwelling older adults.
Design:
Prospective cohort study.
Setting:
Japanese community.
Participants:
A total of 4304 adults age ≥65 years living in the community participated in a baseline assessment from 2011 to 2012. They were followed monthly for incident certification of care needs during the 2 years after the baseline assessment.
Measurements:
Care-needs certification in the national long-term care insurance system of Japan; a self-reported questionnaire including 7 items to define social frailty status, adjustment for several potential confounders such as demographic characteristics; and Kaplan-Meier survival curves for disability incidence by social frailty.
Results:
During the 2 years, 144 participants (3.3%) were certified as requiring long-term care insurance in accordance with incident disability. Five of the 7 items in the self-reported questionnaire were significantly associated with disability incidence. In the adjusted model including potential covariates, participants who were defined as having social frailty (≥2/5) (hazard ratio 1.66, 95% confidence interval 1.00-2.74) and prefrailty (=1/5) (hazard ratio 1.53, 95% confidence interval 1.02-2.531), based on 5 items at the baseline assessment, had an increased risk of disability compared with nonfrail participants (=0/5).
Conclusions:
Social frailty, assessed using simple questions regarding living alone, going out less frequently compared with the prior year, visiting friends sometimes, feeling helpful to friends or family, and talking with someone every day, has a strong impact on the risk of future disability among community-dwelling older people.
Purpose:
To investigate the risk for first depression, assessed as incident hospital contacts for depression and incident use of antidepressants, among women with breast cancer.
Patients and methods:
Danish national registries were used to identify 1,997,669 women with no diagnosis of cancer or a major psychiatric disorder. This cohort was followed from 1998 to 2011 for a diagnosis of breast cancer and for the two outcomes, hospital contact for depression and redeemed prescriptions for antidepressants. Rate ratios for incident hospital contacts for depression and incident use of antidepressants were estimated with Poisson regression models. Multivariable Cox regression was used to evaluate factors associated with the two outcomes among patients with breast cancer.
Results:
We identified 44,494 women with breast cancer. In the first year after diagnosis, the rate ratio for a hospital contact for depression was 1.70 (95% CI 1.41 to 2.05) and that for use of antidepressants was 3.09 (95% CI 2.95 to 3.22); these rate ratios were significantly increased after 3 and 8 years, respectively. Comorbidity, node-positive disease, older age, basic and vocational educational levels, and living alone were associated with use of antidepressants.
Conclusion:
Women with breast cancer are at long-term increased risk for first depression, including both severe episodes leading to hospital contact and use of antidepressants. Clinicians should be aware that the risk is highest in women with comorbid conditions, node-positive disease, and age of 70 years or more. We found no clear association between type of surgery or adjuvant treatment and risk for depression.
Social perceptions of cancer and their impacts: implications for nursing practice arising from the literature
At the millennium cancer still holds a special mystique and is imbued with socio-cultural meanings, which extend far beyond the rational, scientific and biological facts of the disease. Excessive fear and dread may cause family and friends to display avoidance or overprotective behaviours to the ill person, who may subsequently perceive dissatisfaction with social support. Drawing on a literature review this paper explores the impact of cancer on social relationships. Interpersonal strain in relationship is often explained in the stigmatization of the illness and this concept is explored through contemporary social theorizing. These findings have direct implications for nursing practice where the goal of care is to enhance the support relationship.
Cancer survivors report deficits in social functioning even years after completing treatment. Commonly used measures of social functioning provide incomplete understanding of survivors' social behavior. This study describes social activities of survivors and evaluates the psychometric properties of the Social Activity Log (SAL) in a cohort of long-term survivors of hematopoietic stem cell transplantation (HSCT) for cancer.
One hundred and two (5-20 year) survivors completed the SAL, Short-Form-36 Health Survey (SF-36), and other patient-reported outcomes. Principal components analysis determined the factor structure of the SAL along with correlations and regressions to establish validity.
Principal component analysis yielded three factors in the SAL: 'non-contact events' (e.g. telephone calls), 'regular events' (e.g. played cards), and 'special events' (e.g. concerts), which explained 59% of the total variance. The SAL possessed good internal consistency (Cronbach's alpha=0.82). SF-36 social function and SAL were moderately correlated (r=0.31). In linear regressions, physical function and depression explained 16% of the variance in the SAL (P<0.001), while physical function, depression, and fatigue predicted 55% of the variance in SF-36 social function (P<0.001).
Results support the use of the SAL as a measure of social activity in cancer survivors who received HSCT. Although the SAL is designed to measure social behaviors, SF-36 social function assesses subjective experience and is more strongly associated with depression and fatigue. The SAL appears to be a promising tool to understand the behavioral social deficits reported by long-term survivors of cancer.
Later-life depressive disorders are a major public health problem in primary care settings. A validated screening instrument might aid in the recognition of depression. However, available findings from younger patients may not generalize to older persons, and existing studies of screening instruments in older patient samples have suffered substantial methodological limitations.
One hundred thirty patients 60 years or older attending 3 primary care internists' practices participated in the study. Two screening scales were used: the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Geriatric Depression Scale (GDS). The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Third Edition, Revised, was used to establish "gold standard" diagnoses including major and minor depressive disorders. Receiver operating curve analysis was used to determine each scale's operating characteristics.
Both the CES-D and the GDS had excellent properties in screening for major depression. The optimum cutoff point for the CES-D was 21, yielding a sensitivity of 92% and a specificity of 87%. The optimum cutoff point for the GDS was 10, yielding a sensitivity of 100% and a specificity of 84%. A shorter version of the GDS had a sensitivity of 92% and a specificity of 81% using a cutoff point of 5. All scales lost accuracy when used to detect minor depression or the presence of any depressive diagnosis.
The CES-D and the GDS have excellent properties for use as screening instruments for major depression in older primary care patients. Because the GDS's yes or no format may ease administration, primary care clinicians should consider its routine use in their practices.
Screening for depression in elderly primary care patients. A comparison of the center for Epidemiologic studies-depression scale and the geriatric depression scale
- Lyness