Diagnosis of Depression in Patients Receiving Specialist Community Palliative Care: Does Using a Single Screening Question Identify Depression Otherwise Diagnosed by Clinical Interview?

Abstract

Background: Depression affects a quarter of palliative patients and is associated with reduced quality of life. Screening for psychological problems at key points in the patients' pathway is recommended but there is no consensus as to how to do this. Aims: The study's aim was to assess the efficacy of a screening question for depression against a semistructured interview in patients referred to a specialist community palliative care team. Methods: Fifty community palliative care patients were assessed using a single question: ''Have you felt depressed, most of the day, nearly every day for two or more weeks?'' Results were compared with assessment using the validated Mini International Neuropsychiatric Interview (MINI). Results: Sensitivity of the single question was 0.8 and specificity was 0.85. The positive predictive value was 0.57 and the negative predictive value was 0.94. Conclusion: The screening question was shown to have acceptable sensitivity and specificity in a small sample of community palliative care patients. It is likely to be most useful to accurately identify those who are not depressed and identify those patients who need a more in-depth assessment of their mood.

Supportive care and symptom management in patients with advanced hematological malignancies: a literature review

“…A single-item screening tool ("Are you feeling depressed?") has been shown to be useful for identifying depression (80). Both antidepressants and psychotherapy have shown efficacy in treating depression in patients with advanced malignancies (81,82).…”

The Edmonton Symptom Assessment System: Poor performance as screener for major depression in patients with incurable cancer

“…performed poorly in three later studies among patients with advanced cancer. [24][25][26] In contrast to these findings, Taylor et al 27 found good screening capabilities by use of the main criterion on lowered mood for MDE. The question 'Have you felt depressed most of the day, nearly every day, for two or more weeks?'…”

“…23 The single item ‘Are you depressed?’ performed poorly in three later studies among patients with advanced cancer. 24–26 In contrast to these findings, Taylor et al 27 found good screening capabilities by use of the main criterion on lowered mood for MDE. The question ‘Have you felt depressed most of the day, nearly every day, for two or more weeks?’ identified MDD assessed by a structured interview with a sensitivity of 0.80 and a specificity of 0.85.…”

“…The question ‘Have you felt depressed most of the day, nearly every day, for two or more weeks?’ identified MDD assessed by a structured interview with a sensitivity of 0.80 and a specificity of 0.85. 27 This finding indicates that simple items are possible screeners for MDE in patients with advanced cancer.…”