Detecting Depression in Patients - Psychiatry - Lecture Slides, Slides of Psychiatry

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Detecting depression in patients

with physical illness

Classification

• Adjustment disorder • Major illness• Major illness • Dysthymia• Manic depressive disorders

Depression and physical illness

The association may be coincidental

Patient-led barriers

Somatisation

Misconceptions about psychological problems

Misconceptions about psychological problems

Supposed effect on health care professionals

Reasons for why depression is missed

Difficulty distinguishing between clinically important depression and a ‘realistic’ response to stressfuldepression and a ‘realistic’ response to stressful physical illness

Attribution of physical symptoms

Feeling ill-equipped with relevant communicationskills

Negative attitudes to depression

Therapeutic nihilism

Depression and Anxiety in patients with

colorectal cancer

Anxiety

Depression

Nil

Borderline

Case

Total

Nil

108

1

8

117

Borderline

10

0

1

11

Borderline

10

0

1

11

Case

15

5

10

30

Total

133

6

19

158

Anxiety and depression Kendell’s tau b = 0.4, p <0.001. Williams, Potts, Hunter, Richards & Ramirez 2003

Identification of depression and anxiety

among women with breast cancer

Preoperative HADS score >

90% of patients with severe depression and/or

90% of patients with severe depression and/oranxiety in year after diagnosis

Ramirez et al, Br J Cancer 1995

TWO-STAGE SCREENING FOR MAJOR DEPRESSION IN AN ONCOLOGY

CLINIC

TOTAL No. OF PATIENTS ATTENDING CLINICS

5613

TOTAL HADS COMPLETED

3938/5613 (70%)

No. OF HADS COMPLETED WITH HIGH SCORE (>15)

891/3938 (23%)

No. OF HIGH SCORES INTERVIEWEDNo. OF HIGH SCORES INTERVIEWED

570/891 (64%)

No. DIAGNOSED AS HAVING MDD

196/570 (34% OF THOSE INTERVIEWED)

Sharpe, Strong, Allen. Rush, Postmas, Maguire, House, Ramirez, Cull

Submitted 2003

Screening questions for depression

How have you been feeling recently?

Have you been low in spirits?

Have you been able to enjoy the things you usually enjoy?

Have you been able to enjoy the things you usually enjoy?

Have you had your usual level of energy, or have you beenfeeling tired?

How has your sleep been?

Have you been able to concentrate on newspaper articles oryour favourite television or radio programmes?

Framework for Psychological Support

Specialist psychological/psychiatric interventions

Counselling

Psychological interventions

Effective information giving and communication

Annual period prevalence of

depression and/or anxiety^908070

% w o m en rep o rtin g

% w o m en rep o rtin g

ep iso d e

year 1

year 2

year 3

year 4

year 5

Burgess, Cornelius, Love, Richards, Ramirez 2003

Point prevalence (monthly) of episodes

of depression and/or anxiety

Burgess, Cornelius, Love, Richards, Ramirez 2003

Medium term (4 months-2 years)

• previous psychological problems

(HR=1.38 95% CI 1.10, 1.74 p<0.01)

• weak social support

(HR=1.38 95% CI 1.11, 1.72 p<0.01)

• experiencing severe difficulties unrelated to

cancer

(HR=1.36 95% CI 1.06, 1.75 p=0.02)

Burgess, Cornelius, Love, Richards, Ramirez 2003

Longer term (2-5 years)

earlier episodes of depression/anxiety

(HR=1.55 95% CI 1.17, 2.06 p<0.01)

• weak social support

(HR=1.43 95% CI 1.11, 1.86 p<0.01)(HR=1.43 95% CI 1.11, 1.86 p<0.01)

• younger age

(HR=0.96 95% CI 0.93, 0.99 p<0.01)

• experiencing severe non-cancer difficulties

(HR=1.54 95% CI 1.14, 2.09 p<0.01)

Burgess, Cornelius, Love, Richards, Ramirez 2003