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Depression (PDQ®): Supportive care - Health Professional Information [NCI] - Assessment and Diagnosis


Risk Factors for Depression in People With Cancer

  • Cancer-related risk factors:
    • Depression at time of cancer diagnosis.[8,9]
    • Poorly controlled pain.[10]
    • Advanced stage of cancer.[10]
    • Increased physical impairment or discomfort.
    • Pancreatic cancer.[11]
    • Being unmarried and having head and neck cancer.[12]
    • Treatment with certain chemotherapeutic agents:
  • Noncancer-related risk factors:
    • History of depression:
      • Two or more episodes in a lifetime.
      • First episode early or late in life.
    • Lack of family support.[8]
    • Additional concurrent life stressors.[15]
    • Family history of depression or suicide.
    • Previous suicide attempts.
    • History of alcoholism or drug abuse.
    • Concurrent illnesses that produce depressive symptoms (e.g., stroke or myocardial infarction).
    • Past treatment for psychological problems.[16]

Screening and Assessment for Depression

Because of the common underrecognition and undertreatment of depression in people with cancer, screening tools can be used to prompt further assessment.[17] Among the physically ill, in general, instruments used to measure depression have not been shown to be more clinically useful than an interview and a thorough examination of mental status. Simply asking the patient whether he or she is depressed may improve the identification of depression.

The following screening tools are commonly used:

  • A single-item interview. In persons with advanced cancer, a single-item interview question has been found to have acceptable psychometric properties and can be useful. One example is to ask "Are you depressed?"[18] Another example is to say, "Please grade your mood during the past week by assigning it a score from 0 to 100, with a score of 100 representing your usual relaxed mood." A score of 60 is considered a passing grade.[19]
  • The Hospital Anxiety and Depression Scale.[20] The Hospital Anxiety and Depression Scale may have limited utility in certain patient populations such as early-stage breast cancer [21] and palliative care.[22,23]
  • The Psychological Distress Inventory.[24]
  • The Edinburgh Depression Scale.[25]
  • The Brief Symptom Inventory.[26]
  • The Zung Self-Rating Depression Scale.[27]
  • The Distress Thermometer.[28]

One study of women with newly diagnosed breast cancer (n = 236) successfully utilized brief screening instruments such as the Distress Thermometer and the Patient Health Questionnaire (PHQ-9) to identify women requiring further assessment to detect clinically significant levels of distress and psychiatric symptoms.[29]

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