Cancer and depression: Leicester research sheds new light on diagnosis

Posted by mjs76 at Feb 28, 2012 04:00 PM |
Overlooked symptoms can be useful indicators.

How can you tell when someone is suffering from depression if they also have a serious medical condition? As well as psychological symptoms such as low mood and loss of interest, there are a raft of physical or ‘somatic’ symptoms that doctors are trained to watch out for, including lack of energy, sleepiness (or insomnia) and lack of appetite (or over-eating).

But when a patient has already been diagnosed with a serious condition, such as cancer, the situation becomes more complex, and these symptoms are often ascribed to the primary medical condition, meaning that depression may go undiagnosed. Indeed more than half of depressions are thought to be missed in medical settings.

Researchers in our Department of Cancer Studies and Molecular Medicine addressed this issue, examining possible correlation between these somatic symptoms and depression in cancer patients.

A total of 279 patients were each contacted up to three times within nine months of their initial cancer diagnosis and examined using the current versions of the two standard clinical tools for diagnosing depression: the Patient Health Questionnaire (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS-D).

PHQ-9 is a simple set of nine questions asking about the frequency of symptoms, such as those described above, over the previous two weeks (you can see an example here). Each symptom is scored from 0 to 3, giving a maximum possible score of 27. HADS is a similar set of seven questions, with a maximum score of 21, (there is an equivalent test for anxiety, HADS-A).

Using these patient questionnaires, our researchers found that somatic symptoms do continue to correlate strongly with depression among cancer patients. Depressed cancer patients exhibited these symptoms more strongly than non-depressed patients at every stage of the condition, from early diagnosis to final stage palliative care.

The Leicester team, working with colleagues at University Hospitals of Leicester NHS Trust, considered both ‘major depressive disorder’ (MDD) and the more broadly defined ‘any depressive disorder’ (ADD). They found that for ADD one particular symptom, insomnia, was particularly strong and could sometimes be used alone, but a combination of symptoms naturally gave the best results, especially for MDD.

The paper has been published online in the Journal of Affective Disorders.

  • Which symptoms are indicative of DSMIV depression in cancer settings? An analysis of the diagnostic significance of somatic and non-somatic symptoms (doi:10.1016/j.jad.2011.11.009)