Depression in patients with advanced illness: an examination of Ontario complex continuing care using the Minimum Data Set 2.0.
OBJECTIVE
In this study, we examined the prevalence of depression, its recognition, and its treatment in continuing care patients with advanced illness (AI).


METHODS
All data were obtained from the Ontario (Canada) provincially-mandated MDS 2.0 form for chronic care. Of 3,801 patients, 524 met our empiric definition of AI, which was predicated on a previously validated algorithm. The MDS-embedded Depression Rating Scale (DRS) was used to measure psychological well-being and a score of 3 or greater indicated potential depression.


RESULTS
Twenty-nine percent of patients with AI scored greater than 3, making them nearly twice as likely to be potentially depressed as other patients (OR 1.8, 95% CI 1.5-2.2). Despite this patients with AI were less likely to have received antidepressants (28.9% vs. 38.2%), even among those with a diagnosis (45.3% vs. 58.4%). Using logistic regression, correlates of potential depression were identified and surprisingly patients with cancer were substantially less likely to be depressed (AOR 0.37, 95% CI 0.2-0.6). Further investigation revealed that cancer patients were more likely to be treated for depression and to be recognized as being within the terminal phase of illness.


CONCLUSIONS
These findings suggest that a high proportion of terminally ill patients had unmet needs for psychological support. As well, they suggest that cancer patients received better targeted end-of-life care, which resulted in an overall decrease in psychological distress when compared to other patients with similarly advanced illness.
Gruneir
Andrea
A
Department of Community Health, Brown University, Providence, Rhode Island, USA.
Smith
Trevor Frise
TF
Hirdes
John
J
Cameron
Roy
R
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009369:Neoplasms / Q000523:psychology; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D019452:Terminally Ill / Q000523:psychology*