title: Cancer patients' reluctance to discuss psychological distress with their physicians was not associated with underrecognition of depression by physicians: a preliminary study.
abstract: OBJECTIVE
  To investigate the association between cancer patients' reluctance for emotional disclosure to their physician and underrecognition of depression by physicians.
  
  
  METHODS
  Randomly selected ambulatory patients with lung cancer were evaluated by the Hospital Depression and Anxiety Scale (HADS), and those with scores over the validated cutoff value for adjustment disorder or major depressive disorder were included in this analysis. The data set included the responses to the 13-item questionnaire to assess four possible concerns of patients in relation to emotional disclosure to the treating physician ("no perceived need to disclose emotions," "fear of the negative impact of emotional disclosure," "negative attitude toward emotional disclosure," "hesitation to disturb the physician with emotional disclosure"). The attending physicians rated the severity of depression in each patient using 3-point Likert scales (0 [absent] to 2 [clinical]). Depression was considered to be underrecognized when the patients had a HADS score above the cutoff value, but in whom the depression rating by the attending physician was 0.
  
  
  RESULTS
  The HADS score was over the cutoff value in the 60 patients. The mean age was 65.1 +/- 10.0, and 82% had advanced cancer (Stage IIIb or IV or recurrence). Depression was underrecognized in 44 (73%) patients. None of the four factors related to reluctance for emotional disclosure was associated with the underrecognition of depression by the physicians. None of the demographic or cancer-related variables were associated with depression underrecognition by physicians.
  
  
  CONCLUSIONS
  The results did not support the assumption that patients' reluctance for emotional disclosure is associated with the underrecognition of depression by physicians.
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, Japan. okuyama@med.nagoya-cu.ac.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Okuyama
authors.forename: Chiharu
authors.initials: C
authors.lastname: Endo
authors.forename: Takashi
authors.initials: T
authors.lastname: Seto
authors.forename: Masashi
authors.initials: M
authors.lastname: Kato
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Seki
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Akechi
authors.forename: Toshiaki A
authors.initials: TA
authors.lastname: Furukawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Eguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Hosaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D003144:Communication Barriers; D003863:Depression / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012650:Self Disclosure; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires