title: Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data.
abstract: BACKGROUND
  Major depression is an important complication of cancer. However, reliable data are lacking for the prevalence of depression in patients with cancer in different primary sites, the association of depression with demographic and clinical variables within cancer groupings, and the proportion of depressed patients with cancer receiving potentially effective treatment for depression. We investigated these questions with data from a large representative clinical sample.
  
  
  METHODS
  We analysed data from patients with breast, lung, colorectal, genitourinary, or gynaecological cancer who had participated in routine screening for depression in cancer clinics in Scotland, UK between May 12, 2008, and Aug 24, 2011. Depression screening was done in two stages (first, Hospital Anxiety and Depression Scale; then, major depression section of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition). Data for depression status were linked with demographic and clinical data obtained from the Scottish National Cancer Registry.
  
  
  RESULTS
  We analysed data for 21 151 patients. The prevalence of major depression was highest in patients with lung cancer (13·1%, 95% CI 11·9-14·2%), followed by gynaecological cancer (10·9%, 9·8-12·1), breast cancer (9·3%, 8·7-10·0), colorectal cancer (7·0%, 6·1-8·0), and genitourinary cancer (5·6%, 4·5-6·7). Within these cancer groupings, a diagnosis of major depression was more likely in patients who were younger, had worse social deprivation scores, and, for lung cancer and colorectal cancer, female patients. 1130 (73%) of 1538 patients with depression and complete patient-reported treatment data were not receiving potentially effective treatment.
  
  
  CONCLUSIONS
  Major depression is common in patients attending cancer clinics and most goes untreated. A pressing need exists to improve the management of major depression for patients attending specialist cancer services.
  
  
  BACKGROUND
  Cancer Research UK and Chief Scientist Office of the Scottish Government.
authors.affiliation: Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK. Electronic address: jane.walker@psych.ox.ac.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Walker
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Christian Holm
authors.initials: CH
authors.lastname: Hansen
authors.affiliation: Psychological Medicine Research, University of Edinburgh Department of Psychiatry, Edinburgh, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.affiliation: University of Edinburgh Cancer Research UK Centre, Western General Hospital, Edinburgh, UK.
authors.forename: Stefan
authors.initials: S
authors.lastname: Symeonides
authors.affiliation: Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
authors.forename: Ravi
authors.initials: R
authors.lastname: Ramessur
authors.affiliation: University of Edinburgh Centre for Population Health Sciences, Edinburgh, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Murray
authors.affiliation: Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe