ipos08 - clinical significance of dsmiv major, minor & subsyndromal depression [june2008]
DESCRIPTION
This is an academic presentation from June 2008, IPOS (Psycho-oncology) Conference, Madrid re subtypes of depression. It is primarily intended for clinicians and researchers working in this field.TRANSCRIPT
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Alex Mitchell Leicester Royal Infirmary
Elena Baker-Glenn University of NottinghamPaul Symonds Leicester Royal InfirmaryChris Coggan Leicester General Hospital
June 2008June 2008
Clinical Significance of DSM-IV Major, Minor and Sub-Syndromal Depression in Cancer:
Preliminary Report of Chemotherapy Attendees
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[A] About Depression subtypes
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Study DescriptionStudy Description
AuthorsBaker-Glenn, Symonds, Grainger, Mitchell
Demographic Results129 patients were seen at baseline, and 86 were re-interviewed at
1 month. 215 assessments were made.
InstrumentsPHQHADSDTHelp
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Depression
13%
20%
57%
48%
38%
18%
Anxiety
Distress/Adjustment Disorder
Depression
13%
20%
57%
48%
38%
18%
Anxiety
Distress/Adjustment Disorder
Pooled Analysis of 38 studies
Setting: mostly oncology
Instruments: mixedPoint prevalence n=6414
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Depression
13%
20%
57%
48%
38%
18%
Anxiety
Distress/Adjustment Disorder
Depression
13%
20%
57%
48%
38%
18%
Anxiety
Distress/Adjustment Disorder
MajorDepression
MinorDepression
Symptoms
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Definitions by DSM IVDefinitions by DSM IV
Major DepressionAt least 5 of 9 of the questions concerning his mental state of
health with at least “more than half the days.” For a period of two weeks or more include Q1 or Q2
Minor depression2-4 of 9 of the questions concerning his mental state of health
with at least “more than half the days.” For a period of two weeks or more include Q1 or Q2
Subsyndromal DepressionTo meet the criteria for minor depression, patients had to have, for
at least 2 weeks, at least one symptom present for more than half the days but not fulfilling criteria for major or minor depression and with no requirement Q1 or Q2
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Symptom Significance in DepressionSymptom Significance in Depression
(7 or) 8 symptoms (3+4)
(5 or) 6 symptoms
4 symptoms (2+2)
2 or 3 symptoms
0 or 1 symptom
ICD10
16 - 21UnspecifiedSevere
12 - 155 symptoms (Mj)Moderate
8 -112-4 symptoms (minor)Mild
4 - 71 or 2 symptoms(or no core symptoms)
Sub-syndromal
0 - 30 symptomHealthy
HADS-D ScoreDSMIVDepression Severity
=> HADS
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=> Symptoms
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PHQ9PHQ9
Linear vs algorithmic PHQ
The mean score on the PHQ9 was 6.1
23.3% scored above 9
17.7% scored above 10
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
a. L
ittle
inte
rest
or
plea
sure
in d
oing
thin
gs
b. F
eelin
g do
wn,
depr
esse
d, o
r hop
eles
s
c. T
roub
le fa
lling
or
stay
ing
asle
ep, o
rsl
eepi
ng to
o m
uch
d. F
eelin
g tir
ed o
r hav
ing
little
ene
rgy
e. P
oor a
ppet
ite o
rov
erea
ting
f. Fe
elin
g ba
d ab
out
your
self…
.
g. T
roub
le c
once
ntra
ting
on th
ings
,….
h. M
ovin
g or
spe
akin
g so
slow
ly th
at o
ther
peo
ple
coul
d ha
ve n
otic
ed…
i. Th
ough
ts th
at y
ouw
ould
be
bette
r off
dead
….Three
TwoOneZero
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PHQ9 Linear distribution
0
5
10
15
20
25
30
35
Zero One Two
Three
Four
Five Six
Seven
Eight
Nine
TenElev
enTwelveThir
teen
Fourte
enFifte
enSixt
een
Sevente
enEigh
teen
PHQ9 (Major Depression)PHQ9 (Minor Depression)PHQ9 (Non-Depressed)
Baker-Glen, Mitchell et al (2008)
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Basic ResultsBasic Results
Of 215 patient assessment
11.2% had major depression alone7% had minor depression alone28.8% had sub-syndromal depression
18.0% had major or minor depression46.3% had major or minor or sub-syndromal depression.
Only 40.5% of individuals had no symptoms of depression at all.
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Rates of Mj Mn SSRates of Mj Mn SS
11.6
8.5
31
51.1
10.3
4.7
37.2
52.2
0
10
20
30
40
50
60
Major Depression Minor Depression Subsyndromal Any Mood Problem
Baseline1 Month
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[B] About Clinical Significance
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How To Establish Clinical SignificanceHow To Establish Clinical Significance
Correlation with HADS?
Correlation with Distress Thermometer?
Correlation with who wants help?
Prognostic significance
Disability
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0.830.80
0.53
0.79
0.33
0.22
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
Major Depression Minor Depression Sub-Syndromal
HADS-A PositiveHADS-D Positive
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0.79
0.60
0.48
0.42
0.270.23
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
Major Depression Minor Depression Sub-Syndromal
DT PositiveHelp Positive
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Of those Distressed (3v4 on the DT)Of those Distressed (3v4 on the DT)
Only 19 (of 74) had major depression (26%)
Only 9 (of 74) had minor depression (12%)
35 (of 74) had SS depression (48%)
11 had major, minor or SS depression (15%)
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Major Depression26%
Minor Depression12%
Subsyndromal Depression
47%
None of above15%
DistressedPatients
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OutcomeOutcome0.27
0.09
0.18
0.18
0.27
Major DepressionMinor DepressionSub-SyndromalRemissionLost
Prognosis
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SummarySummary
Major depression is not common after cancer (in comparison to other types of depression)
Major depression corresponds poorly with the distress concept
Mj + Mn + SS depression => 85% of distressed patients
Future studies using DSMIV definitions should use minor and possibly SS depression