Depression means different things: A qualitative study of psychiatrists' conceptualization of depression in the palliative care setting

AbstractObjective:Medical practitioners conceptualize depression in different ways, which adds to the challenges of its diagnosis and treatment, as well as research in the palliative care setting. Psychiatric assessment is often considered the “gold standard” for diagnosis, therefore how psychiatrists conceptualize depression in this setting is pertinent. Our study aimed to investigate this issue.Method:Psychiatrists working in palliative care in Australia were individually interviewed using a semistructured approach. Nine participants were interviewed to reach data saturation. Interview transcripts were analyzed for themes.Results:Three overarching themes were identified: (1) depression means different things; (2) depression is conceptualized using different models; and (3) depression is the same concept within and outside of the palliative care setting. Participants explicitly articulated the heterogeneous nature of depression and described a different breadths of concepts, ranging from a narrow construct of a depressive illness to a broader one that encompassed depressive symptoms and emotions. However, depressive illness was a consistent concept, and participants considered this in terms of phenotypic subtypes. Participants used three models (spectral, dichotomous, and mixed) to relate various depressive presentations.Significance of Results:Psychiatrists did not subscribe to a unitary model of depression but understood it as a heterogeneous concept comprised of depressive illness and other less clearly defined depressive presentations. Given the influence of psychiatric opinion in the area of depression, these findings may serve as a platform for further discussions to refine the concepts of depression in the palliative care setting, which in turn may improve diagnostic and treatment outcomes.

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Psychiatric liaison in palliative care

Advances in Psychiatric Treatment ◽

10.1192/apt.9.4.241 ◽

2003 ◽

Vol 9 (4) ◽

pp. 241-248 ◽

Cited By ~ 10

Author(s):

Simon Dein

Keyword(s):

Palliative Care ◽

Care Setting ◽

Depressive Illness ◽

Care Staff ◽

Cognitive Behavioural ◽

Palliative Care Setting ◽

Total Care ◽

Body Image Disturbances ◽

Illness Anxiety

Palliative care is the active, total care of patients whose disease is not responsive to curative treatment. Psychological problems such as depressive illness, anxiety, delirium, problems coping and body image disturbances are common in the palliative care setting, although they are often missed. A full assessment of these patients should take into account physical, emotional and spiritual factors; therapeutic work should include the patient's family. Pharmacological (antidepressants, anxiolytics and antipsychotics) and cognitive–behavioural treatments are often effective in allaying distress in this group of patients, and can improve coping skills and quality of life. Liaison psychiatrists have a role in teaching palliative care staff to recognise psychiatric disorders. A number of case studies are presented to illustrate these points.

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Results of a pilot randomized controlled trial: A couple-based meditation intervention for patients with metastatic lung cancer and their partners.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.135 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 135-135

Author(s):

Kathrin Milbury ◽

Yisheng Li ◽

Sania Durrani ◽

Zhongxing X. Liao ◽

Claire Chunyi Yang ◽

...

Keyword(s):

Lung Cancer ◽

Palliative Care ◽

Depressive Symptoms ◽

Care Setting ◽

Early Stage ◽

Controlled Trial ◽

Self Report ◽

Metastatic Lung Cancer ◽

Palliative Care Setting ◽

Metastatic Lung

135 Background: Although mindfulness-based interventions have been widely examined in patients with early stage cancer, the feasibility and efficacy of these types of programs are largely unknown in the palliative care setting. We developed a couple-based intervention integrating meditation training with emotional disclosure exercises to target psychological distress in patients with metastatic lung cancer and their partners. Methods: Dyads completed baseline self-report measures and were then randomized to a couple-based meditation (CBM), a supportive-expressive (SE), or a waitlist control (WLC) group. Couples in the CBM and ES groups attended 4 weekly, 60 min. therapist-led sessions that were delivered via FaceTime. All groups were reassessed 1 month and 3 months later. Results: Seventy-five patients (51% female; mean age = 64 years) and their partners’ (52% female; mean age = 64 years) were randomized (63% consent rate) of which 79% completed the first and 65% completed the second follow-up assessments. Attrition was mainly due to patients’ death (44%). Although attendance was high in both groups (means: CBM = 3.12; SE = 3.08), dyads in the CBM group indicated greater benefit (P < .003) and usefulness (P < .05) of the sessions compared to those in the SE group. Compared with the WLC group, patients in the CBM group reported significantly lower depressive symptoms (P = .02; d = .49; CES-D means: CBM = 7.87; SE = 11.51; WLC = 12.76) and cancer specific distress (P = .05; d = .44; IES means: CBM = 12.40; SE = 16.34; WLC = 18.22). Similarly, compared with the WLC group, partners in the CBM group reported significantly lower depressive symptoms (P = .02; d = .58; means: CBM = 7.18; AC = 8.91; WLC = 11.62). For both patients and partners, there were no effects between SE and WLC groups. While small effects (d = .22-.42) in favor of the CBM group relative to the SE group were revealed, these differences were not significant. Conclusions: It seems to be feasible, acceptable and possibly efficacious to deliver dyadic interventions via FaceTime to couples coping with metastatic lung cancer. Mindfulness-based interventions may be of value to manage symptom burden in the palliative care setting. Clinical trial information: NCT02596490.

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The development of an abbreviated version of the Cornell scale for depression in dementia (CSDD) for the assessment of depression in palliative care inpatients

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.229 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S316-S316

Author(s):

M. Mohamad ◽

B. Davis ◽

F. Twomey ◽

M. Lucey ◽

M. Conroy ◽

...

Keyword(s):

Palliative Care ◽

Clinical Diagnosis ◽

Care Setting ◽

Clinical Information ◽

Depressive Illness ◽

Accurate Identification ◽

Diagnostic And Statistical Manual ◽

Palliative Care Setting ◽

Dsm Iv ◽

Competing Interest

IntroductionIn the palliative care setting, accurate identification of depression is important to allow delivery of appropriate treatments.Aims:– 1. To assess rates of depression in palliative care inpatients using the CSDD, comparing with formal clinical diagnosis based on diagnostic and statistical manual of mental disorders (DSM-IV) criteria;– 2. To identify items of the CSDD that most distinguish depressive illness in a palliative care setting.MethodsWe measured rates of depression in patients admitted into a palliative care inpatient unit with the CSDD. DSM-IV clinical diagnosis of major depressive disorder (MDD) was achieved using all available clinical information by an experienced independent rater. We calculated Cohen's Kappa to measure concordance between the CSDD and DSM-IV diagnosis.ResultsWe assessed 142 patients (56.3% male; mean age: 69.6 years), the majority of which had a cancer diagnosis (93.7%). 18.3% (n = 26) met DSM-IV criteria for MDD, while 12% scored ≥6 on the CSDD with 15 cases of depression common to these two methods (K = 0.65). Discriminant analysis identified five CSDD items that were especially distinguishing of MDD; sadness, loss of interest, pessimism, lack of reactivity to pleasant events and appetite loss. An abbreviated version of the CSDD, based on these 5 items, proved highly accurate in identifying DSM-IV MDD (AUC = 0.94), with sensitivity of 89% and specificity of 84% at a cut-off score ≥2.ConclusionsThere was good level of concordance between the CSDD and DSM-IV diagnosis of MDD. We identified five depressive symptoms that are especially discriminating for depression in palliative care patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Meeting the social, emotional and psychological needs of patients in a cancer palliative care setting: Student Nurses� experiences from Karachi, Pakistan

i-manager’s Journal on Nursing ◽

10.26634/jnur.1.1.1364 ◽

2011 ◽

Vol 1 (1) ◽

pp. 38-43

Author(s):

Nasreen Sulaiman Lalani ◽

◽

Shabana D. Lakhani ◽

Muslim Shah ◽

◽

...

Keyword(s):

Palliative Care ◽

Care Setting ◽

Student Nurses ◽

Psychological Needs ◽

Social Emotional ◽

The Social ◽

Palliative Care Setting

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Validation of the Phase II Feasibility Study in a Palliative Care Setting

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909112471422 ◽

2012 ◽

Vol 30 (8) ◽

pp. 752-758 ◽

Cited By ~ 9

Author(s):

Cindy Lee ◽

Ryash Vather ◽

Anne O’Callaghan ◽

Jackie Robinson ◽

Briar McLeod ◽

...

Keyword(s):

Palliative Care ◽

Feasibility Study ◽

Phase Ii ◽

Care Setting ◽

Palliative Care Setting

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Outcome measures for holistic, complex interventions within the palliative care setting

Complementary Therapies in Clinical Practice ◽

10.1016/j.ctcp.2007.10.001 ◽

2008 ◽

Vol 14 (1) ◽

pp. 25-32 ◽

Cited By ~ 12

Author(s):

Elizabeth Anita Thompson ◽

Tina Quinn ◽

Charlotte Paterson ◽

Helen Cooke ◽

Deidre McQuigan ◽

...

Keyword(s):

Palliative Care ◽

Outcome Measures ◽

Care Setting ◽

Complex Interventions ◽

Palliative Care Setting

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Bereaved spouses' adjustment after the patients' death in palliative care

Palliative & Supportive Care ◽

10.1017/s1478951507000594 ◽

2007 ◽

Vol 5 (4) ◽

pp. 397-404 ◽

Cited By ~ 24

Author(s):

Maria E. Carlsson ◽

Ingrid M. Nilsson

Keyword(s):

Palliative Care ◽

Sleep Disturbance ◽

Care Setting ◽

Significant Decline ◽

First Year ◽

Inclusion Criteria ◽

Life Situation ◽

Palliative Care Setting ◽

Advanced Home Care ◽

Grief Reactions

ABSTRACTObjectives:To improve the support to bereaved spouses during the year after the patient's death, a project was started consisting of three visits by a nurse (after 1, 3, and 13 months) with conversations about the patient's death and the spouse's life situation. The aim of this study was to describe the bereaved spouse's situation and adaptation during the first year after the loss.Methods:Spouses of patients cared for by The Advanced Home Care Team (APHCT) in Uppsala, Sweden, were invited to participate in the project. Each participant was encouraged to talk freely about his or her situation, but enough direction was given to ensure that all items listed on a standardized questionnaire were covered.Results:Fifty-one spouses met the inclusion criteria and were invited to participate and 45 accepted. The subjects felt quite healthy but were tired and suffered from sleep disturbance. The grief reactions had initially been high but showed a significant decline from 1 to 13 months (p < .01). Forty-nine percent had experienced postbereavement hallucinations.Significance of results:This study showed that the bereaved spouses felt quite healthy and adjusted quite well to their new life situation, after the patient's death in a palliative care setting. The grief reactions had initially been high but showed a significant decline during the year.

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