The utility of the Brief Edinburgh Depression Scale (BEDS) in assessing severity of depression in advanced cancer patients

AimsWhen using an assessment tool, brevity and validity are essential. Although brief depression inventories exist, they rely heavily on the inclusion of somatic symptoms. This can be problematic in advanced cancer populations; weight loss and sleep disturbance are for the most part ubiquitous in these patients and may not necessarily be indicative of depression.The Brief Edinburgh Depression Scale (BEDS) is a 6-item shortened version of the Edinburgh Depression Scale which has been validated for use in patients with advanced cancer and is used internationally. The BEDS cut off threshold of 6/18 indicates that depression may be present. However, the BEDS currently provides no information regarding severity. The aim of this study is to establish severity thresholds for the BEDS by comparing it to another depression scale: the commonly used, rigorously validated, Patient Health Questionnaire (PHQ-9).Method284 advanced cancer patients attending hospice day services in the North West of England completed both the PHQ-9 and the BEDS. Mean participant age was 66.7 (Standard Deviation = 13.2) and the sample contained both males (n = 102, 36%) and females (n = 182, 64%). BEDS severity thresholds with the highest Sensitivity (Sn) and Specificity (Sp) were selected based on their ability to predict PHQ-9 categories.ResultA BEDS score of 4 to 6 was selected to indicate ‘mild depression’ (Sn = 81.7, Sp = 65); 7 to 8 ‘moderate depression’ (Sn = 74.8, Sp = 78.7); 9 to 11 ‘moderately severe depression’ (Sn = 82, Sp = 82.9) and 12 or more ‘severe depression’ (Sn = 63.2, Sp = 92.8). A linearly weighted kappa (with s weighting) showed a moderate level of agreement (0.47, 95% Confidence Interval: 0.40-0.54).ConclusionThe BEDS is a simple and brief tool used to screen for depression in advanced cancer patients. It is administered throughout the UK and multiple translation studies have enabled its global a (including in resource poor countries). The severity thresholds calculated here are derived from a large sample of patients with advanced cancer attending hospice services and demonstrate acceptable sensitivity and specificity in relation to the PHQ-9, a thoroughly validated reference standard. We conclude that the generated BEDS thresholds support use of the BEDS in determining the presence and severity of depression in advanced cancer populations.

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Validation of the Brief Edinburgh Depression Scale (BEDS) in a Mexican population with advanced cancer in a palliative care service

Palliative & Supportive Care ◽

10.1017/s1478951518000640 ◽

2018 ◽

Vol 17 (04) ◽

pp. 436-440 ◽

Cited By ~ 1

Author(s):

Oscar Rodríguez-Mayoral ◽

Bárbara Rodríguez-Ortíz ◽

Leticia Ascencio-Huertas ◽

Adriana Peña-Nieves ◽

Emma Verástegui ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Cancer Patients ◽

Advanced Cancer ◽

Depression Scale ◽

Case Finding ◽

Spanish Language ◽

Advanced Cancer Patients ◽

Major Depressive ◽

Palliative Patients

AbstractObjectiveDepression in palliative advanced cancer patients is common, but often goes unrecognized. One of the first steps toward improving detection is the development of tools that are valid in the specific language and setting in which they are to be used. The Brief Edinburgh Depression Scale (BEDS) is a sensitive case-finding tool for depression in advanced cancer patients that was developed in the United Kingdom. There are no validated instruments to identify depression in Mexican palliative patients. Our aim was to validate the Spanish-language version of the BEDS in Mexican population with advanced cancer.MethodWe conducted a cross-sectional study with outpatients from the palliative care unit at the Instituto Nacional de Cancerología in Mexico City. The Mexican BEDS was validated against a semistructured psychiatric clinical interview according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, classification criteria for major depressive disorder. The interviewer was blind to the BEDS score at the time of the assessment.ResultSeventy subjects completed the scale and interview. Women represented 71.4% of the sample and median age of subjects was 56.5 years (range, 20–85 years). The prevalence of major depressive disorder according to the psychiatric interview was 20%. The most valid cutoff for defining a case of depression was a score ≥5 of 18 on the Mexican BEDS, which gave a sensitivity of 85.7% and specificity of 62.5%. The scale's Cronbach's alpha was 0.71.Significance of resultsMajor depressive disorder is frequent in Mexican palliative patients. The Spanish-language Mexican version of the BEDS is the first valid case-finding tool in advanced cancer patients in this setting.

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The Role of Religiosity in Symptom Expression of Advanced Cancer Patients

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211041349 ◽

2021 ◽

pp. 104990912110413

Author(s):

Sebastiano Mercadante ◽

Claudio Adile ◽

Marianna Ricci ◽

Marco Maltoni ◽

Giuseppe Bonanno ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Social Relationship ◽

Karnofsky Performance Status ◽

Depression Scale ◽

Symptom Expression ◽

Advanced Cancer Patients ◽

Edmonton Symptom Assessment Scale ◽

Relevant Role

Aim: The aim of this study was to assess the religious pattern and its impact on symptom expression in patients with advanced cancer. Methods: A consecutive sample of advanced cancer patients screened at admission to palliative care. Standard epidemiological data were recorded. Patients were asked about their religious beliefs, the degree of social relationship to existing religions, the role of religion in their life, and the frequency of their prayer. The Edmonton Symptom Assessment Scale (ESAS) and Hospital Anxiety Depression scale (HADS) were assessed. Results: Two-hundred-eighty-three patients were screened. Age and gender were found to be independently correlated with religious belief (p = 0.042 and p = 0.016, respectively). Gender (females, p = 0.026), age (p = 0.003), lower Karnofsky performance status (KPS) (p = 0.022), and higher values of HADS-A (p = 0.003) were independently correlated with the degree of social relationship to existing religions. Gender (females, p = 0.002), lower KPS (p = 0.005), and higher values of HADS-A (p = 0.04) were independently correlated with a more relevant role of religiosity. Gender (females, p < 0.0005), lower KPS (p = 0.001), and drowsiness (p = 0.05) were independently correlated with frequency of prayer. Conclusion: The more the patients have demanding religious issues, the greater the state of anxiety, particularly in older and female patients with a lower KPS. The religious pattern did not have relevant role in the expression of other symptoms included in the ESAS.

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Episodic Breathlessness with and without Background Dyspnea in Advanced Cancer Patients Admitted to an Acute Supportive Care Unit

Cancers ◽

10.3390/cancers12082102 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2102

Author(s):

Sebastiano Mercadante ◽

Claudio Adile ◽

Patrizia Ferrera ◽

Giuseppe Bonanno ◽

Vincenzo Restivo ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Depression Scale ◽

Anxiety And Depression ◽

Hospital Anxiety ◽

Advanced Cancer Patients ◽

Clinical Appearance ◽

Factors Influencing ◽

Numerical Scale ◽

The Mean

Aim: To characterize episodic breathlessness (EB) in patients with advanced cancer, and to determine factors influencing its clinical appearance. Methods: A consecutive sample of advanced cancer patients admitted to an acute palliative care unit was surveyed. Continuous dyspnea and EB were measured by a numerical scale. The use of drugs used for continuous dyspnea and EB was recorded. Patients were asked about the characteristics of EB (frequency, intensity, duration and triggers). The Multidimensional dyspnea profile (MDP), the Brief dyspnea inventory (BDI), the Athens sleep scale (AIS) and the Hospital Anxiety and Depression Scale (HADS) were also administered. Results: From 439 advanced cancer patients surveyed, 34 and 27 patients had EB, without and with background dyspnea, respectively. The mean intensity and the number of episodes were higher in patients with background dyspnea (p < 0.0005 and p = 0.05, respectively). No differences in duration were observed. Most episodes lasted <10 min. A recognizable cause triggering EB was often found. The presence of both background dyspnea and EB was associated with higher values of MDP and BDI. EB was independently associated with frequency and intensity of background dyspnea (OR = 20.9, 95% CI (Confidence interval) 9.1–48.0; p < 0.0005 and OR = 1.97, 95% CI 1.09–3.58; p = 0.025, respectively) and a lower Karnofsky level (OR = 0.96, 95%CI 0.92–0.98, p = 0.05). Discussion: EB may occur in patients with and without continuous dyspnea, and is often induced by physical and psychological factors. EB intensity is higher in patients with continuous dyspnea. The duration was often so short that the use of drugs, as needed, may be too late, unless administered pre-emptively when the trigger was predictable.

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Advanced Cancer Patients’ Perceptions of Dignity

Journal of Palliative Care ◽

10.1177/0825859718759882 ◽

2018 ◽

Vol 33 (2) ◽

pp. 88-94 ◽

Cited By ~ 1

Author(s):

Sotiria Kostopoulou ◽

Efi Parpa ◽

Eleni Tsilika ◽

Stylianos Katsaragakis ◽

Irene Papazoglou ◽

...

Keyword(s):

Body Image ◽

Psychological Distress ◽

Cancer Patients ◽

Advanced Cancer ◽

Performance Status ◽

Depression Scale ◽

Physical Symptoms ◽

Role Identity ◽

Advanced Cancer Patients ◽

And Performance

Purpose: The present study assesses the relationship between patient dignity in advanced cancer and the following variables: psychological distress, preparatory grief, and sociodemographic and clinical characteristics. Methods: The sample consisted of 120 patients with advanced cancer. The self-administered questionnaires were as follows: the Preparatory Grief in Advanced Cancer Patients (PGAC), the Patient Dignity Inventory–Greek (PDI-Gr), the Greek Schedule for Attitudes toward Hastened Death (G-SAHD), and the Greek version of the Hospital Anxiety and Depression Scale (G-HADS). Results: Moderate to strong statistically significant correlations were found between the 4 subscales of PDI-Gr (psychological distress, body image and role identity, self-esteem, and social support) with G-HADS, G-SAHD, and PGAC ( P < .005), while physical distress and dependency was moderately correlated with depression. Multifactorial analyses showed that preparatory grief, depression, and age influenced psychological distress, while preparatory grief, depression, and performance status influenced body image and role identity. Conclusions: Preparatory grief, psychological distress, and physical symptoms had significant associations with perceptions of dignity among patients with advanced cancer. Clinicians should assess and attend to dignity-distressing factors in the care of patients with advanced cancer.

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Programmable Pump for Intrathecal Morphine Delivery to Cisterna Magna: Clinical Implications in Novel Management of Refractory Pain Above Middle Thoracic Vertebrae Level Utilizing a Prospective Trial Protocol and Review

Anesthesiology and Pain Medicine ◽

10.5812/aapm.115873 ◽

2021 ◽

Vol 11 (3) ◽

Author(s):

Chang Sun ◽

Yu-Tong Wang ◽

Yu-Jie Dai ◽

Zhi-Hui Liu ◽

Jing Yang ◽

...

Keyword(s):

Pain Relief ◽

Cancer Patients ◽

Advanced Cancer ◽

Short Form ◽

Intrathecal Morphine ◽

Prospective Trial ◽

Depression Scale ◽

Thoracic Vertebrae ◽

Advanced Cancer Patients ◽

Refractory Pain

Background: The cisterna Intrathecal Drug Delivery system (IDDS) with morphine has proven to be effective in treating refractory cancer pain above the middle thoracic vertebrae level in some countries. However, it has not been fully investigated in others. We designed the current project to investigate the efficacy and safety of cisterna IDDS for pain relief in refractory pain above the middle thoracic vertebrae level in advanced cancer patients. Methods: This study protocol allows for eligible cancer patients to receive the cisterna IDDS operation. Pain intensity (Visual Analogue scale, VAS), quality of life (36-Item Short-Form Health Survey, SF-36), and depression (Self-Rating Depression scale, SDS) are assessed along with side effects in the postoperative follow-up visits. Recent literature suggests a potential role for cisterna IDDS morphine delivery for refractory pain states above the middle thoracic level. Conclusion: The results of this study may provide further evidence that cisterna IDDS of morphine can serve as an effective and safe pain relief strategy for refractory pain above the middle thoracic vertebrae level in advanced cancer patients.

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Core Depressive Symptoms In Depressed Cancer OutpatientsB

Clinical Practice and Epidemiology in Mental Health ◽

10.2174/1745017901107010178 ◽

2011 ◽

Vol 7 (1) ◽

pp. 178-181 ◽

Cited By ~ 3

Author(s):

Massimo Pasquini ◽

Isabella Berardelli ◽

Ambra Cabra ◽

Annalisa Maraone ◽

Gabriella Matteucci ◽

...

Keyword(s):

Depressive Symptoms ◽

Cancer Patients ◽

Depressed Mood ◽

Rating Scale ◽

Depression Scale ◽

Well Being ◽

Mild Depression ◽

Self Assessment ◽

Moderate Depression ◽

Severity Of Depression

Objective: This study aimed to estimate the prevalence of core depressive symptoms among cancer outpatients diagnosed with depressive or adjustment disorders with depressed mood. We also aimed to detect potential differences between patient self-assessment and psychiatrist evaluation in classifying the severity of depression. Methods: Fifty-two outpatients diagnosed with solid tumor malignancy and depressive or adjustment disorder with depressed mood were assessed using the Hamilton Depression Rating Scale (HAMD-17) (and its shortened version the HAMD-7) and the Zung Self-Rating Depression Scale (ZSDS) (and its shortened version BZSDS). Results: Based on HAMD-7 results, the prevalence of moderate depression was low (7.7%); using the BZSDS moderate depression was absent. Mild depression was identified in 82.3% and 73% of our subjects using the HAMD-7 and the BZSDS, respectively. The strength of agreement between psychiatrist and patients’ self-evaluation for mild depression was “slight”, employing the original and the abbreviated versions of both scales. Conclusion: Our findings suggest that the prevalence of core depressive symptoms is very low in cancer patients diagnosed with depressive disorder. The lack of a strong agreement between psychiatrist and patient in classifying the severity of depression highlights the importance of factors such as well-being and functional status among depressed cancer patients in their self assessment of depression.

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