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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.
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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
[A] About Depression subtypes
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
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
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
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
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
=> Symptoms
PHQ9PHQ9
Linear vs algorithmic PHQ
The mean score on the PHQ9 was 6.1
23.3% scored above 9
17.7% scored above 10
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
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)
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.
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
[B] About Clinical Significance
How To Establish Clinical SignificanceHow To Establish Clinical Significance
Correlation with HADS?
Correlation with Distress Thermometer?
Correlation with who wants help?
Prognostic significance
Disability
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
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
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%)
Major Depression26%
Minor Depression12%
Subsyndromal Depression
47%
None of above15%
DistressedPatients
OutcomeOutcome0.27
0.09
0.18
0.18
0.27
Major DepressionMinor DepressionSub-SyndromalRemissionLost
Prognosis
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
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