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Depression in patients with advanced illness: An examination of Ontario complex continuing care using the Minimum Data Set 2.0

Published online by Cambridge University Press:  07 December 2005

ANDREA GRUNEIR
Affiliation:
Department of Community Health, Brown University, Providence, Rhode Island
TREVOR FRISE SMITH
Affiliation:
Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada
JOHN HIRDES
Affiliation:
Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada Homewood Research Institute, Homewood Health Center, Guelph, Ontario, Canada
ROY CAMERON
Affiliation:
Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada Centre for Behavioural Research and Program Evolution, Canadian Cancer Society, National Cancer Institute of Canada

Abstract

Objective: In this study, we examined the prevalence of depression, its recognition, and its treatment in continuing care patients with advanced illness (AI).

Methods: All data were obtained from the Ontario (Canada) provincially-mandated MDS 2.0 form for chronic care. Of 3,801 patients, 524 met our empiric definition of AI, which was predicated on a previously validated algorithm. The MDS-embedded Depression Rating Scale (DRS) was used to measure psychological well-being and a score of 3 or greater indicated potential depression.

Results: Twenty-nine percent of patients with AI scored greater than 3, making them nearly twice as likely to be potentially depressed as other patients (OR 1.8, 95% CI 1.5–2.2). Despite this patients with AI were less likely to have received antidepressants (28.9% vs. 38.2%), even among those with a diagnosis (45.3% vs. 58.4%). Using logistic regression, correlates of potential depression were identified and surprisingly patients with cancer were substantially less likely to be depressed (AOR 0.37, 95% CI 0.2–0.6). Further investigation revealed that cancer patients were more likely to be treated for depression and to be recognized as being within the terminal phase of illness.

Significance of results: These findings suggest that a high proportion of terminally ill patients had unmet needs for psychological support. As well, they suggest that cancer patients received better targeted end-of-life care, which resulted in an overall decrease in psychological distress when compared to other patients with similarly advanced illness.

Type
Research Article
Copyright
© 2005 Cambridge University Press

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