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