Is it appropriate to screen palliative care patients for depression?

It is estimated that approximately 25 percent of palliative care patients have symptoms of depression, but much of this depression is not identified and therefore not treated. Reasons for nonidentification include the difficulties of distinguishing between what can be called "appropriate sadness" and depression at the end of life and also the nondisclosure by patients of their own mood. In an effort to improve the early detection of depression, patients of all age groups referred to a clinical nurse specialist team within a six-month period were invited to complete the Edinburgh Postnatal Depression Scale (EPDS); the scale was found in an earlier study to have a sensitivity and specificity of above 80 percent at a cutoff threshold of 13 or above. The present study found that 34 percent of patients scored at or above the previously validated threshold of 13, and that younger patients (under age 50) were twice as likely to score above the threshold than were older patients (over age 70). The scale was easy to complete by patients, and staff found it useful as part of their initial assessment of patients. It is suggested that such a tool may aid the early detection and treatment of depression in palliative care patients.