The detection of depression in palliative care

Depression is prevalent in patients receiving palliative care. Though effective management strategies exist, depression is often not recognised and, therefore, not treated. This review will assess recent research on the detection of depression in palliative care and recommend directions for future research.

Screening is moderately effective in detecting depression in palliative care. It successfully excludes patients without depression, but is less effective in confirming 'caseness'. Clinicians prefer ultra-short screening methods consisting of one or two simple questions, but there is still uncertainty about which tool is optimal. Screening should supplement not substitute comprehensive clinical evaluation. Case-definitions of depression seldom take into account the duration of symptoms or their impact on functioning.

The ability to detect cases of depressive disorder may be less important than the ability to detect depressive symptoms remediable to treatment. This is reflected in the recent interest in conceptualising and detecting psychological distress. Evidence-based guidelines on the detection and management of depression in palliative care are needed to help standardise practice and improve patient outcomes.