Time and life perception in the terminally ill: its utility in screening for depression

The objective was to explore the utility of a new three-item depression screening tool concerning time and life perception (TLP-3), compared with the DSM-IV criteria.

This was a cross-sectional study of 63 Portuguese terminally ill patients, from May 2010 to November 2012. Patients were eligible if they fulfilled the following inclusion criteria: age ≥18 years old; having a life-threatening disease with prognosis of 6 months or less; no evidence of dementia or delirium, based on documentation within the medical chart or by clinical consensus; Mini Mental State score ≥20; being able to read and speak Portuguese; and provision of written informed consent. Participants were assessed for depression using DSM-IV criteria and the newly developed TLP-3. Screening performance for depression using the TLP-3 compared with DSM-IV was calculated using measures of sensitivity, specificity, positive and negative predictive values. Logistic regression was calculated with the aim of identifying variables with the best predictive ability for diagnosing depression.

After logistic regression analysis was made to all three items composing TLP-3, only two items were maintained (OR=2.9, 95% CI [0.9-8.7]; OR=7.6, 95% CI [0.9-65.3], respectively). This final regression model composed of two questions (TLP-2) was able to diagnose correctly 70% of the depressed patients with a sensitivity of 63% and a specificity of 74%. The area under the ROC curve was 72% (95% CI [59-85]).

TLP-3 is a novel and clinically applicable approach to assessing depression among palliative care patients. Further investigation is needed on the psychological significance of time and life perception distortions, and its possible application to screen for depression among patients nearing end of life.