Thoughts of self-harm and depression as prognostic factors in palliative care patients

This study explored whether scores indicating depression on Patient Health Questionnaire 9 and patient reports of thoughts of self-harm were prognostic factors for survival in advanced cancer.

Patients with advanced cancer were recruited into the study from palliative care day units and invited to complete measures for depression which included Patient Health Questionnaire 9, and Edinburgh Depression Scale at recruitment, and at 8, 16 and 24 weeks.

629 patients were recruited into the study; 139 (22%) died during 6 months follow up and 235 patients (37.4%) died during the study period. The age range of patients recruited was 21-94 years-mean age 66 years and 67% of patients recruited were female. The overall median survival of patients recruited was 37.1 weeks (95% CI 36.0, 39.9 weeks) (range 0-116 weeks). The estimated median survival time of patients whose baseline PHQ9≥9 was 36 weeks with 95% confidence interval of (31, 39) and for patients whose baseline PHQ9<9 was 39 weeks (95% CI 37, 45)-baseline PHQ9 alone was predictive of death. The median survival times were 37.9 weeks for patients who did not indicate thoughts of self-harm and 34.7 weeks for patients who reported thoughts of self-harm at baseline suggesting that risk of death was 1.4 times higher among patients who reported thoughts of self-harm.

Patients were recruited only from within palliative day care units and assessments were made only by validated tools and not by clinical interviews.

In this large longitudinal study, moderate to severe depression as measured by PHQ9 and patient reports of thoughts of self-harm were associated with earlier mortality. This paper supports the need for supporting patients psychologically at the end of life and specifically in treating depression in this patient group.