Is palliative care an intervention for depression? An examination of which factors are associated with remission

Dr Laura Goodwin, Postdoctoral Researcher, Institute of Psychiatry, King’s College London, UK

Annabel Price, Laura Goodwin and Lauren Rayner. Matthew Hotopf and William Lee

(Front row, left to right): Annabel Price, Laura Goodwin and Lauren Rayner. (Back row, left to right): Matthew Hotopf and William Lee

In 2007, a team of researchers from the Institute of Psychiatry, led by Professor Matthew Hotopf, set up an epidemiological study with the aim to provide a clearer picture on the prevalence and risk factors for depression in a palliative care setting.1 William Lee, Annabel Price and Lauren Rayner, clinicians and researchers in the Department of Psychological Medicine, managed the study and data collection and were successful in recruiting 300 participants. I joined the team a couple of years later as a health psychologist interested in psychosocial aspects of physical disease and we worked together on this paper which we are delighted has been chosen as the editor’s choice for the July edition of ‘Palliative Medicine’ (Goodwin et al, 2012).

This study followed on from initial research findings (Rayner et al, 2011) 2 showing that approximately half of those who met the criteria for ‘any’ depression at baseline no longer met this criteria four weeks after referral to palliative care services. We were interested in which baseline factors could differentiate between the patients who did and did not remain depressed, so that those at the highest risk of non-remission could be identified at the time of referral. Many of the baseline factors, including quality of life (QoL) and illness perceptions were not associated with change in depression status, but the most striking finding was that individuals reporting low social support from family and friends were found to have the greatest risk of remaining depressed. A further finding related to change in physical symptom burden, showing that symptom improvement paralleled a reduction in depressive symptoms, supporting what health professionals working in palliative care settings already know about the importance of effective symptom management.

So, in answer to the initial question this study highlights the potential effectiveness of palliative care services in treating physical and psychological symptoms, including depression. Furthermore, we showed that patients identified as having low social support may benefit the most from immediate treatment of their depression.

References
1. Goodwin L, Lee W, Price A, Rayner L, Monroe B, Sykes N, Hansford P, Higginson I and Hotopf M. Predictors of non-remission of depression in a palliative care population. Palliative Medicine 2012; 26 (5), 683-695. (To download a copy of this paper see below).

2. Rayner L, Lee W, Price A, Monroe B, Sykes N, Hansford P, Higginson I and Hotopf  M. The clinical epidemiology of depression in palliative care and the predictive value of somatic symptoms. Palliative Medicine 2011; 25(3), 229-241.

Find out more…
EAPC members and registered users of the EAPC website can download a free copy of this article and other ‘editor’s choice’ papers from the EAPC website 

Click here  to view other EAPC originated papers on the EAPC website.

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