Clinically Significant Depressive Symptoms Are Prevalent in People With Extremely Short Prognoses-A Systematic Review

Wei Lee; Marley Pulbrook; Caitlin Sheehan; Slavica Kochovska; Sungwon Chang; Annmarie Hosie; Elizabeth Lobb; Deborah Parker; Brian Draper; Meera R Agar; David C Currow

doi:10.1016/j.jpainsymman.2020.07.011

Clinically Significant Depressive Symptoms Are Prevalent in People With Extremely Short Prognoses-A Systematic Review

J Pain Symptom Manage. 2021 Jan;61(1):143-166.e2. doi: 10.1016/j.jpainsymman.2020.07.011. Epub 2020 Jul 17.

Authors

Affiliations

¹ University of Technology Sydney, Ultimo, New South Wales, Australia; St Vincent Hospital, Darlinghurst, New South Wales, Australia. Electronic address: Wei.lee@svha.org.au.
² St Vincent Hospital, Darlinghurst, New South Wales, Australia.
³ Calvary Hospital, Kogarah, New South Wales, Australia.
⁴ University of Technology Sydney, Ultimo, New South Wales, Australia.
⁵ St Vincent Hospital, Darlinghurst, New South Wales, Australia; University of Notre Dame Australia, New South Wales, Australia.
⁶ Calvary Hospital, Kogarah, New South Wales, Australia; University of Notre Dame Australia, New South Wales, Australia.
⁷ University of New South Wales, Randwick, New South Wales, Australia.

PMID: 32688012
DOI: 10.1016/j.jpainsymman.2020.07.011

Abstract

Context: Currently, systematic evidence of the prevalence of clinically significant depressive symptoms in people with extremely short prognoses is not available to inform its global burden, assessment, and management.

Objectives: To determine the prevalence of clinically significant depressive symptoms in people with advanced life-limiting illnesses and extremely short prognoses (range of days to weeks).

Methods: A systematic review and meta-analysis (random-effects model) were performed (PROSPERO: CRD42019125119). MEDLINE, Embase, PsycINFO, CINAHL, and CareSearch were searched for studies (1994-2019). Data were screened for the prevalence of clinically significant depressive symptoms (assessed using validated depression-specific screening tools or diagnostic criteria) of adults with advanced life-limiting illnesses and extremely short prognoses (defined by survival or functional status). Quality assessment was performed using the Joanna Briggs Institute Systematic Reviews Checklist for Prevalence Studies for individual studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) across studies.

Results: Thirteen studies were included. The overall pooled prevalence of clinically significant depressive symptoms in adults with extremely short prognoses (n = 10 studies; extremely short prognoses: N = 905) using depression-specific screening tools was 50% (95% CI: 29%-70%; I² = 97.6%). Prevalence of major and minor depression was 10% (95% CI: 4%-16%) and 5% (95% CI: 2%-8%), respectively. Major limitations included high heterogeneity, selection bias, and small sample sizes in individual studies.

Conclusions: Clinically, significant depressive symptoms were prevalent in people with advanced life-limiting illnesses and extremely short prognoses. Clinicians need to be proactive in the recognition and assessment of these symptoms to allow for timely intervention.

Keywords: Depression; Meta-analysis; Palliative Care; Prevalence; Prognoses; Systematic Review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Adult
Depression* / diagnosis
Depression* / epidemiology
Humans
Prevalence
Prognosis
Quality of Life*