Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
PLoS One. 2011;6(11):e27181. doi: 10.1371/journal.pone.0027181. Epub 2011 Nov 14.
Several practice guidelines recommend screening for depression in cancer care, but no systematic reviews have examined whether there is evidence that depression screening benefits cancer patients. The objective was to evaluate the potential benefits of depression screening in cancer patients by assessing the (1) accuracy of depression screening tools; (2) effectiveness of depression treatment; and (3) effect of depression screening, either alone or in the context of comprehensive depression care, on depression outcomes.
Data sources were CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO and SCOPUS databases through January 24, 2011; manual journal searches; reference lists; citation tracking; trial registry reviews. Articles on cancer patients were included if they (1) compared a depression screening instrument to a valid criterion for major depressive disorder (MDD); (2) compared depression treatment with placebo or usual care in a randomized controlled trial (RCT); (3) assessed the effect of screening on depression outcomes in a RCT.
There were 19 studies of screening accuracy, 1 MDD treatment RCT, but no RCTs that investigated effects of screening on depression outcomes. Screening accuracy studies generally had small sample sizes (median = 17 depression cases) and used exploratory methods to set sample-specific cutoff scores that varied substantially across studies. A nurse-delivered intervention for MDD reduced depressive symptoms moderately (effect size = 0.37).
The one treatment study reviewed reported modest improvement in depressive symptoms, but no evidence was found on whether or not depression screening in cancer patients, either alone or in the context of optimal depression care, improves depression outcomes compared to usual care. Depression screening in cancer should be evaluated in a RCT in which all patients identified as depressed, either through screening or via physician recognition and referral in a control group, have access to comprehensive depression care.
一些实践指南建议在癌症护理中筛查抑郁症，但尚无系统评价检查抑郁症筛查是否对癌症患者有益。本研究旨在通过评估（1）抑郁筛查工具的准确性；（2）抑郁治疗的效果；（3）单纯或在综合抑郁护理的情况下进行抑郁筛查对抑郁结局的影响，来评估癌症患者中进行抑郁筛查的潜在获益。
数据来源为 2011 年 1 月 24 日前的 CINAHL、Cochrane、EMBASE、ISI、MEDLINE、PsycINFO 和 SCOPUS 数据库、手工检索杂志、参考文献列表、引文追踪、试验注册处审查。如果符合以下标准的癌症患者相关研究则被纳入：（1）将抑郁筛查工具与重度抑郁障碍（MDD）的有效标准进行比较；（2）在随机对照试验（RCT）中，将抑郁治疗与安慰剂或常规护理进行比较；（3）在 RCT 中评估筛查对抑郁结局的影响。
有 19 项研究评估了筛查的准确性，1 项 MDD 治疗 RCT，但没有 RCT 调查筛查对抑郁结局的影响。筛查准确性研究的样本量通常较小（中位数为 17 例抑郁病例），并使用探索性方法设定了特定于研究的样本截断分数，这些分数在不同研究中差异较大。一项针对 MDD 的护士干预措施可适度减轻抑郁症状（效应量为 0.37）。
综述的一项治疗研究报告称抑郁症状有适度改善，但未发现癌症患者进行抑郁筛查（无论是单独进行还是在最佳抑郁护理的情况下进行）是否比常规护理更能改善抑郁结局。应在 RCT 中评估癌症患者的抑郁筛查，在 RCT 中，所有被识别为抑郁的患者（无论是通过筛查还是通过对照组中的医生识别和转诊）都可以获得综合的抑郁护理。
