Identifying and Measuring Depression in Older Cancer Patients

描述(申请人提供)：国际移民组织的报告称，到2030年，20%的人口将超过65岁。目前，60%的癌症诊断和70%的癌症死亡发生在这个年龄段。在这个国家，几乎三分之二的癌症幸存者是老年人，而且在接下来的20到30年里，这一比例将继续上升。抑郁症被认为是老年人最担心的五大问题之一，老年癌症患者抑郁障碍的患病率从17%到25%不等。抑郁症，从孤立的抑郁症状到严重的抑郁障碍，都与生活质量下降、体力活动恶化、人际关系困难、照顾者负担和更大的疼痛有关。据估计，美国每年因抑郁症造成的经济负担超过520亿美元。然而，尽管抑郁症的高患病率和有害影响，老年癌症患者被诊断为抑郁症(严重或轻微)的可能性远远低于任何其他年龄段。老年癌症患者抑郁被低估的一个原因是，这些患者可能不会报告经典的DSM-IV标准。抑郁的自我报告措施通常是识别抑郁症状和进行适当的心理健康转介的一种有效和经济的方法。然而，缺乏心理测量数据来确定现有抑郁测量工具在老年癌症患者中的有效性，而且由于这些工具通常基于DSM标准或经典的抑郁症状，它们不太可能有效地评估这一人群中的抑郁症状。这项建议代表了一项旨在识别、量化并最终缓解老年癌症患者抑郁的研究计划的第一步，并将探索患有癌症的老年人如何表现出抑郁症状，并制定适合这一庞大但未得到充分认识的人群的自我报告量表。这项建议的目的是：1)确定老年癌症患者抑郁的现象学；2)开发一套确定老年癌症患者抑郁的指标，并以问卷项目的形式实施这些指标；3)评估根据老年癌症患者的需求定制的抑郁自我报告的初步心理测量学特性。

DESCRIPTION (provided by applicant): The IOM Report states that by 2030, 20% of the population will be over 65. Currently, 60% of cancer diagnoses and 70% of deaths from cancer occur in this age group. Almost two-thirds of cancer survivors in this country are elderly and these percentages will continue to rise for the next 20 to 30 years. Depression is considered one of the top five concerns for the elderly and the prevalence of depressive disorders in older cancer patients ranges from 17-25%. Depression, throughout the spectrum from isolated depressive symptoms to major depressive disorder, is associated with decreased quality of life, deterioration in physical activities, relationship difficulties, caretaker burden, and greater pain. The economic burden of depression in the US has been estimated to be greater than 52 billion dollars a year. Yet, despite the high prevalence rates and deleterious effects of depression, elderly cancer patients are far less likely to be diagnosed with depression (major or minor) than any other age group. One reason for the underdiagnosis of depression in older cancer patients is that these patients may not report classic DSM-IV criteria. Self-report measures of depression are often an efficient and cost-effective way to identify depressive symptoms and make appropriate mental health referrals. However, there is a dearth of psychometric data establishing the validity of existing depression measurement tools in older cancer patients, and because these instruments are typically based on DSM criteria or classic symptoms of depression, it is unlikely that they can effectively assess depressive symptoms in this population. This proposal represents the first step in a program of research geared towards identifying, quantifying, and ultimately alleviating depression in older cancer patients, and will explore how older adults with cancer experience and express depressive symptomatology and develop a self-report scale tailored to this large, but under-recognized, population. The aims of this proposal are: 1) To identify the phenomenology of depression in older cancer patients, 2) To develop a set of indicators to identify depression in older cancer patients and operationalize these indicators in the form of questionnaire items, and 3) To evaluate the preliminary psychometric properties of a self-report measure of depression tailored to the needs of older cancer patients.