Diagnosing major depression in medical outpatients: Acceptability of telephone interviews

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Abstract

Objective: To assess the acceptability to patients of a diagnostic interview for depression (Structured Clinical Interview for DSM-IV; SCID) conducted over the telephone to their homes. Method: Postal questionnaire survey of patients who had attended an oncology outpatient clinic where they had scored high on a screening questionnaire and had subsequently undergone an SCID interview over the telephone. Results: Of the 224 patients telephoned, five refused the diagnostic interview. Of the 219 who were interviewed, 184 satisfactorily completed and returned the postal questionnaire (84% response rate). Only 17% reported the interview to be distressing. Ninety-four percent of all questionnaire respondents and 84% (n=31) of those who reported the interview to have been distressing endorsed the item “Had I known in advance what answering the questions would have been like for me, I would still have agreed to take part”. Perceiving the interview as distressing was associated with having major depression (P<.001). Forty-seven percent said that, given the choice, they would have preferred a face-to-face interview. Conclusion: Telephone-administered diagnostic interviews are acceptable to most cancer patients and may even be preferred to face-to-face interviews at the hospital. This finding, together with the existing evidence of its validity, should encourage the use of telephone diagnostic interviews for depression, particularly when face-to-face interviews are impracticable, in both research studies and clinical practice. Indeed, a substantial proportion of patients may actually prefer them.

Introduction

Major depressive disorder (MDD) is highly prevalent among medical outpatients and is associated with increased symptom burden, reduced quality of life, increased medical costs, and poorer medical outcome [1]. The importance of depression has been particularly well documented in patients with cancer [2]. However, the evidence suggests that even in cancer services, depression is frequently undetected and consequently untreated [3].

It will be important therefore to develop better methods of detecting and diagnosing depression in patients attending specialist medical outpatient clinics including cancer clinics. One approach to this problem has been to screen patients systematically. Treatment decisions require that a diagnosis be made. Self-rated screening questionnaires are simple to administer but lack specificity as they also identify cases of transient distress. Therefore, if a positive diagnosis of major depression is required, it is necessary for those patients who are high scorers on the screening questionnaire to also be interviewed. However, in practice, this presents a problem. It is difficult to conduct diagnostic interviews during a clinic visit; questionnaires have to be scored in real time, places where interviews can be conducted are few, patients are often unable or unwilling to either spend time completing them during their visit or reattend for interview, and the requirement for the constant availability of a skilled interviewer is an expensive one.

We have sought to address this problem by conducting diagnostic interviews over the telephone to the patients' homes. We identified patients who were high scorers on a screening questionnaire routinely administered during their clinic visit. These patients were subsequently telephoned after they had returned home and invited to participate in a semistructured diagnostic interview for depressive disorder conducted over the telephone.

Being telephoned at home and asked questions about depression is a potentially intrusive and distressing experience. However, we are not aware of any previous studies that have assessed the acceptability to patients of such interviews.

The aim of the study was therefore to assess the acceptability of this procedure to patients. We also wanted to know if the interview was experienced as more distressing by patients with major depression.

Section snippets

Methods

As part of a clinical research and development programme concerned with improving the management of emotional disorders among outpatients attending the Regional Oncology Department, all clinic attenders were routinely asked to complete a Hospital Anxiety and Depression Scale (HADS) self-rated questionnaire [4]. The questionnaire was administered either via touch screen computer or by pencil and paper. Patients were informed at the time of completing the HADS that they might subsequently be

Results

Of the 224 patients who were screened positive, only five refused to complete the SCID diagnostic interview. Of the 219 who agreed to the telephone interview, 184 satisfactorily completed and returned the study questionnaire, a response rate of 84%. The characteristics of responders and nonresponders to the questionnaire are shown in Table 1.

Responders were more often male and more likely to be depressed than nonresponders, but these differences were not statistically significant. Among the

Discussion

These findings indicate that most oncology outpatients who have completed a screening questionnaire in the hospital find a diagnostic interview for depression administered over the telephone to their homes acceptable (although given a choice some patients would have preferred a face-to-face interview).

The main limitation of this study was that it was conducted in only one clinical centre using a single telephone interviewer. However, the study sample was obtained from a survey of consecutive

Acknowledgements

We would like to acknowledge the assistance of Vanessa Strong and Kirstine Postma and the intellectual contribution of Allan House, Peter Maguire, and Amanda Ramirez to this clinical research and development programme. Lothian University Hospitals Trust Funds funded this audit study. The research and development programme upon which the study is based was funded by the NHS National Cancer R&D Programme/Cancer Research Campaign and the Imperial Cancer Research Fund.

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This work was conducted in the Department of Psychiatry, University of Edinburgh and the Edinburgh Cancer Centre, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.

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