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A Flexible Item to Screen for Depression in Inner-City Minorities During Palliative Care Symptom Assessment

From Columbia University School of Social Work, New York, NY.

Objective: There is inconsistent evidence for the validity of a single item to screen depression. In inner-city minority populations, the "yes/no" forced-response option may encourage bias, especially in elders and men, who view depression as stigmatizing or the healthcare system as untrustworthy. In contrast, an open-choice format with a category for ambivalent and missing responses could be acceptable if administered during the legitimized context of a physical symptom assessment.

Method: Retrospective data were analyzed from 146 black and Latino inner-city patients receiving palliative care for various physical conditions. Bivariate analyses and ordinal regressions are based on the most recent comprehensive patient assessment conducted by a black female nurse and a bilingual Latina social worker.

Results: The depression item (no, unknown, yes) predicts pain and symptom attitude, which is more "hopeful" in older men with unknown depression status than in younger and older women with unknown depression status or no depression.

Conclusions: The more "hopeful" pain and symptom attitudes by older men in the unknown category for depression suggest that depression, apathy, and resignation in older minority men may be hidden from clinicians in the absence of the open-choice depression item.

Key Words: Depression • diagnosis and classification • mental health/physical health interactions • pain

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