An article on clinical depression may seem a bit of a reach for the Journal of Wound, Ostomy and Continence Nursing. However, it is not as unrelated to WOC nursing practice as one may think. This article depicts the pervasive nature of depression, and, most certainly, WOC nursing practice consists of many patients who are at high risk for depression. The author describes the increased incidence of depression in a group of women with urinary incontinence, as well as the effect of antidepressants on wound healing and bowel and bladder function. It is clear, however, that many of the people who are receiving healthcare are at some risk for depression. A small review of the literature reveals that some type of depressive symptoms can be found in patients with a great variety of medical conditions, such as burn injuries,1 chronic illnesses,2 head and neck cancers,3 rectal cancer,4 traumatic brain injury,5 and the institutionalized elderly.6 Because many of these patient populations frequently interface with WOC nurses, it is vital that the prevalence and known risk factors described by the authors are recalled. It is also interesting to note that, like our patients with pressure ulcers, one of the greatest risk factors for acquiring a pressure ulcer is having had a previous pressure ulcer; the same holds true for the patient who is depressed, where the most powerful predictor of a major depressive episode is a previous history of depression.

In addition to recognizing the risk factors for major depression, assessment of patients for evidence of depressive symptomatology is warranted. The article includes several tools and suggests specific scales for this purpose. How the clinician will manage to work these assessments into his or her practice depends on the practice setting itself, as well as the patient population.

The spectrum view of depression explains the range of depressive symptoms sometimes seen in various patients. In my experience as a clinician in an outpatient wound center with a population of mostly geriatric patients, I have experienced the gamut of the types of depression described.

A large part of the article contains information about antidepressant medications and their side effects, including effects on bowel and bladder function. This information is timely and important when considering the overall well-being of the patient population.

Recently, there has been a great deal of interest and emphasis on patient's quality of life, that is "those factors that contribute to the goodness and meaning of life, as well as people's happiness."7 Most assuredly, screening for the presence of depression, as well as ensuring appropriate follow up for those requiring diagnosis and treatment, contributes mightily to a patient's quality of life.

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