BackgroundThe Patient Health Questionnaire PHQ-9 is a widely used instrument to screen for depression in clinical research. The first aim of this study was to psychometrically test the PHQ-9 in a large sample of cancer patients. The second aim was to calculate unbiased estimates of the depression burden for several cancer groups taking into account age and gender distributions.MethodsA sample of 2,059 cancer patients with varying diagnoses were examined in this study six months after discharge from a rehabilitation clinic. A representative sample of 2,693 people from the general population served as controls. Expected PHQ-9 mean scores of the general population sample, regressed on age and gender, were calculated to enable a fair comparison of different groups of cancer patients.ResultsWhile the reliability (Cronbach’s alpha) for the PHQ-9 scale was good (alpha ≥ 0.84), the CFA fit indices of the one-dimensional solution were unsatisfactory in the patients’ sample. The factorial analysis confirmed two factors. PHQ-9 mean scores for 15 types of cancer are given, ranging from 4.0 (prostate) to 8.2 (thyroid gland). Differences between expected mean scores (derived from the general population) and raw mean scores of the cancer subsamples are reported that provide a better estimate of the depression burden.ConclusionsThe results confirmed that the PHQ-9 performs well in testing depression in cancer patients. Regression coefficients can be used for performing unbiased comparisons among cancer groups, not only for this study. The burden of patients with testis cancer and Hodgkin lymphoma is underestimated when age and gender are not taken into account.

Objective:To extend evidence on the short-term variability of passive and active suicidal ideation (SI) and the association with suggested proximal risk factors such as interpersonal variables (perceived burdensomeness [PB], thwarted belongingness [TB], hopelessness, and depression) in real-time.Methods:This is an observational study using a prospective design applying ecological momentary assessments (EMA). Eligible for study inclusion were inpatients with unipolar depression, current or lifetime suicidal ideation, and fluent German. Over six days, 74 participants rated their momentary level of passive and active SI, PB, TB, depressiveness, and hopelessness up to 10 times per day on smartphones. Data was collected from August 2015 to July 2017. Compliance was excellent (89.7%).Results:Mean squared successive differences supported temporal instability for all variables. According intra-class correlations, between 25% and 47% of variance was accounted for by within-person variability. Multilevel analysis demonstrated significant positive associations between hopelessness, depressiveness, PB, and TB with passive SI. Prospectively, hopelessness and PB remained predictors of passive SI. For active SI, hopelessness, depression, PB, and TB were significantly associated cross-sectionally. Prospectively, hopelessness, PB, and the interaction PBxTB predicted active SI. All models were controlled for previous level of SI.Conclusions:This study provides further evidence on the short-term variability of SI in very short time frames implying the need of assessing SI repeatedly in clinical and research settings. The associations between interpersonal variables and passive and active SI were only partial in line with assumptions of the Interpersonal Theory of Suicide. Overall, the effects were small warranting further investigation.

Suicidal ideation is a major risk factor for suicidal behavior and has recently been shown to be fluctuating in studies applying ecological momentary assessments (EMAs). The aims of this study are to introduce a reliable and valid item set for assessing suicidal ideation and relevant proximal risk factors that can be used in future EMA studies within suicidology. Additionally, we provide data on the ability of the items to capture moment-to-moment variability and discuss feasibility aspects of EMA studies on suicidal ideation in a clinical sample. Psychiatric inpatients diagnosed with a depressive disorder (N = 74) rated a set of 28 items measuring suicidal ideation, thwarted belongingness, perceived burdensomeness, depression, anxiety, hopelessness, and positive affect 10 times per day on 6 consecutive days. In addition, these constructs were assessed by self-report questionnaires before and after the EMA period. Intraclass correlations and mean squared successive differences were calculated as indicators of item variability. Reliability was calculated at the prompt (within-person) and the person (between-person) level, applying an approach based on multilevel factor analysis. Convergent validity was assessed by correlating the EMA scores with a self-report questionnaire measuring the same constructs. All items demonstrated moment-to-moment-variability and substantial within-person variance. Moreover, all items and scales, except those assessing anxiety, showed satisfying reliability at the prompt and the person level, and correlations indicated convergent validity of the EMA item set. Compliance with the EMAs was excellent (89.7%). Researchers are encouraged to apply this useful tool in future EMA studies in the field of suicidology.

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