Agreement for depression diagnosis between DSM-IV-TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer

Abstract

BackgroundDepression, a major outcome in cancer patients, is often evaluated by physicians relying on their clinical impressions rather than patient self-report. Our aim was to assess agreement between patient self-reported depression, oncologist assessment (OA), and psychiatric clinical interview (PCI) in elderly patients with advanced ovarian cancer (AOC).MethodsThis analysis was a secondary endpoint of the Elderly Women AOC Trial 3 (EWOT3), designed to assess the impact of geriatric covariates, notably depression, on survival in patients older than 70 years of age. Depression was assessed using the Geriatric Depression Scale-30 (GDS), the Hospital Anxiety Depression Scale, the distress thermometer, the mood thermometer, and OA. The interview guide for PCI was constructed from three validated scales: the GDS, the Hamilton Depression Rating Scale, and the Montgomery Asberg Depression Rating Scale (MADRS). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised (DSM) criteria for depression were used as a gold standard.ResultsOut of 109 patients enrolled at 21 centers, 99 (91%) completed all the assessments. Patient characteristics were: mean age 78, performance status ≥2: 47 (47%). Thirty six patients (36%) were identified as depressed by the PCI versus 15 (15%) identified by DSM. We found moderate agreement for depression identification between DSM and GDS (κ=0.508) and PCI (κ=0.431) and high agreement with MADRS (κ=0.663). We found low or no agreement between DSM with the other assessment strategies, including OA (κ=−0.043). Identification according to OA (yes/no) resulted in a false-negative rate of 87%. As a screening tool, GDS had the best sensitivity and specificity (94% and 80%, respectively).ConclusionThe use of validated tools, such as GDS, and collaboration between psychologists and oncologists are warranted to better identify emotional disorders in elderly women with AOC.

The Validity of the Montgomery-Asberg Depression Rating Scale in an Inpatient Sample with Alcohol Dependence

“…The optimal cut-point identified by the Euclidean distance was 14; however, as this cut-point had a relatively low sensitivity and specificity, we are unable to endorse the use of a cut-point for identifying potential depression using the MADRS. This finding may be due to AD and depression both being mental health conditions rather than one being a physical condition, as was the case with the previous studies (Leentjens et al, 2000, Rhondali et al, 2015, Duarte-Guerra et al, 2016). Distinguishing between the two conditions may be more difficult among our study sample due the possibility of alcohol-induced depressive symptoms.…”

“…This has previously been demonstrated in other populations where somatic overlap of symptoms occurs, e.g. bariatric surgery patients (Duarte-Guerra et al, 2016), patients with Parkinson’s disease (Leentjens et al, 2000) and geriatric populations with ovarian cancer (Rhondali et al, 2015). These studies found the MADRS to have a high sensitivity and specificity compared to a clinical diagnosis of a depressive disorder.…”

“…Duarte-Guerra and colleagues found a 13/14 cut score on the MADRS demonstrated a sensitivity of 85% and specificity of 81% among bariatric surgery patients (Duarte-Guerra et al, 2016). Similarly, Leentjens et al found a 14/15 cut score among patients with Parkinson’s Disease had a sensitivity of 88% and a specificity of 89% (Leentjens et al, 2000), and Rhondali et al found a cut score of 16 to have a 88% sensitivity and 91% specificity in elderly patients with ovarian cancer (Rhondali et al, 2015). The present study failed to replicate these findings in an alcohol-dependent inpatient sample.…”

“…This study has one of the largest sample sizes used to evaluate MADRS in a targeted sample (Leentjens et al, 2000, Duarte-Guerra et al, 2016, Rhondali et al, 2015). The inpatient setting allowed for a careful monitoring of alcohol abstinence and withdrawal.…”

The health-related quality of life journey of gynecologic oncology surgical patients: Implications for the incorporation of patient-reported outcomes into surgical quality metrics

“…Finally, although the point has been well made in other publications, 19–21 we want to emphasize the discrepancy between patient-reported anxiety and depression levels, and the limited notation of such in the medical record. Patient reported outcomes have the power, right now, to better inform us of the physical and mental wellbeing of our patients.…”