An Attempt to Employ the Zung Self-Rating Depression Scale as a “Lab Test” to Trigger Follow-Up in Ambulatory Oncology Clinics

Abstract

We examined issues of criterion validity and detection of depression employing the Zung Self-Rating Depression Scale (ZSDS) as a "lab test" to trigger follow-up interviews of ambulatory oncology patients by oncology staff and the possibility of subsequent algorithm-based antidepressant treatment. Sixty oncology patients were screened with the ZSDS and then interviewed using the Mini-International Neuropsychiatric Interview (MINI). We examined the sensitivity and specificity of various cutoffs on the ZSDS and a briefer version, the Brief Zung Self-Rating Depression Scale (BZSDS) as they predicted results of the MINI, which was used as the criterion. Mean age of patients was 58.3 years (SD = 11.9). Thirty-two were female (53.3%) and 28 were male (46.7%). The correlation of the ZSDS (r = -0.66, P <.0001) and BZSDS (r = -0.57, P <.0001) with the MINI overall suggested acceptable levels of criterion validity. Additionally, we examined various cutoff scores on the ZSDS and BZSDS to explore the false negative and false positive rates that are associated with each. For example, using the mild cutoff on the Zung (score > 48) to determine depression or adjustment disorder, 14 false negatives and 2 false positives were found. When the more stringent moderate cutoff (score > 56) was used, 25 false negatives and 0 false positives were found. Oncology staff can utilize such data to make decisions about where to set cut-offs that trigger follow-up based on the amount of error that is allowable in their attempts to identify depressive symptoms in their patients. We discuss that such decisions might be based on many factors including the resources available in a particular site for follow-up or the comfort of particular oncologists and nurses managing and prescribing psychotropic medications, or in providing supportive counseling.

Adult Attachment, Shame, Depression, and Loneliness: The Mediation Role of Basic Psychological Needs Satisfaction.

“…Scores range from 20 to 80, with higher scores reflecting more depressive symptoms. Passik et al (2001) reported a coefficient alpha of .84. The coefficient alpha in the present study was .85.…”

Use of distress and depression thermometers to measure psychosocial morbidity among southern European cancer patients

“…[1] However, far less than 30% of cancer patients showing psychosocial problems are recognized in clinical settings by oncologists and thus referred to proper sources of psychological support [2,3]. Several psychometric instruments, such as the Hospital and Anxiety Depression Scale (HADS) [4][5][6], the Brief Symptom Inventory (BSI) [7], the Profile of Mood States (POMS) [8], and the Zung Depression Inventory [9] have been suggested as clinical tools to be routinely used in cancer settings in order to improve the detection of psychosocial morbidity, especially depression, and the referral of patients who resulted as "cases" [10,11]. Lack of time and lack of self-confidence in exploring psychosocial dimensions and in using psychometric instruments have been raised by cancer physicians as the most frequent barriers for not detecting and referring patients [12].…”

Cancer-related pain management in clinical oncology

“…Depression screening tests that have demonstrated beneft in oncology patients include the Patient Health Questionnaire, 37 the Zung Depression Scale, 38 and the Beck Depression Inventory. 39 Te Hospital Anxiety and Depression Scale is an efcient and commonly used screening tool for anxiety among cancer patients and can also help screen for depression.…”