Development of a brief screening interview for adjustment disorders and major depression in patients with cancer

Abstract

BACKGROUNDAdjustment disorders and major depression are common psychiatric disorders in patients with cancer and have a serious impact on quality of life. The problem in clinical oncology settings is underrecognition of these disorders; as a result, screening is recommended to detect them. The goal of the current study was to develop a new, brief screening tool for adjustment disorders and major depression and to compare its performance with that of existing screening methods.METHODSPatients with cancer completed the newly developed One‐Question Interview (a 1‐item, structured interview); the Distress Thermometer (a 1‐item, self‐report questionnaire), which previously was developed as a brief screening tool; and the Hospital Anxiety and Depression Scale (HADS; a 14‐item, self‐report questionnaire). Psychiatric diagnoses of adjustment disorders and major depression were made by psychiatrists and were based on criteria set forth by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.RESULTSTwo hundred seventy‐five patients participated in the study. Scores on both the One‐Question Interview and the Distress Thermometer were significantly correlated with HADS score (One‐Question Interview: r = −0.66, P < 0.01; Distress Thermometer: r = 0.71, P < 0.01). At the optimal cutoff points, the sensitivity and specificity for detection of adjustment disorders and major depression were 80% and 61%, respectively, for the One‐Question Interview; 84% and 61%, respectively, for the Distress Thermometer; and 92% and 57%, respectively, for the HADS.CONCLUSIONSThe results of the current study suggested that the One‐Question Interview was a valid tool for use in screening patients with cancer for adjustment disorders and major depression. Its performance was inferior to that of the HADS but comparable to that of the Distress Thermometer. The One‐Question Interview may be suitable for widespread use in routine screening. Cancer 2003;10:2605–13. © 2003 American Cancer Society.DOI 10.1002/cncr.11358

Distress screening in a multidisciplinary lung cancer clinic: Prevalence and predictors of clinically significant distress

“…The Distress Thermometer (DT) is a visual-analog tool developed to efficiently screen for distress in cancer patients [7,[33][34][35]. The sensitivity, specificity, and appropriate cut-off score of the DT are established [16], with scores of 4 or above indicative of clinically-significant levels of distress.…”

“…The DT has been used to evaluate distress in patients diagnosed with prostate cancer [33], patients undergoing bone marrow transplant [34], and ambulatory cancer patients with mixed cancer diagnoses [7,16,35]. Categories of symptoms consistently associated with clinicallysignificant levels of distress on the DT were emotional, family, and physical problems.…”

“…In prior research on the DT with ambulatory cancer patients, less than 100 lung cancer patients participated across three studies [7,16,35]. Given that lung cancer is the leading cause of cancerrelated death for women and men [36], additional information on rates and predictors of distress in this population is needed.…”

“…Younger patients and women report higher levels of distress [7,11,14,15], and individuals with lung cancer, compared to individuals with other cancer diagnoses, also report higher levels of distress [15,17]. Approximately 43% of patients with lung cancer report clinically-significant levels of distress [15,18], compared to about 33% of patients with breast cancer and 32% of patients with colon cancer [15].…”

“…Distress has been defined as "a multifactorial, unpleasant experience of an emotional, psychological, social, or spiritual nature that interferes with the ability to cope with cancer, its physical symptoms, and its treatment" [1,2]. In the oncology context, distress is multifactorial, as numerous areas in a patient's life contribute to his or her experience of distress, including physical symptoms, disease severity, treatment [3,4]; physical activity level / performance status [5][6][7]; social support (for a review see [8]); and psychological factors such as optimism [9,10], coping style [11,12], and pre-morbid or current depression [13].…”