Screening for Distress and Depression in Cancer Patients: Is Ultrashort Depression Screening a Valid Measure in the UK? A Prospective Validation Study

Abstract

This study sought to validate the two-question (2Q) depression screen as a screening tool for psychological distress and depression against four criterion measures (Hospital Anxiety and Depression Scale [HADS], General Health Questionnaire-12, Brief Symptom Inventory-18 [BSI-18], and the distress thermometer) for a UK cancer population. We used a prospective cross-sectional study design. A consecutive sample of 399 outpatients from four outpatient oncology clinics and a palliative care day center in North London were initially identified. Of these, 249 were eligible, of whom 171 consented to take part. Data were analyzed using receiver operating characteristic analysis to examine the sensitivity and specificity of the 2Q depression instrument against the cutoff scores already shown to demonstrate clinically significant symptoms ("caseness") in the criterion measures. Sensitivity and specificity, with 95% confidence intervals, were calculated in addition to positive and negative predictive values. The 2Q depression screen showed sensitivity of 68%-89% and specificity of 70%-84% when compared with our four criterion measures in screening for psychological distress; its best performance was against the HADS (89% sensitivity and 79% specificity). In screening for depression, the 2Q depression screen showed sensitivity of 84%-94% and specificity of 72%-73% when compared with our two criterion measures, its best performance being against the BSI depression subscale (94% sensitivity and 72% specificity). Our study demonstrated that the 2Q depression screen showed good psychometric properties, which further supports its usefulness as a simple instrument in screening for psychological distress in cancer patients in the UK.

Sensitivity and specificity of the Distress Thermometer and a two‐item depression screen (Patient Health Questionnaire‐2) with a ‘help’ question for psychological distress and psychiatric morbidity in patients with advanced cancer

“…In examining the diagnostic accuracy of the screening tools, we also calculated sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV). In line with similar studies , levels of sensitivity, specificity, PPV or NPV of >70% were considered acceptable, whereas levels of >80% were considered good. We also calculated two composite scores of overall diagnostic accuracy: Youden's J (sensitivity + specificity − 1), which is unaffected by prevalence and the Predictive Summary Index (PPV + NPV − 1), which reflects the prevalence among the sample .…”

Insights Into Preferences for Psycho-Oncology Services Among Women With Gynecologic Cancer Following Distress Screening

“…The DT is one of the best known tools for distress screening. 8,[12][13][14] In addition, several studies have supported its convergent validity with the Hospital and Anxiety Depression Scale. 8,13,15 A cutoff score of 4 typically results in optimal sensitivity and specificity.…”

Manualised cognitive–behavioural therapy in treating depression in advanced cancer: the CanTalk RCT

“…42 The simplest method asks two simple questions 43 that have been shown to exclude depression in non-depressed individuals in cancer and palliative care with a 97% negative predictive value. 44,45 The first two questions of the Patient Health Questionnaire-9 (PHQ-9), known as the Patient Health Questionnaire-2 (PHQ-2), are routinely used to screen for depression in primary care. Such brief screening is acceptable if followed by a clinical interview to confirm the clinical diagnosis of depression.…”