Screening for major depression in cancer outpatients

Abstract

BACKGROUND: Systematic screening for depression has been recommended for patients who have medical conditions like cancer. The 9-item Patient Health Questionnaire (PHQ-9) is becoming widely used, but its diagnostic accuracy has not yet been tested in a cancer patient population. In this article, the authors report on the performance of the PHQ-9 as a screening instrument for major depressive disorder (MDD) in patients with cancer. METHODS: Data obtained from a depression screening service for patients who were attending clinics of a Regional Cancer Centre in Edinburgh, United Kingdom were used. Patients had completed both the PHQ-9 and a 2-stage procedure to identify cases of MDD. Performance of the PHQ-9 in identifying cases of MDD was determined using receiver operating characteristic (ROC) analysis. RESULTS: Data were available on 4264 patients. When scored as a continuous measure, the PHQ-9 performed well with an area under the ROC curve of 0.94 (95% confidence interval [CI], 0.93-0.95). A cutoff score of !8 provided a sensitivity of 93% (95% CI, 89%-95%), a specificity of 81% (95% CI, 80%-82%), a positive predictive value (PPV) of 25%, and a negative predictive value (NPV) of 99% and could be considered optimum in a screening context. The PHQ-9 did not perform as well when it was scored using an algorithm with a sensitivity of 56% (95% CI, 55%-57%), a specificity of 96% (95% CI, 95%-97%), a PPV of 52%, and an NPV of 97%. CONCLUSIONS: The PHQ-9 scored as a continuous measure with a cutoff score of !8 performed well in identifying MDD in cancer patients and should be considered as a screening instrument in this population.

A multidimensional scale to measure the reproductive concerns of young adult female cancer survivors

“…Respondents are asked to rate how often they have been bothered by the following problems over the past two weeks with response categories ranging from 0 “Not at all” to 3 “Nearly every day.” Higher scores are indicative of more severe depression; scores of 5, 10, 15, and 20 correspond to mild, moderate, moderately severe, and severe depression, respectively. The PHQ-9 has been shown to have adequate construct validity and criterion validity [62, 63], and has been used in studies with cancer patients and survivors [64, 65]. The internal consistency for this sample was good (α = 0.86).…”

Risk Factors for Depression in Patients Undergoing Hematopoietic Cell Transplantation

“…The PHQ-9 has been validated for in-person self-report or interviewer administration as well as administration over the telephone [30–33] Standard PHQ-9 depression scores were categorized as follows: no (≤4), mild (5–9), moderate (10–14), moderately severe (15–19), or severe (≥20) depression. A score of 10 has been found to be the optimal cutoff for identifying probable major depressive disorder (sensitivity, 0.88; specificity, 0.88) in primary care patients [29].…”

Perceived and actual change in religion/spirituality in cancer survivors: Longitudinal relationships with distress and perceived growth.

“…The PHQ-9 corresponds to the Diagnostic and Statistical Manual criteria for Major Depressive Disorder and has demonstrated adequate reliability and validity (Kroenke et al, 2001; Thekkumpurath et al, 2011). The PHQ-9 assesses depressive symptoms over the past two weeks and was administered at all three time points.…”