title: Accuracy of the Danish version of the 'distress thermometer'.
abstract: OBJECTIVE
  Short screening instruments have been suggested to improve the detection of psychological symptoms. We examined the accuracy of the Danish version of the 'Distress Thermometer'.
  
  
  METHODS
  Between October 2008 and October 2009, 426 women with newly diagnosed primary breast cancer who were operated at the Breast Surgery Clinic of the Rigshospitalet, Copenhagen, were eligible for this study. Of these, 357 participated (84%) and 333 completed a questionnaire. The distress thermometer was evaluated against the 'hospital anxiety and depression scale' (HADS). We also examined the women's wish for referral for psychological support.
  
  
  RESULTS
  A cut-off score of 6 vs 7 (low: ≤6, high: ≥7) on the distress thermometer was optimal for confirming distress, with a sensitivity of 42%, a specificity of 93%, a positive predictive value (PPV) of 78% and a negative predictive value (NPV) of 73%. A cut-off score of 2 vs 3 was optimal for screening, with a sensitivity of 99%, a specificity of 36%, a PPV of 47% and a NPV of 99%. Of those who were distressed using the cut-off score of 2 vs 3 on the distress thermometer, 17% (n = 41) wished to be referred for psychological support and 57% (n = 140) potentially wanted a later referral.
  
  
  CONCLUSIONS
  The distress thermometer performed satisfactorily relative to the HADS in detecting distress in our study. A screening procedure in which application of the distress thermometer is a first step could be useful for identifying persons in need of support.
authors.affiliation: Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark. pernille@cancer.dk
authors.forename: Pernille Envold
authors.initials: PE
authors.lastname: Bidstrup
authors.forename: Birgitte Goldschmidt
authors.initials: BG
authors.lastname: Mertz
authors.forename: Susanne Oksbjerg
authors.initials: SO
authors.lastname: Dalton
authors.forename: Isabelle
authors.initials: I
authors.lastname: Deltour
authors.forename: Niels
authors.initials: N
authors.lastname: Kroman
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: Nina
authors.initials: N
authors.lastname: Rottmann
authors.forename: Rune
authors.initials: R
authors.lastname: Gärtner
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis*; D001943:Breast Neoplasms / Q000523:psychology*; D003718:Denmark; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011594:Psychometrics / Q000295:instrumentation; D012680:Sensitivity and Specificity; D013315:Stress, Psychological / Q000175:diagnosis*; D011795:Surveys and Questionnaires