title: 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.
abstract: OBJECTIVE
  Brief screening tools may help clinicians in busy settings detect patients who are experiencing severe psychological distress. This study examined the performance of the Distress Thermometer (DT) and a two-item depression screen [the Patient Health Questionnaire-2 (PHQ-2)] with a 'help' question in screening for distress and psychiatric morbidity among patients with advanced cancer.
  
  
  METHODS
  Two hundred and five patients with advanced cancer completed the DT, the PHQ-2 and 'help' question and the Hospital Anxiety and Depression Scale and were interviewed using the Structured Clinical Interview for DSM-IV (SCID). The performance of the screening tools was examined against the Hospital Anxiety and Depression Scale and the SCID.
  
  
  RESULTS
  Overall, discrimination levels were comparable for the DT [area under the curve (AUC) 0.80-0.81] and the PHQ-2 (AUC 0.73-0.85). The DT performed best in detecting cases of distress and mood, anxiety or adjustment disorders (sensitivity 100%), but it had poor specificity (49-60%). The best performance in terms of combined sensitivity and specificity was the PHQ depression item versus the SCID (sensitivity 88%, specificity 73%). The inclusion of the 'help' question with the PHQ-2 resulted in high levels of specificity (≥89%), but there was a significant drop in sensitivity (≤54%).
  
  
  CONCLUSIONS
  Ultra-brief screening tools offer an efficient means of identifying patients with advanced cancer with severe distress or psychiatric morbidity but are less effective at identifying non-distressed individuals. Used in conjunction with a 'help' question, these tools can help clinicians identify patients who are both distressed and likely to accept professional support.
authors.affiliation: School of Nursing, Dublin City University, Glasnevin, Dublin 9, Ireland. dermot.ryan@dcu.ie
authors.forename: Dermot Anthony
authors.initials: DA
authors.lastname: Ryan
authors.forename: Pamela
authors.initials: P
authors.lastname: Gallagher
authors.forename: Shelagh
authors.initials: S
authors.lastname: Wright
authors.forename: Eugene M
authors.initials: EM
authors.lastname: Cassidy
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009017:Morbidity; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000706:statistics & numerical data; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires / Q000592:standards*; D013821:Thermometers