title: Screening for psychological distress in neurosurgical brain tumor patients using the Patient Health Questionnaire-2.
abstract: OBJECTIVE
  Psychological distress is highly prevalent but often undiagnosed in brain tumor patients. We evaluated the psychometric properties of the Patient Health Questionnaire-2 (PHQ-2) for screening of distressed neurosurgical brain tumor patients.
  
  
  METHODS
  A total of 226 (69% women; mean age 55.6 ± 14.7 years) consecutive patients on admission for elective brain tumor surgery were evaluated for psychological distress using the PHQ-2, the Hospital Anxiety and Depression Scale (HADS; n = 206), and the Beck Depression Inventory-II (BDI-II; n = 196). At discharge, the patients were reevaluated using the PHQ-2 and HADS.
  
  
  RESULTS
  On admission, 43% and 18% of patients had moderate-severe psychological distress according to the HADS (HADS depression or anxiety score ≥ 11) and BDI-II (score ≥ 20), respectively. At discharge, there was a significant decrease in psychological distress among patients according to the PHQ-2 (p = 0.04) and HADS (p < 0.001) screening results. The PHQ-2 had marginal internal consistency (Cronbach's coefficient alpha = 0.68) and suboptimal test-retest reliability (intraclass correlation coefficient = 0.51). The PHQ-2 had acceptable psychometric properties for identifying patients with moderate-severe psychological distress according to the HADS (sensitivity = 74%, specificity = 68%, and positive predictive value (PPV) = 40%) and BDI-II (sensitivity = 71%, specificity = 65%, and PPV = 30%). Psychometric properties of the PHQ-2 were inferior for mild-severe psychological distress. Greater number of PHQ-2 depressive symptoms was associated with greater scores on the HADS and BDI-II (all ps < 0.001).
  
  
  CONCLUSIONS
  Psychological distress is prevalent in brain tumor patients and can be successfully identified using the PHQ-2. The PHQ-2 has moderate internal consistency. The PHQ-2 should be considered for routine use in brain tumor patients for psychological distress screening purposes.
authors.affiliation: Department of Neurosurgery, Lithuanian University of Health Sciences, Kaunas, Lithuania. a.bunevicius@yahoo.com
authors.forename: Adomas
authors.initials: A
authors.lastname: Bunevicius
authors.forename: Vytenis
authors.initials: V
authors.lastname: Deltuva
authors.forename: Sarunas
authors.initials: S
authors.lastname: Tamasauskas
authors.forename: Arimantas
authors.initials: A
authors.lastname: Tamasauskas
authors.forename: Robertas
authors.initials: R
authors.lastname: Bunevicius
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D001932:Brain Neoplasms / Q000523:psychology*; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires / Q000592:standards*