title: Screening for depressed mood in patients with cancer using the MD Anderson Symptom Inventory: investigation of a practical approach for the oncologist.
abstract: OBJECTIVE
  Depression is a significant concern in outpatient oncology care, yet clinicians face practical challenges in accurately and efficiently screening patients for it. This study investigated whether a single item or multiple items from an existing multisymptom scale, the MD Anderson Symptom Inventory (MDASI), might serve as effective initial screens for depressed mood.
  
  
  METHODS
  Data were collected from two cohorts of patients. Cohort 1 comprised 187 patients with non-small-cell lung cancer who completed the Beck Depression Inventory II; cohort 2 comprised 281 patients with renal cell carcinoma who completed the Center for Epidemiologic Studies Depression Scale. All patients completed the MDASI. Single-item and multiple-item MDASI solutions were identified using cohort 1 and validated in cohort 2. Sensitivity and specificity of the solutions were assessed through binary linear regression; cut points were identified using receiver operating characteristic analysis.
  
  
  RESULTS
  The MDASI single item "sadness" was the best solution identified in cohort 1 for screening for depressed mood relative to other affective items (distress, enjoyment of life, mood). At a cut point ≥ 4 (0 to 10 scale), the "sadness" item exhibited a clinically acceptable specificity of 81.5%, sensitivity of 72.0%, a negative predictive value of 95.0%, and a positive predictive value of 37.5%. This solution was successfully validated in cohort 2.
  
  
  CONCLUSIONS
  The MDASI "sadness" item has modest sensitivity and high negative predictive value and can serve as a useful initial screen for depressed mood. This approach may improve the efficiency and acceptability of depression screening for both clinicians and patients.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Desiree
authors.initials: D
authors.lastname: Jones
authors.forename: Elisabeth G
authors.initials: EG
authors.lastname: Vichaya
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cohen
authors.forename: Seema M
authors.initials: SM
authors.lastname: Thekdi
authors.forename: Xin Shelley
authors.initials: XS
authors.lastname: Wang
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fisch
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010820:Physicians; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity