Comparing the distress thermometer (DT) with the patient health questionnaire (PHQ)-2 for screening for possible cases of depression among patients newly diagnosed with advanced cancer.
OBJECTIVE
Distress screening guidelines call for rapid screening for emotional distress at the time of cancer diagnosis. The purpose of this study was to examine the distress thermometer's (DT) ability to screen in patients in treatment for advanced cancer who may be depressed.


METHODS
Using cross-sectional data collected from patients within 30 days of diagnosis with advanced cancer, this study used ROC analysis to determine the optimal-cutoff point of the distress thermometer (DT) for screening for depression as measured by the physician health questionnaire (PHQ)-9; inter-test reliability analysis to compare the DT with the PHQ-2 for screening in possible cases of depression, and multivariate analysis to examine associations among the DT emotional problem list (EPL) items with cases of depression.


RESULTS
The average age of the 123 patients in the study was 59.9 (12.9) years. Seventy (56.9%) were female. All had Stage 3 or 4 cancers (40% gastrointestinal, 19% gynecologic, 20% head and neck, 21% lung). The mean DT score was 4 (2.7)/10; and 56 (43%) were depressed as measured by the PHQ-9 ≥ 5. The optimal DT cut-off score to screen in possible cases of depression was ≥ 2/10, with a sensitivity of .96, compared to a sensitivity of .32 of the PHQ-2 ≥ 2. Correlation coefficients for the DT ≥ 2 and the PHQ-2 with the PHQ-9 ≥ 5 were 0.4 and -0.2, respectively. EPL items associated with cases of depression were Depression (OR = 0.15, 0.02-0.85) and Sadness (OR = 0.21, 0.06-0.72).


CONCLUSIONS
The optimal DT threshold for identifying possible cases of depression at the time of diagnosis is ≥ 2; this threshold is more sensitive than the PHQ-2 ≥ 2. EPL items may be used with the DT score to triage patients for evaluation.
Yale University School of Nursing, New Haven, Connecticut.
Mark
M
Lazenby
Yale University School of Nursing, New Haven, Connecticut.
Jane
J
Dixon
Yale University School of Nursing, New Haven, Connecticut.
Mei
M
Bai
Yale University School of Nursing, New Haven, Connecticut.
Ruth
R
McCorkle
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000451:nursing* / Q000523:psychology; D003237:Connecticut; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000451:nursing* / Q000523:psychology; D005260:Female; D019983:Guideline Adherence; D064946:Hospice and Palliative Care Nursing; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000451:nursing* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000451:nursing* / Q000473:pathology / Q000523:psychology*; D009730:Nursing Assessment / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012803:Sick Role; D011795:Surveys and Questionnaires; D057170:Translational Research, Biomedical