title: Comparison of four brief depression screening instruments in ovarian cancer patients: Diagnostic accuracy using traditional versus alternative cutpoints.
abstract: We compared the diagnostic accuracy of 4 depression screening scales, using traditional and alternative scoring methods, to the gold standard Structured Clinical Interview-DSM IV major depressive episode (MDE) in ovarian cancer patients on active treatment.
  
  
  
  At the beginning of a new chemotherapy regimen, ovarian cancer patients completed the following surveys on the same day: the Center for Epidemiological Studies Depression Scale (CES-D), the Beck Depression Inventory Fast-Screen for Primary Care (BDI-FastScreen), the Patient Health Questionnaire-9 (PHQ-9), and a 1-item screener ("Are you depressed?"). Each instrument's sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated with respect to major depression. To control for antidepressant use, the analyses were re-run for a subsample of patients who were not on antidepressants.
  
  
  
  One hundred fifty-three ovarian cancer patients were enrolled into the study. Only fourteen participants met SCID criteria for current MDE (9%). When evaluating all patients regardless of whether they were already being treated with antidepressants, the two-phase scoring approach with an alternate cutpoint of 6 on the PHQ-9 had the best positive predictive value (PPV=32%). Using a traditional cutpoint of 16 on the CES-D resulted in the lowest PPV (5%); using a more stringent cutpoint of 22 resulted in a slightly improved but still poor PPV, 7%.
  
  
  
  Screening with a two-phase PHQ-9 proved best overall, and its accuracy was improved when used with patients who were not already being treated with antidepressants.
authors.affiliation: Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center: Cancer Prevention Building - Unit 1330, 1155 Pressler St., Houston, TX 77030, USA. Electronic address: eshinn@mdanderson.org.
authors.forename: Eileen H
authors.initials: EH
authors.lastname: Shinn
authors.affiliation: Department of Psychiatry, The University of Texas MD Anderson Cancer Center: T. Boone Pickens Academic Tower - Unit 1454, 1515 Holcombe Blvd., Houston, TX 77030, USA. Electronic address: avalenti@mdanderson.org.
authors.forename: Alan
authors.initials: A
authors.lastname: Valentine
authors.affiliation: Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center: Cancer Prevention Building - Unit 1330, 1155 Pressler St., Houston, TX 77030, USA. Electronic address: gpbaum@mdanderson.org.
authors.forename: George
authors.initials: G
authors.lastname: Baum
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center: T. Boone Pickens Academic Tower - Unit 1414, 1515 Holcombe Blvd., Houston, TX 77030, USA. Electronic address: ccarmack@mdanderson.org.
authors.forename: Cindy
authors.initials: C
authors.lastname: Carmack
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center: T. Boone Pickens Academic Tower - Unit 1414, 1515 Holcombe Blvd., Houston, TX 77030, USA. Electronic address: kkilgore@mdanderson.org.
authors.forename: Kelly
authors.initials: K
authors.lastname: Kilgore
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center: Mid Campus Building 1 - Unit 1727, 1515 Holcombe Blvd., Houston, TX 77030, USA. Electronic address: dcbodurka@mdanderson.org.
authors.forename: Diane
authors.initials: D
authors.lastname: Bodurka
authors.affiliation: Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center: Cancer Prevention Building - Unit 1330, 1155 Pressler St., Houston, TX 77030, USA. Electronic address: kbasenen@mdanderson.org.
authors.forename: Karen
authors.initials: K
authors.lastname: Basen-Engquist
mesh_terms: D003866:Depressive Disorder / Q000175:diagnosis* / Q000209:etiology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000523:psychology*; D011569:Psychiatric Status Rating Scales
keywords: Depression screening; SCID; Sensitivity; Specificity