Two-question survey accurately screens for depression in patients with cancer

Cancer patients can be accurately screened for major depression with a simple two-question survey. This approach proved to be as accurate as a longer nine-question screening test, according to research presented at the 55th annual meeting of the American Society for Radiation Oncology in Atlanta, Georgia.

"We found that a two-question survey can effectively screen for depression," said William Small, Jr., MD, FASTRO of Loyola University Medical Center in Maywood, Illinois. "We hope this will prompt more centers to screen for depression, and to refer patients for treatment when necessary."

The two-question survey asks whether, over the last 2 weeks, a patient has experienced:

  • ·     Little interest or pleasure in doing things
  • ·     Feeling down, depressed, or hopeless

For each question, the patient can answer not at all (worth 0 points); several days (1 point); more than half the days (2 points); or nearly every day (3 points). A patient who scores a total of 3 or more points on both questions is considered to be at risk for being depressed.

The study included 455 cancer patients receiving radiation therapy at 37 centers in the United States. Patients were surveyed before or within 2 weeks of receiving their first radiation treatment. A total of 16% screened positive for depression.

For comparison purposes, patients who screened positive were administered an in-depth telephone interview known as the Structured Clinical Interview for DSM IV Disorders (SCID), which is considered the gold standard for diagnosing depression. A random sample of patients who screened negative for depression also underwent the SCID interview.

The two-question survey consists of the first two questions of the nine-question Patient Health Questionnaire. The study found that the abbreviated two-question survey was just as accurate as the full nine-question survey. In statistical terms, both surveys had an area under the curve (AUC) of 0.83. (A 100% accurate test would have an AUC of 1.0.)

The two-question screening test was more accurate than two other screening tests researchers administered. These less-accurate screening tests are the Hopkins Symptom Checklist (0.79 AUC) and the National Comprehensive Cancer Network Distress Thermometer (0.60 AUC).

The study found that 78% of centers routinely screen patients for depression at the radiation therapy facility, with 51% screening at the initial visit. Mental health services were available at 68% of radiation therapy facilities. However, 67% of sites offered only social workers; 17% offered psychologists, and 22% offered psychiatrists.

"We think the results of this large, nationwide trial will have a major impact on how cancer patients are screened for depression," Small said.

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