The effectiveness of the 9-item Patient Health Questionnaire (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS-D) in screening for major depressive disorder (MDD) in patients with cancer was limited compared to the standardized diagnostic interview, according to a study published in Cancer.

Patients with cancer with comorbid depression have higher rates of mortality, lower health-related quality of life, and lower adherence to cancer treatments. As a result, these patients should be screened for symptoms of depression throughout the course of therapy.

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This multicenter trial had a random sample of 2141 patients complete the PHQ-9 and HADS-D, which was assessed and compared to the Composite International Diagnostic Interview for Oncology (CIDI-O) in terms of diagnostic accuracy and receiver operating characteristic (ROC) curves for depression as established by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV).

The CIDI-O determined the prevalence of MDD was 5%, any mood disorder (AMD) was 7%, and adjustment disorder was 11%. The PHQ-9 and HADS-D performed fairly in diagnosing MDD, with PHQ-9 having an area under the ROC curve of 0.78 (95% confidence interval [CI], 0.76-0.79), and HADS-D having an area of 0.75 (95% CI, 0.74-0.77), and there were no significant differences in their areas under the ROC curves (p = 0.15). The best screening performance was seen in the PHQ-9 with a cutoff score of 7 and greater, with a sensitivity of 83% (95% CI, 78%-89%), and specificity of 61% (95% CI, 59%-63%).

The trial results show that 2 of the most established assessments in determining MDD may not be as diagnostically accurate as observed from prior studies. Patient authors conclude by saying that “thoroughly trained psycho-oncologic specialists are needed to reliably diagnose depression in this population.”


1. Hartung TJ, Friedrich M, Johansen C, et al. The Hospital Anxiety and Depression Scale (HADS) and the 9-item Patient Health Questionnaire (PHQ-9) as screening instruments for depression in patients with cancer [published online June 27, 2017]. Cancer. doi: 10.1002/cncr.30846