Miriam Grapp1, Valentin Terhoeven2, Christoph Nikendei2, Hans-Christoph Friederich2, Imad Maatouk3. 1. Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; National Center for Tumor Diseases Heidelberg, University Hospital Heidelberg, Germany. 2. Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany. 3. Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; National Center for Tumor Diseases Heidelberg, University Hospital Heidelberg, Germany. Electronic address: Imad.Maatouk@med.uni-heidelberg.de.
Abstract
BACKGROUND: The PHQ-9 is a standard screening tool for depressive disorders in cancer patients. As for the frequently reported symptom overlap with somatic disease, it has been debated whether somatic items are suitable for identifying depressive disorders in cancer patients. Thus, this study examines the diagnostic accuracy of somatic versus cognitive-emotional PHQ-9 items. METHODS: The routine data of 4,705 patients, screened at the National Center for Tumor Diseases in Heidelberg between 2011 and 2016, was analyzed. For the single PHQ-9 items, receiver operating characteristics (ROC), sensitivity, specificity, positive, and negative predictive values (PPV and NPV), the Youden Index (YI), and the Clinical Utility Index (UI+/UI-) were applied for the diagnoses of major depressive disorder (MDD) and any depressive disorder (ADD). RESULTS: The non-somatic items played a pivotal role in the diagnosis of MDD, whereas the diagnostic accuracy of the somatic items increased in the diagnosis of ADD. For both MDD and ADD, the best performance was achieved by the non-somatic items "little interest" and "feeling down." LIMITATIONS: In this study, only one self-reported instrument was used (i.e., the PHQ-9). In other words, the diagnoses were not validated by clinical interviews or other self-reported instruments. CONCLUSION: The somatic PHQ-9 items showed less discriminatory value than the non-somatic items. However, they may be useful as screening mechanisms for identifying at-risk cancer patients with mild/moderate depression. Disregarding the somatic items would lead to an underestimation of depressive syndromes and inadequate treatment of somatic symptoms.
BACKGROUND: The PHQ-9 is a standard screening tool for depressive disorders in cancerpatients. As for the frequently reported symptom overlap with somatic disease, it has been debated whether somatic items are suitable for identifying depressive disorders in cancerpatients. Thus, this study examines the diagnostic accuracy of somatic versus cognitive-emotional PHQ-9 items. METHODS: The routine data of 4,705 patients, screened at the National Center for Tumor Diseases in Heidelberg between 2011 and 2016, was analyzed. For the single PHQ-9 items, receiver operating characteristics (ROC), sensitivity, specificity, positive, and negative predictive values (PPV and NPV), the Youden Index (YI), and the Clinical Utility Index (UI+/UI-) were applied for the diagnoses of major depressive disorder (MDD) and any depressive disorder (ADD). RESULTS: The non-somatic items played a pivotal role in the diagnosis of MDD, whereas the diagnostic accuracy of the somatic items increased in the diagnosis of ADD. For both MDD and ADD, the best performance was achieved by the non-somatic items "little interest" and "feeling down." LIMITATIONS: In this study, only one self-reported instrument was used (i.e., the PHQ-9). In other words, the diagnoses were not validated by clinical interviews or other self-reported instruments. CONCLUSION: The somatic PHQ-9 items showed less discriminatory value than the non-somatic items. However, they may be useful as screening mechanisms for identifying at-risk cancerpatients with mild/moderate depression. Disregarding the somatic items would lead to an underestimation of depressive syndromes and inadequate treatment of somatic symptoms.