Screening for major depression in cancer outpatients: The diagnostic accuracy of the 9-item patient health questionnaire

Parvez Thekkumpurath, Jane Walker, Isabella Butcher, Laura Hodges, Annet Kleiboer, Mark O'Connor, Lucy Wall, Gordon Murray, Kurt Kroenke, Michael Sharpe

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84 Scopus citations

Abstract

BACKGROUND: Systematic screening for depression has been recommended for patients who have medical conditions like cancer. The 9-item Patient Health Questionnaire (PHQ-9) is becoming widely used, but its diagnostic accuracy has not yet been tested in a cancer patient population. In this article, the authors report on the performance of the PHQ-9 as a screening instrument for major depressive disorder (MDD) in patients with cancer. METHODS: Data obtained from a depression screening service for patients who were attending clinics of a Regional Cancer Centre in Edinburgh, United Kingdom were used. Patients had completed both the PHQ-9 and a 2-stage procedure to identify cases of MDD. Performance of the PHQ-9 in identifying cases of MDD was determined using receiver operating characteristic (ROC) analysis. RESULTS: Data were available on 4264 patients. When scored as a continuous measure, the PHQ-9 performed well with an area under the ROC curve of 0.94 (95% confidence interval [CI], 0.93-0.95). A cutoff score of a≥8 provided a sensitivity of 93% (95% CI, 89%-95%), a specificity of 81% (95% CI, 80%-82%), a positive predictive value (PPV) of 25%, and a negative predictive value (NPV) of 99% and could be considered optimum in a screening context. The PHQ-9 did not perform as well when it was scored using an algorithm with a sensitivity of 56% (95% CI, 55%-57%), a specificity of 96% (95% CI, 95%-97%), a PPV of 52%, and an NPV of 97%. CONCLUSIONS: The PHQ-9 scored as a continuous measure with a cutoff score of a≥8 performed well in identifying MDD in cancer patients and should be considered as a screening instrument in this population.

Original languageEnglish (US)
Pages (from-to)218-227
Number of pages10
JournalCancer
Volume117
Issue number1
DOIs
StatePublished - Jan 1 2011

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Keywords

  • cancer
  • diagnostic accuracy
  • major depression
  • Patient Health Questionnaire
  • screening
  • sensitivity and specificity

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Thekkumpurath, P., Walker, J., Butcher, I., Hodges, L., Kleiboer, A., O'Connor, M., Wall, L., Murray, G., Kroenke, K., & Sharpe, M. (2011). Screening for major depression in cancer outpatients: The diagnostic accuracy of the 9-item patient health questionnaire. Cancer, 117(1), 218-227. https://doi.org/10.1002/cncr.25514