Yale University School of Nursing, New Haven, Connecticut.
Palliat Support Care. 2014 Feb;12(1):63-8. doi: 10.1017/S1478951513000394.
Distress screening guidelines call for rapid screening for emotional distress at the time of cancer diagnosis. The purpose of this study was to examine the distress thermometer's (DT) ability to screen in patients in treatment for advanced cancer who may be depressed.
Using cross-sectional data collected from patients within 30 days of diagnosis with advanced cancer, this study used ROC analysis to determine the optimal-cutoff point of the distress thermometer (DT) for screening for depression as measured by the physician health questionnaire (PHQ)-9; inter-test reliability analysis to compare the DT with the PHQ-2 for screening in possible cases of depression, and multivariate analysis to examine associations among the DT emotional problem list (EPL) items with cases of depression.
The average age of the 123 patients in the study was 59.9 (12.9) years. Seventy (56.9%) were female. All had Stage 3 or 4 cancers (40% gastrointestinal, 19% gynecologic, 20% head and neck, 21% lung). The mean DT score was 4 (2.7)/10; and 56 (43%) were depressed as measured by the PHQ-9 ≥ 5. The optimal DT cut-off score to screen in possible cases of depression was ≥ 2/10, with a sensitivity of .96, compared to a sensitivity of .32 of the PHQ-2 ≥ 2. Correlation coefficients for the DT ≥ 2 and the PHQ-2 with the PHQ-9 ≥ 5 were 0.4 and -0.2, respectively. EPL items associated with cases of depression were Depression (OR = 0.15, 0.02-0.85) and Sadness (OR = 0.21, 0.06-0.72).
The optimal DT threshold for identifying possible cases of depression at the time of diagnosis is ≥ 2; this threshold is more sensitive than the PHQ-2 ≥ 2. EPL items may be used with the DT score to triage patients for evaluation.
困扰筛查指南呼吁在癌症诊断时快速筛查情绪困扰。本研究的目的是检查困扰温度计（DT）在接受晚期癌症治疗的患者中筛查可能抑郁的能力。
本研究使用横断面数据，从诊断为晚期癌症后 30 天内的患者中收集，使用 ROC 分析确定困扰温度计（DT）的最佳截断点，用于筛查由医生健康问卷（PHQ）-9 测量的抑郁；测试间可靠性分析比较 DT 与 PHQ-2 用于筛查可能的抑郁病例，以及多变量分析检查 DT 情绪问题清单（EPL）项目与抑郁病例之间的关联。
本研究中 123 例患者的平均年龄为 59.9（12.9）岁。70 例（56.9%）为女性。所有人都患有 3 期或 4 期癌症（40%胃肠道癌，19%妇科癌，20%头颈部癌，21%肺癌）。DT 评分平均值为 4（2.7）/10；56 例（43%）PHQ-9≥5 为抑郁。DT 筛查可能抑郁病例的最佳截断分数为≥2/10，敏感性为 0.96，而 PHQ-2≥2 的敏感性为 0.32。DT≥2 和 PHQ-2 与 PHQ-9≥5 的相关系数分别为 0.4 和-0.2。与抑郁病例相关的 EPL 项目为抑郁（OR=0.15，0.02-0.85）和悲伤（OR=0.21，0.06-0.72）。
用于识别诊断时可能的抑郁病例的最佳 DT 阈值为≥2；该阈值比 PHQ-2≥2 更敏感。EPL 项目可与 DT 评分一起用于对患者进行分诊评估。
