Abstract
BackgroundAlthough depression is highly prevalent among cancer patients, it is often underdiagnosed and poorly managed particularly in developing nations. These shortcomings can have substantial adverse effects not only on the disease prognosis but also on patients’ quality of life. The Patient Health Questionnaire-9 is a widely used depression screening tool but it has not been validated among patients with chronic illnesses such as cancer in Ethiopia. We aim to validate the PHQ-9 among Ethiopian cancer patients in an outpatient setting.MethodsA cross-sectional study was conducted among cancer patients attending the oncology clinic at Tikur Anbessa Specialized Hospital (TASH). We assessed criterion validity and performance of the PHQ-9 test against the gold standard Mini-International Neuropsychiatric Interview (MINI) diagnostic tool among patients with cancer. The MINI was administered by psychiatric nurses who were blind to the initial PHQ-9 screening tool.ResultsA total of 163 patients completed the 2 stages of a diagnostic interview in the study. The majority (64%) of the participants were women, the mean age was 46 (13.5) years. Using the gold standard MINI test the prevalence of Major Depressive Episode (MDE) was 15%. The internal consistency (Cronbach’s α) for PHQ-9 was 0.78 suggesting good (acceptable) internal consistency for the reliability of the test scores. When the total PHQ-9 score was used to identify cases of MDE, the Area under the Curve (AUC) was 0.93 (95% confidence interval [CI], 0.88–0.97) on Receiver Operating Characteristic (ROC) analysis. This shows evidence for the excellent discriminating power of the PHQ-9 between cases and non-cases of MDE. At cutoff point ≥4, the PHQ-9 had a sensitivity of 88% and specificity of 78.1% on the ROC curve to detect MDE.ConclusionPHQ-9 is a reliable and valid instrument to detect MDE among individuals with chronic conditions such as cancer patients in outpatient settings and it can be used in resource-limited settings for early diagnosis and proper therapy of such patients.
Highlights
Depression is highly prevalent among cancer patients, it is often underdiagnosed and poorly managed in developing nations
The prevalence of depression among patients with cancer ranged widely from 3% up to 50% depending on the method of ascertaining depression, study population concerning to cancer type, stage, treatment modality, and the use of different instruments
Studies show that clinicians working in cancer services have recognized that depression is often undiagnosed and untreated, and these shortcomings can have substantial effects, on patients’ quality of life and on their acceptance of cancer treatment [3, 4] This co-morbidity of chronic medical condition with depression is a public health concern due to its negative effects on the course of the illness and its impact on overall prognosis [5, 6]
Summary
Depression is highly prevalent among cancer patients, it is often underdiagnosed and poorly managed in developing nations These shortcomings can have substantial adverse effects on the disease prognosis and on patients’ quality of life. Studies show that clinicians working in cancer services have recognized that depression is often undiagnosed and untreated, and these shortcomings can have substantial effects, on patients’ quality of life and on their acceptance of cancer treatment [3, 4] This co-morbidity of chronic medical condition with depression is a public health concern due to its negative effects on the course of the illness and its impact on overall prognosis [5, 6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
