Screening for major depressive disorder in adults with cerebral glioma: an initial validation of 3 self-report instruments

Abstract

No depression screening tool is validated for use in cases of cerebral glioma. To address this, we studied the operating characteristics of the Hospital Anxiety and Depression Scale (Depression subscale) (HAD-D), the Patient Health Questionnaire-9 (PHQ-9), and the Distress Thermometer (DT) in glioma patients.We conducted a twin-center prospective observational cohort study of major depressive disorder (MDD), according to the Diagnostic and Statistical Manual, 4th edition, in adults with a new diagnosis of cerebral glioma receiving active management or "watchful waiting." At each of 3 interviews over a 6-month period, patients completed the screening questionnaires and received a structured clinical interview to diagnose MDD. Internal consistency, area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value, and positive likelihood ratio were calculated. A maximum of 154 patients completed the DT, 133 completed the HAD-D, and 129 completed the PHQ-9. The HAD-D and PHQ-9 showed good internal consistency (α ≥ 0.77 at all timepoints). Median AUCs were 0.931 ± 0.074 for the HAD-D and 0.915 ± 0.055 for the PHQ-9. The optimal threshold was 7+ for the HAD-D, but 8+ had similar operating characteristics. There was no consistently optimal PHQ-9 threshold, but 10+ was optimal in the largest sample. The DT was inferior to the multi-item instruments. Clinicians can screen for depression in well-functioning glioma patients using the HAD-D at the existing recommended lower threshold of 8+, or the PHQ-9 at a threshold of 10+. Due to a modest positive predictive value of either instrument, patients scoring above these thresholds need a clinical assessment to diagnose or exclude depression.

Health-related quality of life in patients with high-grade gliomas: a quantitative longitudinal study

“…It is difficult to distinguish between depression, 'understandable' sadness [53] or vegetative symptoms of depression such as loss of interest, emotion and energy [54]. Systematic screening and quantification for levels of depression and anxiety is imperative [55] and recommended in this group of patients, especially in case of physical decline and tumour progression. However, instruments should not be used as a substitute for in-depth conversations but rather function as guidance for clinicians that facilitate the dialogue with the patient [56].…”

Neurobehavioural changes in patients following brain tumour: patients and relatives perspective

“…All participants gave written informed consent prior to participating in the study. The Hospital Anxiety and Depression Scale (HADS) [19]), was given to measure depressed mood, as this has been found to be common in patients with brain tumours and because of the behavioural similarities between the syndromes of apathy and depression [20,21]. Although less studied in cancer populations, anxiety has also been shown to be prevalent among oncology patients [22].…”

Clinical Manifestations and Imaging Characteristics of Gliomatosis Cerebri with Pathological Confirmation

“…GC is often misdiagnosed as cerebral hemorrhage disease and encephalitis in that its primary symptoms include headache, vomiting and stroke with less positive signs in initial stage, and (Rooney et al, 2013;Boele et al, 2014;Rudà et al, 2014). According to WHO Criteria in Tumor (Herrlinger et al, 2002), the severity of malignancy belong to level III manifested as diffuse lesions, often involving in 2 or more lobes and bilateral brain tissues, and extending to infratentorial structures and even to spinal cord.…”