Psychometric Properties of the PHQ-9, HADS, and CES-D Questionnaires and the Prevalence of Depression in Patients with Cancer Receiving Radiotherapy

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Kantanut Yutrirak
Woraphat Ratta-apha
Pittaya Dankulchai
Panate Pukrittayakamee


Objective: The primary aim was to compare the psychometric properties among the Patient Health Questionnaire (PHQ-9) (both including and excluding somatic symptom items), the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), and the Center for Epidemiologic Studies Depression Scale (CES-D) in detecting depression in cancer patients receiving radiotherapy. The secondary aim was to investigate the prevalence of depression in this group of patients.
Materials and Methods: Overall, 198 participants with cancer diagnosis from a radiology clinic took part in the study. They completed PHQ-9, HADS-D, and CES-D questionnaires and were interviewed in line with the Mini-International Neuropsychiatric Interview (M.I.N.I.) to confirm the diagnosis. The PHQ-9 was analyzed for three scoring methods: sum-score, inclusive (including all items), and exclusive (excluding 4 somatic symptom items) methods. The psychometric properties of each questionnaire were analyzed. The prevalence of depression measured by the M.I.N.I. was evaluated.
Results: The sum-score method of the PHQ-9 had an equal sensitivity (100%) to the HADS-D and CES-D, and had a slightly higher specificity (91.1%) than the HADS-D (87.4%) and CES-D (90.6%). When compared results within the PHQ-9, the sum-score method had greater sensitivity than the inclusive (71.4%) and exclusive (42.9%) methods, and had a slightly lower specificity than the inclusive (96.9%) and exclusive (97.4%) methods. The prevalence of depression assessed by the M.I.N.I was 3.5%.
Conclusion: The sum-score method of the PHQ-9 seemed to be the best tool to use for depression screening in cancer patients receiving radiotherapy due to its excellent sensitivity and specificity.


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Yutrirak, K. ., Ratta-apha, W. ., Dankulchai, P. ., & Pukrittayakamee, P. . (2021). Psychometric Properties of the PHQ-9, HADS, and CES-D Questionnaires and the Prevalence of Depression in Patients with Cancer Receiving Radiotherapy. Siriraj Medical Journal, 73(12), 793–800.
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