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

Kantanut  Yutrirak; Woraphat  Ratta-apha; Pittaya  Dankulchai; Panate  Pukrittayakamee

doi:10.33192/Smj.2021.103

Authors

Kantanut Yutrirak Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University
Woraphat Ratta-apha Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University
Pittaya Dankulchai Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Panate Pukrittayakamee Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University

DOI:

https://doi.org/10.33192/Smj.2021.103

Keywords:

PHQ-9, HADS, CES-D, Depression, Cancer, Radiotherapy

Abstract

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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