Журнал онкологической медицины и практики

Clinic-based Depression Screening in Gynaecologic Oncology Patients Using the Patient Health Questionnaires-2 (PHQ-2): Are we Identifying the Highest Risk Patients at their Initial Visit?

Abstract

Dominique Barnes, Richard Rivera O, Bradley Monk J and Dana Chase

Objectives: The 2-item Patient Health Questionnaire (PHQ-2) is a short self-reported questionnaire used to screen for depression. Currently, no studies have evaluated the use of this tool among gynecology oncology patients. The objective of this study was to evaluate the sensitivity of the PHQ-2 in a gynaecologic oncology patient population compared with patient reported symptoms, medical history, and treatment for depression. Risk factors for depressive symptoms and treatment effect of antidepressants were also evaluated.
Methods: Consecutive 12-month new patient visits attending a gynaecologic oncology clinic completed the PHQ-2 and written intake form. Each new patient was verbally administered the PHQ-2, and then administered a written health questionnaire which gathers information about current symptoms of depression (ROS, within the past week), current diagnosis of depression, and medications with a treatment indication of depression. Additional clinical data was abstracted from patient charts and entered into a database.
Results: A total of 439 patients completed the PHQ-2 and written intake form. The average age was 53 years old (SD=15). The majority were White (67%), primarily spoke English (92%) and 54% did not have current diagnosis of cancer at their initial visit. Sixty-one patients screened positive on the PHQ-2, while 121 had a positive history, 92 had positive review of systems, and 79 indicated medications prescribed for depression. The sensitivity of the PHQ-2 for identifying patients meeting any criteria for depression on the written questionnaire was 18.7% with a specificity of 87.9%. The sensitivity and specificity of the PHQ-2 to identify patients reporting a current diagnosis of depression was 56.3% and 97.4% respectively, 28.8% and 89.5% respectively for the intake form, and 20.4% and 87.8% for patients on medications. Among the variables, pain correlated positively to PHQ-2 (r=0.13, p<.01), and those with a diagnosis of depression (r=0.22, p<.01). Menopause had a positive association (r=.13, p<.01) in women who scored positive on the PHQ-2. Hysterectomy, oophorectomy, current administration of chemotherapy, hormone replacement therapy did not significantly alter rates of depression.
Conclusion: Depression is prevalent in the gynaecologic oncology clinic population, with forty-six percent of all new patients reporting depressive symptoms, diagnosis of depression and/or current treatment for depression. PHQ- 2 demonstrated good psychometric properties when screening for depressive symptoms in Gynaecologic oncology patients. Learning Objectives: Learners will be able to identify risk factors for patients at risk of depression utilizing PHQ-2 in a gynaecologic oncology population.