Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis.

OBJECTIVES: Validated diagnostic interviews are required to classify depression status and estimate prevalence of disorder, but screening tools are often used instead. We used individual participant data meta-analysis to compare prevalence based on standard Hospital Anxiety and Depression Scale - depression subscale (HADS-D) cutoffs of ≥8 and ≥11 versus Structured Clinical Interview for DSM (SCID) major depression and determined if an alternative HADS-D cutoff could more accurately estimate prevalence. METHODS: We searched Medline, Medline In-Process & Other Non-Indexed Citations via Ovid, PsycINFO, and Web of Science (inception-July 11, 2016) for studies comparing HADS-D scores to SCID major depression status. Pooled prevalence and pooled differences in prevalence for HADS-D cutoffs versus SCID major depression were estimated. RESULTS: 6005 participants (689 SCID major depression cases) from 41 primary studies were included. Pooled prevalence was 24.5% (95% Confidence Interval (CI): 20.5%, 29.0%) for HADS-D ≥8, 10.7% (95% CI: 8.3%, 13.8%) for HADS-D ≥11, and 11.6% (95% CI: 9.2%, 14.6%) for SCID major depression. HADS-D ≥11 was closest to SCID major depression prevalence, but the 95% prediction interval for the difference that could be expected for HADS-D ≥11 versus SCID in a new study was -21.1% to 19.5%. CONCLUSIONS: HADS-D ≥8 substantially overestimates depression prevalence. Of all possible cutoff thresholds, HADS-D ≥11 was closest to the SCID, but there was substantial heterogeneity in the difference between HADS-D ≥11 and SCID-based estimates. HADS-D should not be used as a substitute for a validated diagnostic interview.

Probability of major depression diagnostic classification based on the SCID, CIDI and MINI diagnostic interviews controlling for Hospital Anxiety and Depression Scale - Depression subscale scores: An individual participant data meta-analysis of 73 primary studies.

OBJECTIVE: Two previous individual participant data meta-analyses (IPDMAs) found that different diagnostic interviews classify different proportions of people as having major depression overall or by symptom levels. We compared the odds of major depression classification across diagnostic interviews among studies that administered the Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). METHODS: Data accrued for an IPDMA on HADS-D diagnostic accuracy were analysed. We fit binomial generalized linear mixed models to compare odds of major depression classification for the Structured Clinical Interview for DSM (SCID), Composite International Diagnostic Interview (CIDI), and Mini International Neuropsychiatric Interview (MINI), controlling for HADS-D scores and participant characteristics with and without an interaction term between interview and HADS-D scores. RESULTS: There were 15,856 participants (1942 [12%] with major depression) from 73 studies, including 15,335 (97%) non-psychiatric medical patients, 164 (1%) partners of medical patients, and 357 (2%) healthy adults. The MINI (27 studies, 7345 participants, 1066 major depression cases) classified participants as having major depression more often than the CIDI (10 studies, 3023 participants, 269 cases) (adjusted odds ratio [aOR] = 1.70 (0.84, 3.43)) and the semi-structured SCID (36 studies, 5488 participants, 607 cases) (aOR = 1.52 (1.01, 2.30)). The odds ratio for major depression classification with the CIDI was less likely to increase as HADS-D scores increased than for the SCID (interaction aOR = 0.92 (0.88, 0.96)). CONCLUSION: Compared to the SCID, the MINI may diagnose more participants as having major depression, and the CIDI may be less responsive to symptom severity.

Does routine psychosocial screening improve referral to psychosocial care providers and patient-radiotherapist communication? A cluster randomized controlled trial.

OBJECTIVE: This study tests whether using a screening instrument improves referral to psychosocial care providers (e.g. psychologist) and facilitates patient-radiotherapist communication. METHODS: A cluster randomized controlled trial was used. Fourteen radiotherapists were randomly allocated to the experimental or control group and 568 of their patients received care in accordance with the group to which their radiotherapist was allocated. Patients in the experimental group were asked to complete a screening instrument before and at the end of the radiation treatment period. All patients were requested to complete questionnaires concerning patient-physician communication after the first consultation and concerning psychosocial care 3 and 12 months post-intervention. RESULTS: Patients who completed the screening instrument were referred to social workers at an earlier stage than patients who did not (P<0.01). No effects were observed for numbers of referred patients, or for improved patient-radiotherapist communication. CONCLUSIONS: Our results suggest that a simple screening procedure can be valuable for the timely treatment of psychosocial problems in patients. Future efforts should be directed at appropriate timing of screening and enhancing physicians' awareness regarding the importance of identifying, discussing and treating psychosocial problems in cancer patients. PRACTICE IMPLICATIONS: Psychosocial screening can be enhanced by effective radiotherapist-patient communication.

Psychosocial screening effects on health-related outcomes in patients receiving radiotherapy. A cluster randomised controlled trial.

OBJECTIVE: This study examined the short-term and long-term effects of using a screening instrument on psychological distress and health-related quality of life (HRQoL) among cancer patients receiving radiotherapy. In addition, we investigated the effect of early psychosocial treatment on patients' overall health-related outcomes as previous research showed that patients in the screening condition were referred to a psychosocial caregiver at an earlier stage. METHODS: A cluster randomised controlled trial with a randomisation at the levels of 14 radiotherapists, 568 patients was conducted. Patients were asked to complete questionnaires at 3 and 12 months follow-up. RESULTS: Mixed models analyses showed no significant intervention effects on patients' overall extent of psychosocial distress and HRQoL, both on the short and long terms. Post-hoc analyses revealed significant interactions of the intervention with early referral and improved HRQoL and anxiety, suggesting that earlier referral might influence short-term HRQoL and experienced anxiety in patients. CONCLUSIONS: Our results suggest that the use of a psychosocial screening instrument among patients receiving radiotherapy in itself does not sufficiently improve patients' health-related outcome. The effective delivery of psychosocial care depends upon several components such as identification of distress and successful implementation of screening procedures. One of the challenges is to get insight in the effects of early referral of cancer patients for psychosocial support because early referral might have a favourable effect on some of the patients' health-related outcomes.

The usefulness and feasibility of a screening instrument to identify psychosocial problems in patients receiving curative radiotherapy: a process evaluation.

BACKGROUND: Psychosocial problems in cancer patients are often unrecognized and untreated due to the low awareness of the existence of these problems or pressures of time. The awareness of the need to identify psychosocial problems in cancer patients is growing and has affected the development of screening instruments. This study explored the usefulness and feasibility of using a screening instrument (SIPP: Screening Inventory of Psychosocial Problems) to identify psychosocial problems in cancer patients receiving curative radiotherapy treatment (RT). METHODS: The study was conducted in a radiation oncology department in The Netherlands. Several methods were used to document the usefulness and feasibility of the SIPP. Data were collected using self-report questionnaires completed by seven radiotherapists and 268 cancer patients. RESULTS: Regarding the screening procedure 33 patients were offered to consult a psychosocial care provider (e.g. social worker, psychologist) during the first consultation with their radiotherapist. Of these patients, 31 patients suffered from at least sub-clinical symptoms and two patients hardly suffered from any symptoms. Patients' acceptance rate 63.6% (21/33) was high. Patients were positive about the content of the SIPP (mean scores vary from 8.00 to 8.88, out of a range between 0 and 10) and about the importance of discussing items of the SIPP with their radiotherapist (mean score = 7.42). Radiotherapists' perspectives about the contribution of the SIPP to discuss the different psychosocial problems were mixed (mean scores varied from 3.17 to 4.67). Patients were more positive about discussing items of the SIPP if the radiotherapists had positive attitudes towards screening and discussing psychosocial problems. CONCLUSIONS: The screening procedure appeared to be feasible in a radiotherapy department. In general, patients' perspectives were at least moderate. Radiotherapists considered the usefulness and feasibility of the SIPP generally to be lower, but their evaluations were mixed. A positive attitude to using screening instruments like the SIPP needs to be encouraged among radiotherapists, as this may not only improve the usefulness of a screening instrument, but also patients' satisfaction with care. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00859768.

Psychometric properties of the Dutch version of the Mental Adjustment to Cancer scale in Dutch cancer patients.

OBJECTIVES: The measurement of adjustment to cancer is relevant for research purposes and daily practice. In this study, the psychometric properties of the original five subscales and the two recently proposed summary scales of the Mental Adjustment to Cancer (MAC) scale were examined in Dutch cancer patients. METHODS: Data from 289 cancer patients were assessed with the Dutch version of the MAC scale and the Hospital and Anxiety Depression scale (HADS); 259 patients completed the MAC scale for a second time. RESULTS: In total, 85.5% of the participants completed the full MAC scale. The internal consistency of the five subscales and the summary scales were mostly similar to the original versions. The test-retest reliability of the Fighting Spirit, Helplessness/Hopelessness, Anxious Preoccupation, Summary Positive Adjustment and Summary Negative Adjustment subscales were moderate and the test-retest reliability of the Fatalism and Avoidance subscales were low. Correlations between the original and the two summary scales of the MAC scale and the depression and anxiety subscales of the HADS indicated good convergent validity. The structure of the five original subscales as well as the structure of the two proposed summary scales was adequate as shown by construct validity using confirmatory factor analyses. CONCLUSION: The Dutch version of the MAC scale is a feasible questionnaire and appeared to have comparable psychometric properties as demonstrated by studies in the UK. The psychometric properties of the summary scales and Fighting Spirit and Helplessness/Hopelessness subscales seem to be acceptable. This supports the cross-national usefulness of the MAC scale.

The effectiveness of the Screening Inventory of Psychosocial Problems (SIPP) in cancer patients treated with radiotherapy: design of a cluster randomised controlled trial.

BACKGROUND: The Screening Inventory of Psychosocial Problems (SIPP) is a short, validated self-reported questionnaire to identify psychosocial problems in Dutch cancer patients. The one-page 24-item questionnaire assesses physical complaints, psychological complaints and social and sexual problems. Very little is known about the effects of using the SIPP in consultation settings. Our study aims are to test the hypotheses that using the SIPP (a) may contribute to adequate referral to relevant psychosocial caregivers, (b) should facilitate communication between radiotherapists and cancer patients about psychosocial distress and (c) may prevent underdiagnosis of early symptoms reflecting psychosocial problems. This paper presents the design of a cluster randomised controlled trial (CRCT) evaluating the effectiveness of using the SIPP in cancer patients treated with radiotherapy. METHODS/DESIGN: A CRCT is developed using a Solomon four-group design (two intervention and two control groups) to evaluate the effects of using the SIPP. Radiotherapists, instead of cancer patients, are randomly allocated to the experimental or control groups. Within these groups, all included cancer patients are randomised into two subgroups: with and without pre-measurement. Self-reported assessments are conducted at four times: a pre-test at baseline before the first consultation and a post-test directly following the first consultation, and three and 12 months after baseline measurement. The primary outcome measures are the number and types of referrals of cancer patients with psychosocial problems to relevant (psychosocial) caregivers. The secondary outcome measures are patients' satisfaction with the radiotherapist-patient communication, psychosocial distress and quality of life. Furthermore, a process evaluation will be carried out. Data of the effect-evaluation will be analysed according to the intention-to-treat principle and data regarding the types of referrals to health care providers and patient satisfaction about the with radiotherapists will be analysed by means of descriptive techniques. The process evaluation data will also be analysed by means of descriptive techniques. DISCUSSION: Using the SIPP may prevent underdiagnosis of early symptoms reflecting psychosocial problems, should facilitate communication between physicians and patients about psychosocial distress and may contribute to adequate referral to relevant (psychosocial) caregivers. TRIAL REGISTRATION: NCT00859768.

Evaluation of three different CT simulation and planning procedures for the preoperative irradiation of operable rectal cancer.

PURPOSE: To find the best procedure regarding quality and work load for treatment planning in operable non-locally advanced rectal cancer using 3D CT-based information. METHODS: The study population consisted of 62 patients with non-locally advanced tumours, as defined by MRI in the lower (N=16), middle (N=25) and upper (N=21) rectum referred for preoperative short-course radiotherapy. In procedure 1 (Pr1), planning in one central plane was performed (field borders/shielding based on bony anatomy). In procedure 2 (Pr2), field borders were determined by 2 markers for the extension of the CTV in the cranial and ventral direction. Dose optimization was performed in one central and two border planes. In procedure 3(Pr3) the PTV volume (CTV was contoured on CT) received conformal treatment (3D dose optimization). RESULTS: Conformity index reached 1.6 for Pr3 vs. 2.2 for Pr2 (p<0.001). PTV coverage was 87%, 94%, 99% in Pr1, Pr2, Pr3, respectively (p=0.001). In Pr2 target coverage was below 95% for low/middle tumours. PTV coverage was reduced by narrow field borders (18-23%) and shielding (28%). A total of 43.5% (1-100) of the bladder volume was treated in Pr2 in contrast to 16% (0-68) in Pr3 (p<0.001). The maximum dose was exceeded in 10 patients (26-298 cc) and 2 patients (21-36 cc) in procedures 1 and 2, respectively. The overall time spent by technologists was 86 min for Pr3 vs 17 min in Pr2 and Pr1 (p<0.001), for radiation oncologists this difference was 24 vs 4 min (p<0.001). CONCLUSIONS: Pr1 does not fulfill todays quality requirements. Pr3 provides the best quality at the cost of working time. Pr2 is less time consuming, however, the PTV coverage was insufficient, with also much larger treatment volumes. An optimization of the PTV coverage in Pr2 even further enlarged the treatment volume.