An attempt to employ the Zung Self-Rating Depression Scale as a 'lab test' to trigger follow-up in ambulatory oncology clinics: Criterion validity and detection

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
Journal of Pain and Symptom Management (Impact Factor: 2.74). 04/2001; 21(4):273-81. DOI: 10.1016/S0885-3924(00)00264-5
Source: PubMed

ABSTRACT We examined issues of criterion validity and detection of depression employing the Zung Self-Rating Depression Scale (ZSDS) as a "lab test" to trigger follow-up interviews of ambulatory oncology patients by oncology staff and the possibility of subsequent algorithm-based antidepressant treatment. Sixty oncology patients were screened with the ZSDS and then interviewed using the Mini-International Neuropsychiatric Interview (MINI). We examined the sensitivity and specificity of various cutoffs on the ZSDS and a briefer version, the Brief Zung Self-Rating Depression Scale (BZSDS) as they predicted results of the MINI, which was used as the criterion. Mean age of patients was 58.3 years (SD = 11.9). Thirty-two were female (53.3%) and 28 were male (46.7%). The correlation of the ZSDS (r = -0.66, P <.0001) and BZSDS (r = -0.57, P <.0001) with the MINI overall suggested acceptable levels of criterion validity. Additionally, we examined various cutoff scores on the ZSDS and BZSDS to explore the false negative and false positive rates that are associated with each. For example, using the mild cutoff on the Zung (score > 48) to determine depression or adjustment disorder, 14 false negatives and 2 false positives were found. When the more stringent moderate cutoff (score > 56) was used, 25 false negatives and 0 false positives were found. Oncology staff can utilize such data to make decisions about where to set cut-offs that trigger follow-up based on the amount of error that is allowable in their attempts to identify depressive symptoms in their patients. We discuss that such decisions might be based on many factors including the resources available in a particular site for follow-up or the comfort of particular oncologists and nurses managing and prescribing psychotropic medications, or in providing supportive counseling.

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    • "It is a self-report scale comprising 20 statements related to depression, with half being formulated in positive terms and half in negative terms. The scores obtained are interpreted according to the following categories: normal (not depressed, raw score b 40), mild (raw score 40–47), moderate (raw score 48–55) and severe (raw score N 55) (Passik et al., 2001). "
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    • "Esta versão resumida foi projetada para maximizar a confiabilidade da identificação dos sintomas cognitivos da depressão (por exemplo, anedonia,concentração, disforia, desesperança ), ao eliminar os sintomas somáticos que muitas vezes são confundidos com o tratamento do câncer – por exemplo, fadiga, alterações do apetite e insônia (Passik et al., 2001). Os itens são respondidos por meio de uma escala de 1 a 4. Escores entre 22 a 32 são indicativos de depressão com gravidade leve, entre 33 a 38 com gravidade moderada e entre 39 a 44 com gravidade severa (Passik et al., 2001). No atual estudo, o coeficiente alfa de Cronbach foi de 0,82, valor similar ao relatado (0,84) por Dugan et al. (1998) em pacientes com câncer. "
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    • "The sum of the 20 items, after transposing the 10 items that are reverse-scored, produces a raw score of 20–80. Previous studies pointed out that scores are not meant to offer strict diagnostic guidelines but rather denote levels of depressive symptoms that might be clinically significant (Passik et al. 2001; Zung 1965, 1967). The Korean version of SDS was used in this study and has high internal consistency (i.e., Cronbach alpha for the SDS=0.79; Lee and Song 1991). "
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