An Attempt to Employ the Zung Self-Rating Depression Scale as a “Lab Test” to Trigger Follow-Up in Ambulatory Oncology Clinics

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
Journal of Pain and Symptom Management (Impact Factor: 2.8). 04/2001; 21(4):273-81. DOI: 10.1016/S0885-3924(00)00264-5
Source: PubMed


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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    ABSTRACT: The most important factor which predisposes young people to suicide is depression, although protective factors such as self-esteem, emotional adaptation and social support may reduce the probability of suicidal ideation and suicide attempts. Several studies have indicated an elevated risk of suicide for health-related professions. Little is known, however, about the relationship between perceived emotional intelligence and suicide risk among nursing students. The main goals were to determine the prevalence of suicide risk in a sample of nursing students, to examine the relationship between suicide risk and perceived emotional intelligence, depression, trait anxiety and self-esteem, and to identify any gender differences in relation to these variables. Cross-sectional study of nursing students (n=93) who completed self-report measures of perceived emotional intelligence (Trait Meta-Mood Scale, which evaluates three dimensions: emotional attention, clarity and repair), suicide risk (Plutchik Suicide Risk Scale), self-esteem (Rosenberg Self-esteem Scale), depression (Zung Self-Rating Depression Scale) and anxiety (Trait scale of the State-Trait Anxiety Inventory). Linear regression analysis confirmed that depression and emotional attention are significant predictors of suicidal ideation. Moreover, suicide risk showed a significant negative association with self-esteem and with emotional clarity and repair. Gender differences were only observed in relation to depression, on which women scored significantly higher. Overall, 14% of the students were considered to present a substantial suicide risk. The findings suggest that interventions to prevent suicidal ideation among nursing students should include strategies to detect mood disorders (especially depression) and to improve emotional coping skills. In line with previous research the results indicate that high scores on emotional attention are linked to heightened emotional susceptibility and an increased risk of suicide. The identification and prevention of factors associated with suicidal behaviour in nursing students should be regarded as a priority.
    Full-text · Article · Jul 2013 · Nurse education today
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    • "The HAMD-17 was used to assess the severity of depression. The brief versions, HAMD-7 and BZSDS [6, 7], were employed to detect melancholic symptoms. The HAMD-7 and the BZSDS both focus on the core depressive symptoms of depression, minimizing the anxiety or somatic items. "
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    ABSTRACT: This study aimed to estimate the prevalence of core depressive symptoms among cancer outpatients diagnosed with depressive or adjustment disorders with depressed mood. We also aimed to detect potential differences between patient self-assessment and psychiatrist evaluation in classifying the severity of depression. Fifty-two outpatients diagnosed with solid tumor malignancy and depressive or adjustment disorder with depressed mood were assessed using the Hamilton Depression Rating Scale (HAMD-17) (and its shortened version the HAMD-7) and the Zung Self-Rating Depression Scale (ZSDS) (and its shortened version BZSDS). Based on HAMD-7 results, the prevalence of moderate depression was low (7.7%); using the BZSDS moderate depression was absent. Mild depression was identified in 82.3% and 73% of our subjects using the HAMD-7 and the BZSDS, respectively. The strength of agreement between psychiatrist and patients' self-evaluation for mild depression was "slight", employing the original and the abbreviated versions of both scales. Our findings suggest that the prevalence of core depressive symptoms is very low in cancer patients diagnosed with depressive disorder. The lack of a strong agreement between psychiatrist and patient in classifying the severity of depression highlights the importance of factors such as well-being and functional status among depressed cancer patients in their self assessment of depression.
    Full-text · Article · Dec 2011 · Clinical Practice and Epidemiology in Mental Health
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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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    ABSTRACT: This study investigated the sleep quality of women with breast cancer and their relationship with quality of life and depression. Fifty women with breast cancer (clinical group) and a control group of other 50 women without the disease answered a clinical-demographic questionnaire and the Pittsburgh Sleep Quality Index. The clinical group also completed the Quality of Life Cancer-Survivor and the Brief Zung Self-Rating Depression Scale questionnaires. It was found that women with breast cancer had significantly more complaints of nocturia, heat and nighttime awakenings. The clinical group with poor quality of sleep reported impaired quality of life and more symptoms of depression. In general terms, sleep quality in women with breast cancer can predict their quality of life and psychological well-being.
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