Similaire à IPOS10 T276 - Large Scale Validation of the Emotion Thermometers as a Screening Tool for Major Depression in an Ethnically Diverse Cancer Popn
Similaire à IPOS10 T276 - Large Scale Validation of the Emotion Thermometers as a Screening Tool for Major Depression in an Ethnically Diverse Cancer Popn (20)
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IPOS10 T276 - Large Scale Validation of the Emotion Thermometers as a Screening Tool for Major Depression in an Ethnically Diverse Cancer Popn
1. T276 - -A Large Scale Validation of the Emotion Thermometers as
T276 A Large Scale Validation of the Emotion Thermometers as
aaScreening Tool for MDD & Distress in an Ethnically Diverse
Screening Tool for MDD & Distress in an Ethnically Diverse
Cancer Population
Cancer Population
Alex Mitchell www.psycho-oncology.info
Paul Symonds
Lorraine Grainger
Elena Baker-Glenn
Department of Cancer & Molecular Medicine, Leicester Royal Infirmary
IPOS 2010
2. Audit / Research Protocol
Phase I – DT across LNR network (incl training)
Phase II – Enhancements to DT
Phase III - Screening plus Intervention
4. Qualitative Limitations of DT
DT not always interpreted by patients
Distress not always understood by patients
There is no anchor
Patients who are angry or depressed may not say
“distressed”
But some patients may not interpret “depression”
5. Quantitative Limitations of DT
Of 401 chemotherapy attendees
59% have an emotional complication (3v4)
37% (62% of 59%) it included distress
23% it excluded distress
Validity of DT vs depression (DSMIV)
SE 80% SP 60% PPV 32% NPV 93%
7. ET - Table of Cut-Points
Distress Anxiety Depression Anger Help
Thermomete thermomet Thermomete Thermomete Thermomete
r er r r r Cut-point
Insignifica
nt 39.0 25.6 50.1 55.7 54.3 0,1
Minimal 20.1 22.5 18.3 13.6 15.4 2,3
Mild 16.9 16.5 12.2 10.5 12.2 4,5
Moderate 12.0 14.5 9.8 6.6 6.6 6,7
Severe 11.9 20.8 9.5 13.6 11.2 8,9,10
p130
8. 1.00
0.90
0.80
Ten
0.70 Nine
Eight
0.60 Seven
Six
0.50
Five
Four
0.40
Three
Two
0.30
One
0.20
Zero
0.10
0.00
Distress Anxiety Depression Anger
Thermometer Thermometer Thermometer Thermometer
12. Concerns linked with distress
t = 7.705129 P < 0.0001 Anxiety
t = 4.859186 P < 0.0001 depression/hopeless
t = 4.448083 P < 0.0001 Family concerns/issues
t = 4.10916 P < 0.0001 Anger/Irritability
t = 2.699969 P = 0.0073 Self-Esteem
t = 2.69652 P = 0.0073 Cancer worries
t = 2.497361 P = 0.013 Coping concerns
t = 2.371534 P = 0.0183 Sleep
15. Graphical – Screening principles
#
of Cut-Off
Individuals
Low High
Non-Depressed
<<<< low Specificity
Severity of Depression
High Sensitivity >>>> Depressed
#
of
Individuals
16. Validity Against HADS-T (distress)
We analysed data collected from Leicester Cancer Centre
from 2007-2009
The researcher applied the HADS and used a HADS-T >14
to signify distress.
We collated full data on 660 patient assessments
17. HADS-T
In the parent sample of 660:
SE SP AUC CUT
DT – 71.9% 78.4% 0.814 cut point =4
18. HADS-T
In the parent sample of 660:
SE SP AUC CUT
DT – 71.9% 78.4% 0.814 cut point =4
AnxT – 75.7% 73.4% 0.821 cut point =5
DepT – 77.6% 82.2% 0.855 cut point =3
AngT – 77.5% 77.6% 0.823 cut point =2
HelpT - 69.1% 80.8% 0.809 cut point =3
19. Against MDD
The researcher applied criteria for MDD. We collated full data on
660 patient assessments
MDD was defined by DSMIV criteria (5 of 9 symptoms)
12.9% had MDD and 14.8% were from ethnic minorities (largely
British South Asian of India descent).
25. Summary
Against Distress
All thermometers were “good” but DepT was best
Against Depression (all)
DepT > DT were “good”
Against Depression in BSA
DT may be best?