The validity of the Edmonton Symptom Assessment System-Depression item for screening for depression in individuals with cancer pain: A cross-sectional study

Abstract

Context Depression is common in individuals with cancer and pain, negatively impacts quality of life, treatment adherence, tumor progression, and survival. Objectives The primary aims of this study were to (1) evaluate the validity of the Edmonton Symptom Assessment System's depression (ESAS-D) for detecting major depressive disorder (MDD) as diagnosed by a psychiatrist and (2) identify the best cutoff for this purpose in a sample of cancer pain individuals. The secondary aim was to compare ESAS-D with another commonly used screening measure (Patient Health Questionnaire-2 [PHQ-2]) for classifying individuals as meeting or not meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for depression. Methods 49 cancer pain individuals completed the ESAS-D and PHQ-2 Within 2 weeks, a psychiatrist interviewed the participants and determined whether or not they met criteria for MDD based on the DSM-5. Results The ESAS-D demonstrated acceptable accuracy and validity for classifying MDD. A cutoff of ≥2 was identified as being best able to balance sensitivity (85%) and specificity (76%) and had an overall accuracy of 79%. A receiver operating characteristic curve analysis showed an area under the curve (AUC) of 0.81 (95% confidence interval [CI]: 0.68-0.94). The ESAS-D also compared favorably with the modified Thai PHQ-2 (sensitivity, 75%; specificity, 72%; overall accuracy, 73%; AUC, 0.74 [95% CI: 0.59-0.88]) for identifying MDD individuals. Conclusions The ESAS-D showed acceptable sensitivity, specificity, and overall accuracy for screening for MDD in cancer and pain. It could therefore be used to screen for probable depression in this population.