Screening for major depressive disorder in adults with cerebral glioma: an initial validation of 3 self-report instruments

No depression screening tool is validated for use in cases of cerebral glioma. To address this, we studied the operating characteristics of the Hospital Anxiety and Depression Scale (Depression subscale) (HAD-D), the Patient Health Questionnaire–9 (PHQ-9), and the Distress Thermometer (DT) in glioma patients.We conducted a twin-center prospective observational cohort study of major depressive disorder (MDD), according to the Diagnostic and Statistical Manual, 4th edition, in adults with a new diagnosis of cerebral glioma receiving active management or “watchful waiting.” At each of 3 interviews over a 6-month period, patients completed the screening questionnaires and received a structured clinical interview to diagnose MDD. Internal consistency, area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value, and positive likelihood ratio were calculated. A maximum of 154 patients completed the DT, 133 completed the HAD-D, and 129 completed the PHQ-9. The HAD-D and PHQ-9 showed good internal consistency (a ≥ 0.77 at all timepoints). Median AUCs were 0.931+ + 0.074 for the HAD-D and 0.915+ 0.055 for the PHQ-9. The optimal threshold was 71 for the HAD-D, but 81 had similar operating characteristics. There was no consistently optimal PHQ-9 threshold, but 101 was optimal in the largest sample. The DT was inferior to the multi-item instruments. Clinicians can screen for depression in wellfunctioning glioma patients using the HAD-D at the existing recommended lower threshold of 81, or the PHQ-9 at a threshold of 101. Due to a modest positive