The Sickness Behavior Inventory-Revised: Sickness behavior and its associations with depression and inflammation in patients with metastatic lung cancer
Open accessAbstract
BACKGROUND: Inflammation may contribute to the high prevalence of depressive symptoms seen in lung cancer. "Sickness behavior" is a cluster of symptoms induced by inflammation that are similar but distinct from depressive symptoms. The Sickness Behavior Inventory-Revised (SBI-R) was developed to measure sickness behavior. We hypothesized that the SBI-R would demonstrate adequate psychometric properties in association with inflammation. METHOD: Participants with stage IV lung cancer (n = 92) were evaluated for sickness behavior using the SBI-R. Concomitant assessments were made of depression (Patient Hospital Questionniare-9, Hospital Anxiety and Depression Scale) and inflammation [C-reactive protein (CRP)]. Classical test theory (CTT) was applied and multivariate models were created to explain SBI-R associations with depression and inflammation. Factor Analysis was also used to identify the underlying factor structure of the hypothesized construct of sickness behavior. A longitudinal analysis was conducted for a subset of participants. RESULTS: The sample mean for the 12-item SBI-R was 8.3 (6.7) with a range from 0 to 33. The SBI-R demonstrated adequate internal consistency with a Cronbach's coefficient of 0.85, which did not increase by more than 0.01 with any single-item removal. This analysis examined factor loadings onto a single factor extracted using the principle components method. Eleven items had factor loadings that exceeded 0.40. SBI-R total scores were significantly correlated with depressive symptoms (r = 0.78, p < 0.001) and CRP (r = 0.47, p < 0.001). Multivariate analyses revealed that inflammation and depressive symptoms explained 67% of SBI-R variance. SIGNIFICANCE OF RESULTS: The SBI-R demonstrated adequate reliability and construct validity in this patient population with metastatic lung cancer. The observed findings suggest that the SBI-R can meaningfully capture the presence of sickness behavior and may facilitate a greater understanding of inflammatory depression.
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There is strong evidence that activation of the innate immune system may lead to sickness behaviors characterized by depression-like symptomatology, including anhedonia, weight and appetite loss, memory impairment, as well as cognitive and social dysfunction.
“Furthermore, there is strong evidence that the activation of the innate immune system may lead to “sickness behaviors” characterized by depression-like symptomatology, including anhedonia, weight and appetite loss, memory impairment, as well as cognitive and social dysfunction [27,28].”
From C-Reactive protein as a biomarker for major depressive disorder? (2022) · cites this paper as [28]
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C-Reactive protein as a biomarker for major depressive disorder?
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- Authors
- McFarland, D. C., Walsh, L. E., Saracino, R., Nelson, C. J., Breitbart, W., & Rosenfeld, B.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Fordham University (US)
- Corresponding author
- McFarland, Daniel C.
- ORCID
- Venue
- Palliative and Supportive Care
- Publisher
- Cambridge University Press (CUP)
- Published
- 2020-11-23
- Volume
- 19
- Issue
- 3
- Pages
- 312-321
- ISSN
- 1478-9515 (ISSN-L)
- 1478-9523
- PMC
- PMC8311665
- OpenAlex
- W3107281367
- Cited by
- 5
- References
- 60
- Citations by year
- 2026: 3 · 2025: 1 · 2022: 1
- FWCI
- 0.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Palliative & Supportive Care (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (L30 CA220778, P30CA008748, T32CA009461)
- Topics
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- sickness behavior, metastatic lung cancer, depression, inflammation, C-reactive protein, inflammatory depression, psychometric properties, construct validity, reliability statistics, factor structure
- MeSH terms
- Depression, Humans, Inflammation, Lung Neoplasms, Psychometrics, Surveys and Questionnaires, Reproducibility of Results, Illness Behavior
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