Assessment of depression severity with the PHQ-9 in cancer patients and in the general population
Open accessAbstract
BACKGROUND: The Patient Health Questionnaire PHQ-9 is a widely used instrument to screen for depression in clinical research. The first aim of this study was to psychometrically test the PHQ-9 in a large sample of cancer patients. The second aim was to calculate unbiased estimates of the depression burden for several cancer groups taking into account age and gender distributions. METHODS: A sample of 2,059 cancer patients with varying diagnoses were examined in this study six months after discharge from a rehabilitation clinic. A representative sample of 2,693 people from the general population served as controls. Expected PHQ-9 mean scores of the general population sample, regressed on age and gender, were calculated to enable a fair comparison of different groups of cancer patients. RESULTS: While the reliability (Cronbach's alpha) for the PHQ-9 scale was good (alpha ≥ 0.84), the CFA fit indices of the one-dimensional solution were unsatisfactory in the patients' sample. The factorial analysis confirmed two factors. PHQ-9 mean scores for 15 types of cancer are given, ranging from 4.0 (prostate) to 8.2 (thyroid gland). Differences between expected mean scores (derived from the general population) and raw mean scores of the cancer subsamples are reported that provide a better estimate of the depression burden. CONCLUSIONS: The results confirmed that the PHQ-9 performs well in testing depression in cancer patients. Regression coefficients can be used for performing unbiased comparisons among cancer groups, not only for this study. The burden of patients with testis cancer and Hodgkin lymphoma is underestimated when age and gender are not taken into account.
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Emotional distress was assessed with the well-validated 8-item Patient Health Questionnaire (PHQ-8).
“We assessed emotional distress with the well-validated 7-item Generalized Anxiety Disorder questionnaire (GAD-7) [31,32] and the 8-item Patient Health Questionnaire (PHQ-8) [33,34].”
From Pilot randomized trial of an acceptance-based telehealth intervention for women with ovarian cancer and PARP inhibitor-related fatigue (2023) · cites this paper as [33]
The Background describes the validated instrument as the PHQ-9, not the PHQ-8. The Methods > Instruments table lists nine items, including suicidal ideation, so this paper does not substantiate the citing sentence’s identification of an 8-item questionnaire. (LLM, conf=0.86)
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Experimental — accuracy not yet measuredAmong adults with various forms of cancer, the PHQ-9 shows good internal consistency α ≥ 0.84.
“Among adults with various forms of cancer, the PHQ-9 shows good internal consistency α ≥ 0.84 [57].”
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- Authors
- Hinz, A., Mehnert, A., Kocalevent, R.-D., Brähler, E., Forkmann, T., Singer, S., & Schulte, T.
- Affiliations
- Leipzig University (DE)
- University Medical Center Hamburg-Eppendorf (DE)
- Johannes Gutenberg University Mainz (DE)
- Universitätsklinikum Aachen (DE)
- Klinik Bad Oexen (DE)
- Corresponding author
- Hinz, Andreas
- Venue
- BMC Psychiatry
- Published
- 2016-02-02
- Volume
- 16
- Issue
- 1
- Pages
- 22-22
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC4736493
- OpenAlex
- W2265298155
- Cited by
- 272
- References
- 44
- Citations by year
- 2026: 27 · 2025: 36 · 2024: 38 · 2023: 18 · 2022: 31 · 2021: 41 · 2020: 30 · 2019: 28 · 2018: 11 · 2017: 9 · 2016: 2 · 2013: 1
- FWCI
- 8.99
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RWTH Publications (RWTH Aachen) (submittedVersion, other-oa)
- Qucosa (Saxon State and University Library Dresden) (submittedVersion, other-oa)
- RWTH Publications (RWTH Aachen)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- PHQ-9, depression severity, cancer patients, psychometric validation, depression screening, cancer type differences, Hodgkin's disease, factor structure
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Depression, Female, Humans, Male, Middle Aged, Neoplasms, Psychiatric Status Rating Scales, Psychometrics, Sex Factors, Reproducibility of Results, Case-Control Studies, Young Adult
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