The DOI matches its Crossref record; 44 of the 44 references it cites were found in a registry or an index.
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source doesn’t support the claim as written.
In the citing paper
“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]
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Among adults with various forms of cancer, the PHQ-9 shows good internal consistency α ≥ 0.84 [57].”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788
The CES-D Scale: A Self-Report Depression Scale for Research in the General Population
Radloff, L. S. (1977) · Applied Psychological Measurement · doi:10.1177/014662167700100306 · Cited by 53,267
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910
An inventory for measuring depression
BECK, A. T. (1961) · Archives of General Psychiatry · doi:10.1001/archpsyc.1961.01710120031004 · Cited by 38,032
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765
Significance tests and goodness of fit in the analysis of covariance structures.
Bentler, P. M., & Bonett, D. G. (1980) · Psychological Bulletin · doi:10.1037/0033-2909.88.3.588 · Cited by 19,933
Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., Filiberti, A., Flechtner, H., Fleishman, S. B., Haes, J. C. J. M. D., et al. (1993) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/85.5.365 · Cited by 16,005
Depression and quality of life in older persons: A review
Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A.-S. (2015) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000437299 · Cited by 14,152
Structural model evaluation and modification: An interval estimation approach
Steiger, J. H. (1990) · Multivariate Behavioral Research · doi:10.1207/s15327906mbr2502_4 · Cited by 7,408
Selective Cortical Undercutting As a Means of Modifying and Studying Frontal Lobe Function in Man
Scoville, W. B. (1949) · Journal of neurosurgery · doi:10.3171/jns.1949.6.1.0065 · Cited by 7,374
A Reliability Coefficient for Maximum Likelihood Factor Analysis
Tucker, L. R., & Lewis, C. (1973) · Psychometrika · doi:10.1007/bf02291170 · Cited by 7,330 · cited 2×
“We used the following criteria: Bayesian Information Criterion (BIC), Standardized Root Mean Square Residual (SRMR), Root Mean Square Error of Approximation (RMSEA) [35], Comparative Fit Index (CFI) [36], and Tucker Lewis Index (TLI) [37].”
MethodInfluentialLöwe, B., Wahl, I., Rose, M., Spitzer, C., Glaesmer, H., Wingenfeld, K., Schneider, A., & Brähler, E. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.06.019 · Cited by 2,473
Self-citationValidity of the brief patient health questionnaire mood scale (PHQ-9) in the general population
Martin, A., Rief, W., Klaiberg, A., & Braehler, E. (2006) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2005.07.003 · Cited by 1,379
Depression and cancer mortality: a meta-analysis
Pinquart, M., & Duberstein, P. R. (2010) · Psychological Medicine · doi:10.1017/s0033291709992285 · Cited by 1,083 · cited 1×
“Depression may negatively affect treatment outcomes [3] and can be associated with elevated mortality in cancer patients [4].”
BackgroundKocalevent, R.-D., Hinz, A., & Brähler, E. (2013) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2013.04.006 · Cited by 748
Oncologists' recognition of depression in their patients with cancer.
Passik, S. D., Dugan, W., McDonald, M., Rosenfeld, B. D., Theobald, D., & Edgerton, S. (1998) · Journal of Clinical Oncology · doi:10.1200/jco.1998.16.4.1594 · Cited by 587
Diagnostic accuracy of the mood module of the patient health questionnaire: a systematic review
Wittkampf, K. A., Naeije, L., Schene, A. H., Huyser, J., & van Weert, H. C. (2007) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2007.06.004 · Cited by 493
Mitchell, A. J. (2007) · Journal of Clinical Oncology · doi:10.1200/jco.2006.10.0438 · Cited by 468
Prevalence of mental health conditions in cancer patients in acute care—a meta-analysis
Singer, S., Das-Munshi, J., & Brähler, E. (2010) · Annals of Oncology · doi:10.1093/annonc/mdp515 · Cited by 392
Fear of cancer progression and cancer‐related intrusive cognitions in breast cancer survivors
Mehnert, A., Berg, P., Henrich, G., & Herschbach, P. (2009) · Psycho-Oncology · doi:10.1002/pon.1481 · Cited by 354
Fear of progression in chronic diseases
Herschbach, P., Berg, P., Dankert, A., Duran, G., Engst-Hastreiter, U., Waadt, S., Keller, M., Ukat, R., & Henrich, G. (2005) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2005.02.007 · Cited by 312
Hjermstad, M. J., Fayers, P. M., Bjordal, K., & Kaasa, S. (1998) · European Journal of Cancer · doi:10.1016/s0959-8049(98)00136-1 · Cited by 282
Depression and Survival in Metastatic Non–Small-Cell Lung Cancer: Effects of Early Palliative Care
Pirl, W. F., Greer, J. A., Traeger, L., Jackson, V., Lennes, I. T., Gallagher, E. R., Perez-Cruz, P., Heist, R. S., & Temel, J. S. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2011.38.3166 · Cited by 228 · cited 1×
“Depression may negatively affect treatment outcomes [3] and can be associated with elevated mortality in cancer patients [4].”
BackgroundWahl, I., Löwe, B., Bjørner, J. B., Fischer, F. H., Langs, G., Voderholzer, U., Aita, S. A., Bergemann, N., Brähler, E., & Rose, M. (2013) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2013.04.019 · Cited by 193
Screening for major depression in cancer outpatients
Thekkumpurath, P., Walker, J., Butcher, I., Hodges, L. J., Kleiboer, A. M., O’Connor, M. J., Wall, L. R., Murray, G. D., Kroenke, K., & Sharpe, M. (2010) · Cancer · doi:10.1002/cncr.25514 · Cited by 186
Psychometrics of the PHQ-9 as a measure of depressive symptoms in patients with heart failure
Hammash, M., Hall, L. A., Lennie, T. A., Heo, S., Chung, M. L., Lee, K. S., & Moser, D. K. (2012) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515112468068 · Cited by 173
Elhai, J. D., Contractor, A. A., Tamburrino, M., Fine, T. H., Prescott, M. R., Shirley, E. R., Chan, P. K., Slembarski, R., Liberzon, I., Galea, S., et al. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.05.018 · Cited by 158
Factors associated with patient involvement in surgical treatment decision making for breast cancer
Hawley, S. T., Lantz, P. M., Janz, N. K., Salem, B., Morrow, M., Schwartz, K., Liu, L., & Katz, S. J. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2006.09.010 · Cited by 148
Richardson, E. J., & Richards, J. S. (2008) · Rehabilitation Psychology · doi:10.1037/0090-5550.53.2.243 · Cited by 142
What is the General Health Questionnaire-12 assessing?
Romppel, M., Brähler, E., Roth, M., & Glaesmer, H. (2012) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2012.10.010 · Cited by 130
Quality of Life in Patients with Thyroid Cancer Compared with the General Population
Singer, S., Lincke, T., Gamper, E., Bhaskaran, K., Schreiber, S., Hinz, A., & Schulte, T. (2011) · Thyroid · doi:10.1089/thy.2011.0139 · Cited by 125
The factor structure of the PHQ-9 in palliative care
Chilcot, J., Rayner, L., Lee, W. E., Price, A. C., Goodwin, L., Monroe, B., Sykes, N. P., Hansford, P., & Hotopf, M. H. (2013) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.12.012 · Cited by 111
Krause, J. S., Reed, K. S., & McArdle, J. J. (2010) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2010.04.015 · Cited by 104
Walker, J., Hansen, C. H., Butcher, I., Sharma, N., Wall, L. R., Murray, G. D., & Sharpe, M. (2011) · Psychosomatics · doi:10.1016/j.psym.2011.02.003 · Cited by 99
Krause, J. S., Bombardier, C. H., & Carter, R. E. (2008) · Rehabilitation Psychology · doi:10.1037/a0013354 · Cited by 95
Screening for depression: Rasch analysis of the dimensional structure of the PHQ-9 and the HADS-D
Kendel, F., Wirtz, M. A., Dunkel, A., Lehmkuhl, E., Hetzer, R., & Regitz‐Zagrosek, V. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.07.004 · Cited by 90
Patient-reported depression measures in cancer: a meta-review
Wakefield, C. E., Butow, P. N., Aaronson, N. K., Hack, T. F., Hulbert-Williams, N., & Jacobsen, P. B. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00168-6 · Cited by 66
Forkmann, T., Gauggel, S., Spangenberg, L., Brähler, E., & Glaesmer, H. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.12.019 · Cited by 61
Longitudinal Comparison of Three Depression Measures in Adult Cancer Patients
Johns, S. A., Kroenke, K., Krebs, E. E., Theobald, D., Wu, J., & Tu, W. (2012) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2011.12.284 · Cited by 44
Hinz, A., Krauß, O., Stolzenburg, J., Schwalenberg, T., Michalski, D., & Schwarz, R. (2008) · Urologic Oncology Seminars and Original Investigations · doi:10.1016/j.urolonc.2008.02.003 · Cited by 43
Identifying tumor patients' depression
Singer, S., Brown, A., Einenkel, J., Hauss, J., Hinz, A., Klein, A., Papsdorf, K., Stolzenburg, J., & Brähler, E. (2010) · Supportive Care in Cancer · doi:10.1007/s00520-010-1004-9 · Cited by 42
Watzke, B., Heddaeus, D., Steinmann, M., König, H., Wegscheider, K., Schulz, H., & Härter, M. C. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0230-y · Cited by 34
Stafford, L., Judd, F. K., Gibson, P., Komiti, A., Quinn, M. A., & Mann, G. B. (2013) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2013.08.010 · Cited by 31
Research works printed but not linked: 1
- Cohen J. Statistical power analysis for the behavioral sciences, ed 2. Hillsdale, NJ: Erlbaum; 1988.
Cited by
Sorted by citations
Pieh, C., Budimir, S., & Probst, T. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110186 · Cited by 1,122
The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis
Deng, J., Zhou, F., Hou, W., Silver, Z., Wong, C. Y., Chang, O., Huang, E., & Zuo, Q. K. (2021) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.14506 · Cited by 771
Naser, A. Y., Dahmash, E. Z., Al‐Rousan, R., Alwafi, H., Alrawashdeh, H. M., Ghoul, I., Abidine, A., Bokhary, M. A., AL‐Hadithi, H. T., Ali, D., et al. (2020) · Brain and Behavior · doi:10.1002/brb3.1730 · Cited by 398
Depression and Anxiety in Patients With Cancer: A Cross-Sectional Study
Naser, A. Y., Hameed, A. N., Mustafa, N., Alwafi, H. H., Dahmash, E. Z., Alyami, H. S., & Khalil, H. Z. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.585534 · Cited by 309
Greer, J. A., Jacobs, J. M., El-Jawahri, A. R., Nipp, R. D., Gallagher, E. R., Pirl, W. F., Park, E. R., Muzikansky, A., Jacobsen, J. C., Jackson, V. A., et al. (2017) · Journal of Clinical Oncology · doi:10.1200/jco.2017.73.7221 · Cited by 178
Metadata
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
