Screening for depression in head and neck cancer

Objectives: The objectives of this study are to identify the prevalence of depression and the accuracy of depression screening instruments in ambulatory head and neck cancer patients who have received radiation. This population is at risk for depression because of the life-threatening nature of the illness, and treatment-induced oral morbidity.

Methods: Sixty subjects were evaluated for Major and Minor Depression according to Research Diagnostic Criteria using the Schedule for Affective Disorders and Schizophrenia (SADS). Screening instruments examined were the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS) and the Centre for Epidemiological Studies-Depression (CES-D) scale. Accuracy was assessed by calculating the sensitivities, specificities, positive predictive values (PPV) and areas under curve (AUC) from Receiver Operating Characteristic (ROC) curves.

Results: The prevalence of Major and Minor Depression was 20%. All of the screening instruments tested were found to be highly accurate. Statistically significant differences between the instruments were not observed but the HADS demonstrated the highest absolute levels of sensitivity, specificity and PPV. No cases of Major Depression were missed by any of the instruments tested.

Conclusions: These results suggest that a significant minority of head and neck cancer patients are depressed in the post radiation period, and that accurate screening for clinically significant depression is possible using any of the three instruments evaluated here.