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OBJECTIVE: To determine the validity of a 50% drop in the 20-item Symptom Checklist Depression Scale (SCL-20) score against the "gold standard" of no longer meeting criteria for major depression as assessed using a diagnostic interview in an outpatient cancer population and also to examine the validity of other potential cut-offs (i.e., percentage drops). MATERIALS AND METHODS: Secondary analysis of data from a randomized trial which compared collaborative care with usual care for cancer patients with major depression. A total of 194 trial participants who had both SCL-20 scores and depression diagnoses on the Structured Clinical Interview for DSM-IV at both baseline and at 12-week outcome formed the analyzed sample. RESULTS: A 50% reduction in the SCL-20 score from baseline to 12 weeks correctly identified the patients who no longer met criteria for major depression in 153 (78.9%) of 194 (95% CI 73.1% to 84.6%) cases. Most of those misclassified had not achieved a 50% reduction in SCL-20 score despite no longer meeting criteria for major depression. Examination of the performance of percentage drops other than 50% on the SCL-20 using a receiver operating characteristics (ROC) curve and histogram of misclassification suggested that the 50% drop was best if both a low overall misclassification rate and the minimizing of false positives of improvement were required. CONCLUSIONS: A 50% reduction in the SCL-20 score performs well as a conservative measure of change in depression status in cancer patients

Type

Journal article

Journal

Gen.Hosp.Psychiatry

Publication Date

05/2010

Volume

32

Pages

334 - 336

Keywords

analysis, cancer, care, case, CLINICAL, collaborative care, depression, examination, HAD, interview, measure, Medicine, methods, outcome, outpatient, patient, Patients, performance, population, psychological, psychological medicine, randomized, research, Research Support, scale, school, scl-20, Scotland, secondary, symptom, trial, uk, Universities, usual care, validity, WHO