Various and accurate psychiatric assessments in patients with breast cancer who frequently suffer from psychological problems due to long-term survivors are warranted. This systematic review aimed to investigate the current evidence on psychometric properties of psychiatric assessment for evaluating psychological problems in breast cancer patients.
This systematic review progressed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Four electronic databases such as Web of Science, PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature were searched. This study protocol was registered on Open Science Framework.
Of the 2,040 articles, 21 papers were finally included. Among them, only five studies showed the performance of psychiatric assessment tools. Among 13 assessment tools used in the selected articles, the Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), or Mini-Mental Adjustment to Cancer Scale was frequently used for the evaluation of psychological problems. The DT and Psychosocial Distress Questionnaire-Breast Cancer showed acceptable performances for the prediction of depression and anxiety assessed by the HADS.
This systematic review found psychiatric assessment tools with acceptable reliability and validity for breast cancer patients. However, comparative studies on reliability and validity of various scales are required to provide useful information for the selection of appropriate assessment tools based on the clinical settings and treatment stages of breast cancer. Joint research among the fields of psychiatry and breast surgery is needed for research to establish the convergent, concurrent, and predictive validity of psychiatric assessment tools in breast cancer patients.
Psychological problems of cancer patients including depression, anxiety, or psychological distress can occur at any stage in diagnosis and treatment process of cancer. The prevalence of depression in cancer patients is about 8%–24% [
When the psychological problems of cancer patients are not adequately treated, they may last chronically and may significantly degrade their quality of life by stopping them from returning to their normal daily lives [
Systems based solely on referrals initiated by physicians or patients for depression in cancer patients could overlook a significant portion of patient’s suffering [
We conducted a systematic review and reported its results to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline (
The purpose of this review was to investigate the reliability and validity of assessment tools for evaluating psychological problems in breast cancer patients.
To examine the status of research related to assessments on psychological problems in breast cancer patients, papers were explored using four search engines, Web of Science, PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), for articles published in the past 11 years from 2011 to 2021. The search used these key terms ((anxiety OR depression OR distress OR psychologi*) AND (validation OR reliability) AND (assessment OR tool OR screening OR instrument) ) AND breast cancer (
We deduplicated the articles electronically. The inclusion criteria included clinical studies measuring the validity and/or reliability of psychological problem evaluation tools. The exclusion criteria were 1) articles unrelated to this topic; 2) articles without new research data such as editorials, comments, letters, and reviews; and 3) books. To evaluate the inclusion and exclusion criteria, titles and abstracts of articles in a potential eligible list were read independently by two authors (HSP, KEK). Articles by both reviewers who met the exclusion criteria were removed from the potential eligibility list. The full text of the remaining articles on the potential eligibility list was read independently by two authors (HSP, KEK) to evaluate the article’s eligibility. If there was a disagreement, a consensus meeting was held with the third and fourth reviewers (ESM, TWK).
To prevent bias or omission, two authors (HSP, KEK) independently extracted data from the included studies. When there were any disagreements on the extracted data, a consensus meeting with other reviewers (ESM, TWK) was held to solve the disagreements. We used structured data extraction on the author, year of publication, country, study type, age group, patients’ stage, sample size, study aim and conclusion, reliability, and validity assessment related to numerical value key findings. Cronbach’s alpha for internal consistency, model indices for validity, and the results of performance such as sensitivity, specificity, positive predictive value, and negative predictive value were extracted.
As a result, 2,040 documents were searched, and duplicate documents were primarily excluded. After that, 42 papers studied based on the contents of screening and evaluation of psychological problems in breast cancer patients were finally selected by reviewing the abstract and title; after reading the full text of the remaining articles, 21 articles were finally selected (
Twenty-one studies included patients from various stages, and five studies included stage IV patients [
The results of the reliability of the psychiatric assessment tools for psychological problems assessment tools were summarized in
The results of the validity of the psychiatric assessment tools for psychological problems assessment tools using factor analysis and correlation analysis were summarized in
Among the included 21 studies, there were only five studies showing performance on sensitivity, specificity, positive predictive value, and negative predictive value [
This systematic review examined the evidence during the recent decade on reliability and validity of assessment tools for depression, anxiety, distress, and psychological problems in breast cancer patients. Given that the necessity of cancer-specific psychiatric assessment tools as well as reliable and valid scales in breast cancer patients, this systematic review provided useful information on the selection of proper assessment tools for screening and monitoring principal psychological problems such as depression, anxiety, and distress in patients with breast cancer. This systematic review finally included 21 studies that used various assessment tools (
The most frequent assessment tool among the selected 21 studies was the HADS which was developed in 1983 by Zigmond and Snaith [
Meanwhile, in case of breast cancer, it is important to accept and adapt to the disease because the survival rate is relatively high and long-term treatment is required [
This systematic review found various assessment tools to have good reliability and validity for breast cancer patients. However, there seems to be a lack of studies for comparison of the psychometric properties of psychiatric assessment tools for breast cancer patients. To provide useful information for the selection of appropriate assessment tools according to clinical settings and treatment stages of breast cancer, comparative studies on the reliability and validity of various scales are warranted. In perspectives of validity, convergent validity on each scale in breast cancer patients needs to be established. Additionally, for the application of psychiatric scales in real practice for breast cancer patients, more studies on the concurrent validity associated with various psychological problems or psychiatric symptoms need to be explored. Furthermore, the predictive validity related to the development into psychiatric illness or surgical prognosis of breast cancer needs to be investigated in future studies.
There were some limitations in this systematic review. Firstly, the previous studies published before 2011 were not included, because the search time frame for this systematic review was limited from 2011 to 2021. Unfortunately, a small portion of English-speaking studies among all studies was included, although there were not any language restrictions. The English-speaking studies might be performed before 2011 than non-English-speaking studies. Secondly, because this systematic review only used four databases, studies published in other databases were not included in this systematic review. However, because four databases such as Web of Science, PubMed, Embase, and CINAHL in this study were known as principal databases, most of the well-designed studies might be included.
This systematic review summarized the evidence on psychometric properties of psychiatric evaluation tools for breast cancer patients. This review identified 2,040 articles and showed the results of reliability and validity in 10 studies among included 21 articles. The HADS and DT for measuring depression, anxiety, and emotional distress were widely used. There have been studies to reduce the number of items in the MAC, which evaluate coping responses in cancer patients, to make it an easy-to-use tool. As well as breast cancer-specific tools such as the PDQ-BC and NDBCSS were being developed to evaluate distress focused on breast cancer patients. This systematic review found reliable and valid assessment tools to evaluate depression, anxiety, distress, and psychological problems for breast cancer patients. However, comparative studies on reliability and validity of various scales are required for selection of proper assessment tools according to clinical situations. Furthermore, convergent validity on each scale needs to be established, and concurrent or predictive validity on psychiatric symptoms, psychiatric illness or surgical prognosis should be explored for effective use in breast cancer patients.
The online-only Data Supplement is available with this article at
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist
Search strategies used in this systematic review
The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.
The authors have no potential conflicts of interest to disclose.
Conceptualization: Eunsoo Moon, Taewoo Kang. Data curation: Heeseung Park, Kyoung-Eun Kim. Investigation: Heeseung Park, Eunsoo Moon, Taewoo Kang. Methodology: all authors. Project administration: Eunsoo Moon, Taewoo Kang. Resources: Heeseung Park, Kyoung-Eun Kim. Supervision: Eunsoo Moon, Taewoo Kang. Validation: Eunsoo Moon, Taewoo Kang. Visualization: Heeseung Park. Writing—original draft: Heeseung Park. Writing—review & editing: Kyoung-Eun Kim, Eunsoo Moon, Taewoo Kang.
None
Flowchart of the search process and the number of selected studies. Initial searching retrieved 2,040 articles. After deduplication and screening of titles and abstracts, 42 articles were selected. After checking full-text articles and assess eligibility and the purpose of this study, 21 articles were finally selected.
Selected studies on the psychometric properties of the psychiatric assessment tools for psychological problems in breast cancer patients from 2011 to 2021
Study | Articletype | Assessment scale (items)/comparative measure scale (items) | Psychological assessment domain | Ethnicity | No. of participants | Age of participants | Stage of participants | Study’s aim | Study’s conclusion | |
---|---|---|---|---|---|---|---|---|---|---|
Ashing-Giwa and Rosales [ |
Full | CES-D (20) | Depression | AA | 320 Breast cancer surgery | 18 & older | 0–III | Cross-cultural validation | The CES-D had very good internal consistency across ethnic and language groups | |
EP | 88 AA | |||||||||
LEP | 95 EP | |||||||||
137 LEP | ||||||||||
Bidstrup et al. [ |
Full | DT (1)/HADS (14) | Distress | Danish | 333 | 60±10.0 | Newly diagnosed primary Breast cancer who were operated | Measures of the accuracy of the DT according to HADS | 1. The DT performed satisfactorily relative to the HADS for detecting distress in Danish women with newly diagnosed BC | |
2. For screening to rule out distress, a cut-off score of 2 vs. 3 is recommended on the Danish DT | ||||||||||
Bogaarts et al. [ |
Full | PDQ-BC (35)/CES-D (20) | Distress | Netherlands | 123 | 50.8±10.2 (29–73) | Early stage | To examine the psychometric properties of the PDQ-BC | 1. The PDQ-BC has expected sufficient internal consistency. | |
2. The construct validity on the PDQ-BC subscales social support, sexual problems and financial problems was good. | ||||||||||
Bogaarts et al. [ |
Full | PDQ-BC (35)/DT (1), HADS (14) | Distress | Netherlands | 154 | 51.4±8.0 (34–68) | Group 1: disease-free breast cancer patients who had completed their treatment with adjuvant chemotherapy | 1. The test–retest reliability and sensitivity to change of the PDQ-BC | 1. PDQ-BC has good test–retest reliability and a satisfactory sensitivity to change | |
Group 1 (54/64) | 2. The sensitivity and specificity of the subscales state anxiety and depressive symptoms (PDQ-BC) compared to the HADS-A and HADS-D for identifying psychological problems | |||||||||
Sensitivity to change & construct validity | 51.3±8.6 (29–71) | 2. PDQ-BC has a satisfactory sensitivity and specificity | ||||||||
Group 2 (80/90) | Group 2: early-stage breast cancer who visited the outpatient clinic | 3. The referral rate of the PDQ-BC to psychosocial health care professionals compared with the referral rate of a generic measure (the DT) | 3. PDQ-BC can be regarded as a useful, psychometrically sound instrument for selecting and referring those patients with BC who experience psychosocial problems | |||||||
Group 3 (55/80) | 4. The construct validity of the PDQ-BC subscales body image, physical problems, and social problem | |||||||||
Charalampopoulou et al. [ |
Full | NDBCSS (17)/PSS (14), HADS (14) | Stress | Greek | 100 | 58.3±12.3 | Stage 0–III | Validation of NDBCSS in the Greek population | The scale seems to have construct and criterion validity | |
24%+37%+25%+14% | ||||||||||
De Vries et al. [ |
Abstract | PDQ-BC (35)/CES-D (20), DT (1), HADS (14) | Distress | Not described | 164 (98.8%) | Unavailable | Before the start of adjuvant chemotherapy | To examine the psychometric properties of the PDQ-BC, a BC specific screening list | PDQ-BC has good psychometric properties and takes only a few minutes to complete | |
De Vries et al. [ |
Full | STAI (20) → Short form (10) | Anxiety | Dutch Version Netherlands | 118+158 (group 1) | 54.5±11 (19–87) | Group 1: | To develop a short form of the Dutch version of the STAI and to provide initial validation data in a sample of BC patients and survivors. | The 6-item Anxiety Present scale has even a better structure fit than the 10-item version and has similar reliability and validity, while reducing patient burden and facilitating implementation of the questionnaire even further. | |
139 (group 2) | 56.6±11.4 (26–85) | - Early BC+benign breast problems | ||||||||
119+413 (group 3) | 53.1±11.7 (19–84) | - Except locally advanced or proven systemic disease | ||||||||
Group 2: | ||||||||||
- Disease free early-stage BC survivor | ||||||||||
Group 3: | ||||||||||
- Early BC+benign breast problems | ||||||||||
Estapé et al. [ |
Abstract | HADS (14) & Mini-MAC (29) | Anxiety, depression | Not described | 434 | 43.86±8.9 | Establish the prevalence of psychological distress among a large sample of Spanish-speaking breast cancer patients recruited on-line | 1. High reliability of distress measurement by internet | ||
2. No significant results by age and medical status and analyze why this is different when comparing with “real” samples | ||||||||||
Estapé and Estapé [ |
Abstract | Mini-MAC (29) | Coping | Not described | 294 | Not described | Not described | To ascertain if Mini-MAC scale is reliable by internet | 1. Even reliability is good | |
2. Not sure about the coping strategies we are assessing. | ||||||||||
Hajian-Tilaki and Hajian-Tilaki [ |
Full | HADS (14) | Anxiety, depression | Persian | 305 | 49.58±10.1 | Not described | To assess the psychometric properties of the Persian version of this scale in Iranian breast cancer survivors | 1. The CFA and item reliability analysis have indicated an excellent psychometric property of the Persian version of HADS to measure depressive and anxiety symptoms in BC survivors. | |
2. HADS is an effective screening tool to identify post-BC anxiety and depressive disorders and to measure the impact of disease condition on depression and anxiety in Iranian BC survivors. | ||||||||||
Iskandarsyah et al. [ |
Full | DT (1)/HADS (14) | Distress | Indonesian | 120 | 45.5±8.04 | Stage I–IV | To translate the DT into Indonesian, test its validity in Indonesian women with BC and determine norm scores of the Indonesian DT for clinically relevant distress | The DT was found to be a valid tool for screening distress in Indonesian BC patients. → Recommend using a cutoff score of 5 in this population. | |
Anxiety, depression | (28–66) | 3/54/46/17 | ||||||||
Kim et al. [ |
Full | PHQ-9 (9) by Mobile daily check | Depression | Korean | 78 (5,792 set) | 44.35±7.01 | Unavailable | 1. Evaluate the potential of a mobile mental-health tracker that uses three daily mental-health ratings (sleep satisfaction, mood, and anxiety) as indicators for depression. | 1. Self-reported daily mental-health ratings obtained via a mobile phone app can be used for screening for depression in BC patients. | |
2. Examine the impact of adherence on reporting using a mobile mentalhealth tracker and accuracy in depression screening. | 2. Adherence to self-reporting can improve the efficacy of mobile phone based approaches for managing distress in this population. | |||||||||
Lee et al. [ |
Full | NDBCSS (21→17)/PSS (10) | Stress | Taiwan | 125 | 52.2±9.4 | 0 34 (38.2%) | To assess the reliability and validity of a developed instrument entitled NDBCSS | Acceptable reliability and good validity to measure stress in newly diagnosed patients with breast cancer | |
Stress | I 30 (33.75%) | |||||||||
HADS (14) | II 19 (21.3%) | |||||||||
III 4 (4.5%) | ||||||||||
IV 2 (2.2%) | ||||||||||
Unknown 36 (28.8%) | ||||||||||
Neto et al. [ |
Full | PAS (20)/DASS (21) | Coping/Anxiety, depression | Portugues | 98 | 53.03±9.33 (32–75) | Unavailable | The validation of the PAS, which assesses adaptation to the disease in specific domains | 1. A new factorial structure of 3 subscales was obtained, with external validity and high reliability values. | |
2. The PAS appears as a valid instrument for the characterization of adaptation to cancer disease and for the identification of specific domains of adaptation that may need intervention | ||||||||||
Ragala et al. [ |
Full | Mini-MAC (29→24) | Coping | Morrocan | EFA 158 | 49.01±11.38 (27–83) | EFA/CFA | To validate the Mini-MAC, translated and adapted to the Arabic language and Moroccan culture, in women with BC | Reliability; and both convergent and discriminant validity tests indicated that the Arabic version of the Mini-MAC had a good performance and may serve as a valid tool for measuring psychological responses to cancer diagnosis and treatment. | |
English → Arabic | CFA 203 | 48.86±11.65 (26–88) | II 80 (50.63%)/102 (50.25) | |||||||
III 30 (18.99%)/38 (18.72) | ||||||||||
IV 48 (30.38%)/59 (29.06) | ||||||||||
Unknown 0/4 | ||||||||||
Saboonchi et al. [ |
Full | HADS (14) | Anxiety, depression | Swedish | Prior BC 727 | 51.3±8.1 (20–63) | Recently had BC surgery | To examine the construct validity of the Swedish version of HADS in women with breast cancer. | The findings support the utility of scoring procedure based on the original bi-dimensional model, but add indication of co-occurrence of anxiety and depression in this patient population. The discriminant validity of a third factor of negative affectivity in a three-factorial model, however, remains unclear. | |
No prior BC 725→707 | ||||||||||
Tomljenović et al. [ |
Abstract | HADS (14) | Anxiety, depression | Croatian | 325 | 59±10.95 (31–83) | Not described | To examine HADS’s psychometric properties, including factor structure, reliability, and discriminant validity on a sample of Croatian BC patients | HADS has overall good psychometric validity and can be useful in adjuvant care of women with BC. | |
Torres et al. [ |
Abstract | PHQ-9 (9)/HADS (14) | Depression/Anxiety, depression | Portuguese | 49 | 29.27±11.12 (30–80) | Not described | Evaluate psychometric characteristics of PHQ-9 in a Portuguese sample | The validation of the Portuguese PHQ-9 has good psychometric proprieties of internal consistency, test-retest reliability and concurrent validity. → PHQ-9 is useful and a valid scale. | |
Andreu Vaillo et al. [ |
Full | Mini-MAC (29)/BSI (18) | Coping | Spanish | 368 | 51±10.72 (27–78) | N=306 | 1. To explore the factor structure, using CFA | The Spanish version of the Mini-MAC has a satisfactory overall performance and serves as a brief, reliable and valid tool measuring cognitive appraisals and ensuing reactions to cancer. | |
0 3 (1.0%) | ||||||||||
I 64 (20.9%) | 2. Psychometric properties of the Mini-MAC in Spanish BC patients | |||||||||
II 139 (45.4%) | ||||||||||
III 78 (25.5%) | ||||||||||
V 22 (7.2%) | ||||||||||
Unknown 62 | ||||||||||
Yong et al. [ |
Full | DT (1)/HADS (1) | Distress/Anxiety, depression | Malay and Chinese language | 150 | 49.11±7.10 | I 64 (42.7%) | 1. To validate the translated DT as a tool to determine the psychological distress level and assess the factors associated with distress among the working BC survivors | The translated DT has good sensitivity and specificity for screening psychological distress among the Malaysian BC survivors. | |
II 86 (57.3%) | 2. To compare with the HADS | |||||||||
Zhang et al. [ |
Full | B-IPQ (9) | Coping | Chinese | 358 | 51.36±9.65 | 0/I 117 (32.7%) | Examined the validity and reliability of a traditional Chinese version of the B-IPQ in Hong Kong Chinese BC survivors. | B-IPQ 7 items appears to be a moderately valid measure of illness perception in cancer population, potentially useful for assessing illness representation in Chinese women with BC. | |
II 162 (45.3%) | ||||||||||
III/V 75 (20.9%) | ||||||||||
Missing 4 (1.1%) |
CES-D, Center for Epidemiologic Studies Depression Scale; AA, African-American; EP, English language proficient Latina-American; LEP, limited English language proficient Latina-American; DT, Distress thermometter; HADS, Hospital Anxiety and Depression Scale; BC, breast cancer; PDQ-BC, Psychosocial Distress Questionnaire-Breast Cancer; NDBCSS, Newly Diagnosed Breast Cancer Stress Scale; PSS, Perceived Stress Scale; STAI, State-Trait Anxiety Inventory; CFA, confirmatory factor analysis; PHQ-9, Patient Health Questionnaire-9; PAS, Psychological Adaptation Scale; DASS, Depression Anxiety Stress Scale; Mini-MAC, Mini-Mental Adjustment to Cancer Scale; EFA, exploratory factor analysis; BSI, Brief Symptom Inventory; B-IPQ, Brief Illness Perception Questionnaire
Results of reliability and validity of psychiatric assessment tools used in the included articles
Assessment scales | Study | Ethnicity or language | Reliability (Cronbach’s Alpha) | Validity |
---|---|---|---|---|
HADS | Bidstrup et al. [ |
Danish | - | AUC 0.86 (95% CI 0.82–0.90) |
Hajian-Tilaki and Hajian-Tilaki [ |
Persian | 0.81 | χ2/df=2.83; NFI=0.88; RFI=0.82; IFI=0.92; CFI=0.92; and RMSEA=0.078 | |
0.78 | ||||
Saboonchi et al. [ |
Swedish | Bi-dimensional | - | |
Depression 0.871 | ||||
Anxiety 0.881 | ||||
Three-factorial model | ||||
Depression 0.871 | ||||
Anxiety 0.815 | ||||
Negative affectivity 0.777 | ||||
Tomljenović et al. [ |
Croatian | Depression 0.74 | The two-factor model | |
Anxiety 0.75 | CFI=0.96; RMSEA=0.04 | |||
Yong et al. [ |
Malay and Chinese language | - | AUC Depression 0.92 | |
Anxiety 0.94 | ||||
Total 0.95 | ||||
DT | Iskandarsyah et al. [ |
Indonesian | - | AUC 0.81 |
Pearson’s correlation coefficient (r) between the DT scores and the HADS total was 0.58 (p<0.01) | ||||
Mini-MAC | Estapé et al. [ |
Not described | T-test of distress as two category was significant with labor situation, F=4.7, p<0.031; marital status, F=7.77, p<0.006 and maternity, F=9.04, p<0.003, and psychological measures | - |
Estapé and Estapé [ |
Not described | Helplessness-Hopelessness 0.78 | - | |
Fighting spirit 0.77 | ||||
Cognitive avoidance 0.79 | ||||
Fatalism 0.81 | ||||
Anxious preoccupation 0.79 | ||||
Ragala et al. [ |
Morrocan (English→Arabic) | - | KMO value 0.89 | |
Composite reliability 0.93–0.97 | ||||
Square root of the AVE 0.66–0.93 | ||||
Andreu Vaillo et al. [ |
Spanish | Helplessness-Hopelessness 0.82 | 1. “Hopelessness-Helplessness” and “Anxious preoccupation” had positive and moderate/strong correlations with all BSI-18 scores (between r=0.30 and r=0.55). | |
Fighting spirit 0.60 | ||||
Cognitive avoidance 0.80 | 2. All BSI-18 scores were positively and modestly correlated with “Cognitive avoidance” (between r=0.17 and r=0.28) and negatively and modestly correlated with “Fatalism” (between r=-0.16 and r=-0.26). | |||
Fatalism 0.70 | ||||
Anxious preoccupation 0.90 | 3. The association of “Fatalism” with somatization, depression, and distress caseness was not found to be significant. | |||
CES-D | Ashing-Giwa and Rosales [ |
AA | 0.92 (0.88–0.92) | - |
EP | ||||
LEP | ||||
Bogaarts et al. [ |
Netherlands | - | r=0.80 | |
PDQ-BC | Bogaarts et al. [ |
Netherlands | 0.70–0.87 | - |
Bogaarts et al. [ |
Netherlands | 0.91 (state anxiety) | - | |
0.93 (depressive symptom) | ||||
De Vries et al. [ |
Not described | 0.69–0.88, except for social problems (0.42) | CFI=0.95; NNFI=0.91; RMSEA=0.073 | |
NDBCSS | Charalampopoulou et al. [ |
Greek | Item deleted (0.85–0.87) | |
Lee et al. [ |
Taiwan | 0.84 | - | |
PSS: r=0.46 (p<0.001) | ||||
HADS: r=0.57 (p<0.001) | ||||
PHQ-9 | Kim et al. [ |
Korean | - | Total 0.8012 |
Higher adherence group 0.8524 | ||||
Lower adherence group 0.7234 | ||||
Torres et al. [ |
Portuguese | 0.82 | rS=0.60 (p<0.001) for anxiety | |
test-retest reliability rS=0.82 (p<0.001) | rS=0.65 (p<0.001) for depression | |||
STAI | De Vries et al. [ |
Netherlands (Dutch version) | Group 2 | |
One factor short form 0.85 | - | |||
Two factors short form (Anxiety +/−) 0.81/0.80 | CFI=0.97; TLI=0.97; RMSEA=0.05 | |||
Group 3 | ||||
One factor short form 0.85 | - | |||
Two factors short form (Anxiety +/−) 0.82/0.83 | CFI=0.97; TLI=0.96; RMSEA=0.05 | |||
B-IPQ | Zhang et al. [ |
Chinese | 0.653 & 0.821 | - |
7 items: 0.783 | Physical symptom distress 0.392–0.442 | |||
Anxiety 0.422–0.552 | ||||
Depression 0.429–0.494 | ||||
RMSEA | ||||
Two factor hierarchical model 0.090 (90% CI 0.065–0.117) | ||||
Two factor correlated model 0.086 (90% CI 0.061–0.112) | ||||
PAS | Neto et al. [ |
Portugues | Total 0.96 (0.82–0.94) | - |
HADS, Hospital Anxiety and Depression Scale; AUC, area under the curve; CI, confidence interval; χ2/df, chi-sqaure/degree of freedom; NFI, normed fit index; RFI, relative fit index; IFI, incremental fit index; CFI, comparative fit index; RMSEA, root mean square error of approximation; DT, Distress thermometter; r, Pearson’s correlation coefficient; Mini-MAC, Mini-Mental Adjustment to Cancer Scale; KMO, Kaiser-Meyer-Olkin; AVE, average variance extracted; BSI, Brief Symptom Inventory; CES-D, Center for Epidemiologic Studies Depression Scale; AA, African-American; EP, English language proficient Latina-American; LEP, limited English language proficient Latina-American; PDQ-BC, Psychosocial Distress Questionnaire-Breast Cancer; NNFI, non-normed fit index; NDBCSS, Newly Diagnosed Breast Cancer Stress Scale; PSS, Perceived Stress Scale; PHQ-9, Patient Health Questionnaire-9; rS, Spearman’s rank correlation coefficient; STAI, State-Trait Anxiety Inventory; TLI, Tucker-Lewis index; B-IPQ, Brief Illness Perception Questionnaire; PAS, Psychological Adaptation Scale
Results on the performance of the psychiatric assessment tools among included articles
Study | Assessment scale/Comparative measure scale | Cutoff | Sensitivity | Specificity | PPV | NPV |
---|---|---|---|---|---|---|
Bidstrup et al. [ |
DT/HADS (≥15) | ≥3 | 0.99 | 0.36 | 0.47 | 0.99 |
≥4 | 0.97 | 0.42 | 0.49 | 0.96 | ||
≥5 | 0.94 | 0.55 | 0.55 | 0.94 | ||
≥6 | 0.87 | 0.69 | 0.62 | 0.90 | ||
≥7 | 0.81 | 0.79 | 0.69 | 0.87 | ||
≥8 | 0.71 | 0.86 | 0.74 | 0.84 | ||
Yong et al. [ |
DT/HADS (≥8) | ≥3 | 0.517 | 0.946 | 0.88 | 0.75 |
≥4 | 0.692 | 0.928 | 0.82 | 0.90 | ||
≥5 | 0.909 | 0.898 | 0.61 | 0.98 | ||
≥6 | 0.750 | 0.796 | 0.21 | 0.99 | ||
Iskandarsyah et al. [ |
DT/HADS (≥15) | ≥3 | 0.92 | 0.40 | 0.62 | 0.82 |
≥4 | 0.90 | 0.50 | 0.66 | 0.83 | ||
≥5 | 0.81 | 0.64 | 0.70 | 0.76 | ||
≥6 | 0.52 | 0.91 | 0.86 | 0.64 | ||
≥7 | 0.42 | 0.95 | 0.90 | 0.60 | ||
≥8 | 0.24 | 0.98 | 0.94 | 0.54 | ||
De Vries et al. [ |
PDQ-BC/CES-D, DT, HADS | - | 0.786–0.875 | 0.730–0.811 | - | - |
Bogaarts et al. [ |
PDQ-BC/HADS-A (≥8) and HADS-D (≥8) | - | State anxiety 0.875 | 0.811 | - | - |
Depressive symptom 0.786 | 0.730 |
PPV, positive predictive value; NPV, negative predictive value; DT, Distress thermometter; HADS, Hospital Anxiety and Depression Scale; PDQ-BC, Psychosocial Distress Questionnaire-Breast Cancer; CES-D, Center for Epidemiologic Studies Depression Scale; HADS-A, Hospital Anxiety and Depression Scale Anxiety subscale; HADS-D, Hospital Anxiety and Depression Scale Depression subscale