Alex Mitchell Leicester Royal Infirmary

Elena Baker-Glenn University of Nottingham

Paul Symonds Leicester Royal Infirmary

June 2008June 2008

Screening using the Emotion Thermometer tool

A useful extension to the distress thermometer?

1. Purpose of Screening?1. Purpose of Screening?

PHQ9 Linear distribution

0

5

10

15

20

25

30

35

Zero One Two

Three

Four

Five Six

Seven

Eight

Nine

TenElev

enTwelveThir

teen

Fourte

enFifte

enSixt

een

Sevente

enEigh

teen

PHQ9 (Major Depression)PHQ9 (Minor Depression)PHQ9 (Non-Depressed)

Baker-Glen, Mitchell et al (2008)

Depression

13%

20%

57%

48%

38%

18%

Anxiety

Distress/Adjustment Disorder

Rate of anxiety 18% from StarkDistress 57% from Ransom DT

- Please circle the number (0-10) that best describes how much distress you have been experiencing in the past week, including today.

- What phone number would you like us to contact you on if necessary?

Please tick WHICH of the following is a cause of distress:

DiarrhoeaAnger

ConstipationWorry

IndigestionSadness

EatingNervousness

Is there anything important you would like to add to the list?__________________________________________________________________________________________

Mouth soresFears

BreathingDepression

Bathing/ DressingEmotional Problems

Getting around

Hot flushesSleepDealing with children

SexualFatigueDealing with partner

Feeling swollenNauseaFamily Problems

Metallic taste in mouthPain

Tingling in hands/ feetPhysical problemsWork/School

Nose dry/ congestedTransport

Skin dry/ itchyLoss of meaning or purpose in lifeMoney

FeversRelating to GodHousing

Changes in UrinationLoss of faithChildcare

Physical Problems contd…Spiritual/ Religious ConcernsPractical Problems

The distress thermometerThe distress thermometer

=> Validity

Distribution of DT ScoresRansom (2006) PO (n=491)

13.814.7

15.7

13.2

10.4

8.47.7 7.3

3.7 3.3

1.8

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

Score 0 Score 1 Score 2 Score 3 Score 4 Score 5 Score 6 Score 7 Score 8 Score 9 Score 10

1,2 or 3 Simple QQ15%

Clinical Skills Alone73%

ICD10/DSMIV0%

Short QQ3%

Other/Uncertain9% Other/Uncertain

2%

Use a QQ15%

ICD10/DSMIV13%

Clinical Skills Alone55%

1,2 or 3 Simple QQ15%

Cancer Staff Psychiatrists

Mitchell, Kaar, Poster APA 2007Current Method

1,2 or 3 Simple QQ24%

Clinical Skills Alone20%

ICD10/DSMIV24%

Short QQ24%

Long QQ8%

Algorithm26%

Short QQ23%

ICD10/DSMIV0%

Clinical Skills Alone17%

1,2 or 3 Simple QQ34%

Cancer Staff Psychiatrists

Mitchell, Kaar, Poster APA 2007Ideal Method

Effective?

2. Can We Rely on the DT Alone2. Can We Rely on the DT Alone

DepT & Major DepressionDepT & Major Depression

21719324

20218814Test -ve

15510Test +ve

DepressionABSENT

DepressionPRESENT

Sensitivity42%

PPV 67%

Specificity97%

NPV 93%

Prevalence 11%

DT 28%

DT79%

DT67%

DT 95%

Ultra-short Tests & DepressionUltra-short Tests & Depression

36033816787

27952643152Test -ve

18081173635Test +ve

DepressionABSENT

DepressionPRESENT

Sensitivity81%

PPV 32%

Specificity69%

NPV 93%

Prevalence 18%

N=17 studies 3603

DT 28%

DT 95%

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

1 - Specificity

Sens

itivi

tyPHQ2 Two QQ

PHQ2 Interest

PHQ9

PHQ2 Depression

HADS-D DT (4v5)

DT (3v4)

HADS-T

(3v4)

3. New Methods for 20083. New Methods for 2008

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

DistressThermometer

AnxietyThermometer

DepressionThermometer

AngerThermometer

TenNineEightSevenSixFiveFourThreeTwoOneZero

DT

15%

DT(38%)

AngT(26%)

DepT(30%)

AnxT(65%)

8%

2%

4%

0%

10%

0%

0%

0%

2%

21%

1%

2%

ET vs DT; of 130 patients:ET vs DT; of 130 patients:

37% +ve NCCN on the DT vs 69% on the ET

Of 63% DT low scorers 51% recorded emotional difficulties on the new Emotion Thermometers (ET) tool

Out of those with any emotional complication93.3% would be recognised using the AnxT alone, vs 54.4% who would be recognised using the DT alone.

HADS-A Score & AnxT Score

y = 1.014x + 2.3207R2 = 0.5702

0

5

10

15

20

0 1 2 3 4 5 6 7 8 9 10

HADS-D Score & DeptT Score

y = 0.8165x + 2.7614R2 = 0.3048

0

5

10

15

20

0 1 2 3 4 5 6 7 8 9 10

DT DepTVsHADS-A

AnxT AngT

AUC:DT=0.82DepT=0.84AnxT=0.87AngT=0.685

DT DepTVsHADS-D

AnxT AngT

AUC:DT=0.67DepT=0.75AnxT=0.62AngT=0.69

DepT & Major DepressionDepT & Major Depression

21719324

20218814Test -ve

15510Test +ve

DepressionABSENT

DepressionPRESENT

Sensitivity42%

PPV 67%

Specificity97%

NPV 93%

Prevalence 11%

DT 28%

DT79%

DT67%

DT 95%

4. Extras4. Extras

HADS-A Score & DT Score

y = 0.9117x + 3.9311R2 = 0.4098

0

5

10

15

20

0 1 2 3 4 5 6 7 8 9 10

HADS-D Score & DT Score

y = 0.4334x + 3.3146R2 = 0.11870

5

10

15

20

0 1 2 3 4 5 6 7 8 9 10

Credits & Acknowledgments

Elena Baker-Glenn University of NottinghamPaul Symonds Leicester Royal InfirmaryChris Coggan Leicester General HospitalBurt Park University of NottinghamLorraine Granger Leicester Royal Infirmary

For more information see www.psycho-oncology.info

For more presentations www.psycho-oncology.info/slides

© Alex J Mitchell 2008