Short CommunicationMeasuring improvement in depression in cancer patients: a 50% drop on the self-rated SCL-20 compared with a diagnostic interview☆,☆☆,★,★★
Introduction
A commonly accepted operational definition of clinically significant improvement in depression status in clinical trials is a decrease of at least 50% from the baseline value of a standard scale [1]. A 50% reduction in the 20-item Symptom Checklist self-rated depression scale (SCL-20) [2], [3], [4] has been used to this end in a number of primary care depression trials [5], [6], [7], [8], [9], [10]. We are, however, not aware of any previously published validation of this 50% change. Furthermore, it is possible that other cut-offs are better for identifying a clinically significant improvement in depression status. We therefore aimed to assess the performance of a 50% drop in the SCL-20 score as a valid measure of improvement in depression status by comparing it with no longer meeting diagnostic criteria for major depression as measured by a “gold standard” interview [11], [12]. We also aimed to examine alternative cut-offs of reduction in SCL-20 score to determine which was best.
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Material and methods
We performed a secondary analysis of data from a clinical trial (SMaRT Oncology-1) that had compared collaborative care with usual care for cancer patients who met criteria for major depressive disorder (MDD) [13]. We used the baseline and 12-week outcome data from this trial to compare a 50% reduction in SCL-20 score with change in major depression status to no longer meeting criteria as measured using the “gold standard” Structured Clinical Interview for DSM-IV (SCID) [12].
The trial sample
Results
Our sample had a mean age of 56.4 (S.D. 11.9; range 24.9 to 87.1 years) and included 136 (70%) females. There was a variety of cancer types (83 breast; 30 gynecological; 20 hematological; 19 prostate; 16 testicular; 13 colorectal; 4 lung; 4 urinary tract; 3 skin; 2 sarcoma).
As can be seen from Table 1, in the majority of cases a 50% reduction from baseline in SCL-20 scores coincided with an interview-determined improvement in depression status. Overall, 153 (78.9%) of the 194 (95% C.I. 73.1% to
Discussion
Clinical trials of interventions for depression need to be able to measure change in depression status in a feasible manner. Consequently, the scores of self-rated questionnaires are often used. In order to determine a clinically significant change in this score a 50% reduction from baseline has frequently been chosen. We found that using this criterion the self-rated SCL-20 measured improvement was in good agreement with that measured by a “gold standard” diagnostic interview. The
References (14)
- et al.
Management of depression for people with cancer (SMaRT Oncology 1): a randomised trial
The Lancet
(2008) - et al.
Telephone assessment of depression severity
J Psychiatric Res
(1993) Past, present, and future directions for defining optimal treatment outcome in depression: remission and beyond
JAMA
(2003)- et al.
SCL-90: An outpatient psychiatric rating scale — preliminary report
Psychopharmacol Bull
(1973) - et al.
The Hopkins Symptom Checklist (HSCL): a measure of primary symptom dimensions
Mod Probl Pharmacopsychiatry
(1974) SCL-90-R®. Administration, Scoring, and Procedures Manual
(1994)- et al.
Collaborative management to achieve treatment guidelines. Impact on depression in primary care
JAMA
(1995)
Cited by (10)
Associations between affective factors and high-frequency heart rate variability in primary care patients with depression
2022, Journal of Psychosomatic ResearchCitation Excerpt :Patients unable to understand English were also not eligible, as our intervention was available in English only. Depressive symptom severity was assessed by the reliable and valid Hopkins Symptom Checklist-20 (SCL-20; [49–51], which is the primary measure of depressive symptom severity used in the eIMPACT trial and its predecessor, the IMPACT trial [44]. On a 0–4 scale (not at all to extremely), participants indicated how much they were bothered or distressed by various depressive symptoms during the past week.
Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): A multicentre randomised controlled effectiveness trial
2014, The LancetCitation Excerpt :Treatment response was defined as at least a 50% reduction in depression severity from baseline on the self-rated Symptom Checklist Depression Scale (SCL-20) version B.30 The SCL-20 has 20 items, each of which is rated from 0–4 and the patient's overall SCL-20 score at each measurement is an average of these (with higher scores indicating more severe symptoms); this widely used scale is derived from the SCL-90.31 A 50% reduction in score has been shown to be comparable to no longer meeting diagnostic criteria for major depression and was chosen to indicate a clinically useful improvement.32 Secondary outcomes were: average depression severity (SCL-20 score averaged over 24, 36, and 48 weeks); remission of depression (defined as an SCL-20 score <0·75 at all of the 24, 36, and 48 week assessments);22 and self-rated improvement in depression (five-point scale from much worse to much better).
Collaborative depression care sensitive to the needs of underserved patients with cancer: Feasibility, acceptability and outcomes
2024, Journal of Psychosocial Oncology
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Work performed at Psychological Medicine Research, The University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh and the Edinburgh NHS Cancer Centre, Edinburgh, Scotland, UK.
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Funding: Cancer Research UK.
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This work is original and has not been published elsewhere.
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Disclosures: The authors report no competing interests.