Frequency and network analysis of depressive symptoms in patients with cancer compared to the general population

TY - JOUR

T1 - Frequency and network analysis of depressive symptoms in patients with cancer compared to the general population

AU - Hartung, Tim J

AU - Fried, Eiko I

AU - Mehnert, Anja

AU - Hinz, Andreas

AU - Vehling, Sigrun

N1 - Copyright © 2019 Elsevier B.V. All rights reserved.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - BACKGROUND: The use of sum scores of depressive symptoms has been increasingly criticized and may be particularly problematic in oncological settings. Frameworks analyzing individual symptoms and their interrelationships such as network analysis represent an emerging alternative.METHODS: We aimed to assess frequencies and interrelationships of 9 DSM-5 symptom criteria of major depression reported in the PHQ-9 questionnaire by 4020 patients with cancer and 4020 controls from the general population. We estimated unregularized Gaussian graphical models for both samples and compared network structures as well as predictability and centrality of individual symptoms.RESULTS: Depressive symptoms were more frequent, but less strongly intercorrelated in patients with cancer than in the general population. The overall network structure differed significantly between samples (correlation of adjacency matrices: rho=0.73, largest between-group difference in any edge weight: 0.20, p < 0.0001). Post-hoc tests showed significant differences in interrelationships for four symptom pairs. The mean variance of symptoms explained by all other symptoms in the same network was lower among cancer patients than in the general population (29% vs. 43%).LIMITATIONS: Cross-sectional data do not allow for temporal or causal inferences about the directions of associations and results from population-based samples may not apply to clinical psychiatric populations.CONCLUSIONS: In patients with cancer, both somatic and cognitive/affective depression symptoms are less likely to be explained by other depressive symptoms than in the general population. Rather than assuming a consistent depression construct, future research should study individual depressive symptom patterns and their potential causes in patients with cancer.

AB - BACKGROUND: The use of sum scores of depressive symptoms has been increasingly criticized and may be particularly problematic in oncological settings. Frameworks analyzing individual symptoms and their interrelationships such as network analysis represent an emerging alternative.METHODS: We aimed to assess frequencies and interrelationships of 9 DSM-5 symptom criteria of major depression reported in the PHQ-9 questionnaire by 4020 patients with cancer and 4020 controls from the general population. We estimated unregularized Gaussian graphical models for both samples and compared network structures as well as predictability and centrality of individual symptoms.RESULTS: Depressive symptoms were more frequent, but less strongly intercorrelated in patients with cancer than in the general population. The overall network structure differed significantly between samples (correlation of adjacency matrices: rho=0.73, largest between-group difference in any edge weight: 0.20, p < 0.0001). Post-hoc tests showed significant differences in interrelationships for four symptom pairs. The mean variance of symptoms explained by all other symptoms in the same network was lower among cancer patients than in the general population (29% vs. 43%).LIMITATIONS: Cross-sectional data do not allow for temporal or causal inferences about the directions of associations and results from population-based samples may not apply to clinical psychiatric populations.CONCLUSIONS: In patients with cancer, both somatic and cognitive/affective depression symptoms are less likely to be explained by other depressive symptoms than in the general population. Rather than assuming a consistent depression construct, future research should study individual depressive symptom patterns and their potential causes in patients with cancer.

KW - Adult

KW - Affective Symptoms

KW - Cross-Sectional Studies

KW - Depression/psychology

KW - Depressive Disorder, Major/psychology

KW - Diagnostic and Statistical Manual of Mental Disorders

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasms/psychology

KW - Surveys and Questionnaires

U2 - 10.1016/j.jad.2019.06.009

DO - 10.1016/j.jad.2019.06.009

M3 - SCORING: Journal article

C2 - 31200167

VL - 256

SP - 295

EP - 301

JO - J AFFECT DISORDERS

JF - J AFFECT DISORDERS

SN - 0165-0327

ER -