Automated interviews to validate distress measures in cancer survivors

描述（申请人提供）：除身体健康影响外，已知癌症幸存者面临各种长期心理社会影响的风险增加，最常见的是抑郁和焦虑。3，7 - 12年轻成人（YA）幸存者是特别脆弱的群体，因为癌症破坏了他们的身体和情感发育，并且他们在治疗后的许多年内将生活在晚期效应中。15 - 18对YA幸存者的研究表明，心理困扰的发生率很高，10，19以及接受适当的心理社会护理的许多障碍。12，20，21了解这些心理后期效应的病因以及识别和治疗受影响的幸存者的研究受益于使用为精神病人群开发的自我报告症状检查表，12 - 14，但几乎没有研究已经做了验证这些措施在癌症幸存者。事实上，YA幸存者护理的评论一致指出，研究和患者护理都受到缺乏患者报告结果（PRO）措施的阻碍，这些措施已在这一人群中得到验证。15，20，21为了解决这一关键需求，本研究调查了现有焦虑和抑郁措施的有效性 通过将其与200名YA癌症幸存者（年龄18 - 40岁）样本中经过验证的精神病学评估进行比较。将使用DSM疾病结构化临床访谈（SCID）22作为"金标准"，评估简明症状量表-18（BSI-18）23和PROMIS倡议24、25焦虑和抑郁简表的有效性。先前的研究支持BSI-18和PROMIS测量的可靠性，13，24和25，27但没有研究根据精神病诊断标准验证它们。除了检查表的措施，有效性和实用性的创新诊断面试，精神疾病的初级保健评估（PRIME-MD），管理使用计算机自动电话面试（ATI）也将进行调查。研究已经在精神病和内科患者中验证了PRIME-MD的面对面和ATI版本，28 - 31，但这将是第一次研究其在癌症幸存者中的效用。分析将侧重于确定研究措施的病例规则，以优化SCID中具有临床显著抑郁和焦虑的幸存者的识别。该研究还将评估幸存者是否更愿意使用ATI与书面形式相比披露有关性和自杀症状的敏感信息，目的是确定ATI是否增强了这些重要但经常被忽视的症状的报告。通过检验这些措施的标准效度，并确定最佳的方法，使用它们来检测幸存者的临床显着的心理症状，本研究将大大提高这些措施的价值，并提供新的方法，为研究和临床护理的YA幸存者。虽然这项研究是在YA癌症生存率的背景下进行的，但结果将为制定最佳实践提供信息，以增强其他人群中心理困扰和敏感行为的PRO措施。 公共卫生相关性：年轻的成年癌症幸存者在身体和情感发展方面受到严重干扰，即使在治疗多年后也有心理困扰的风险。由于缺乏在这一人群中得到验证的自我报告痛苦措施，研究发现这些心理后期影响的风险因素，并确定和治疗受影响的幸存者受到阻碍。通过确定使用自我报告措施来检测具有临床显著心理困扰的年轻成年幸存者的最佳方法，本研究为年轻成年癌症幸存者的研究和临床护理做出了重要贡献。

DESCRIPTION (provided by applicant): In addition to physical health effects, cancer survivors are known to be at increased risk for a variety of long- term psychosocial effects, most commonly depression and anxiety.3, 7-12 Young adult (YA) survivors are a particularly vulnerable group, as cancer disrupts their physical and emotional development, and they will live with late-effects for many years after treatment.12, 15-18 Studies of YA survivors show high rates of psychological distress,10, 19 as well as many barriers to receiving appropriate psychosocial care.12, 20, 21 Research to understand the etiology of these psychological late-effects and to identify and treat affected survivors has benefited from the use of self-report symptom checklists developed for psychiatric populations,12-14 but almost no research has been done to validate these measures in cancer survivors. In fact, reviews of YA survivor care consistently note that both research and patient care are hampered by a lack of patient reported outcome (PRO) measures that have been validated for this population.15, 20, 21 To address this critical need, this study investigates validity of existing measures of anxiety and depression by comparing them to a validated psychiatric assessment in a sample of 200 YA cancer survivors (age 18-40). Using the Structured Clinical Interview for DSM Disorders (SCID) 22 as a "gold standard," the validity of the Brief Symptom Inventory-18 (BSI- 18), 23 and PROMIS initiative 24, 25 anxiety and depression short forms will be assessed. Previous research supports reliability of the BSI-18 and PROMIS measures, 13, 24, and 25, 27 but no studies have validated them against a psychiatric diagnostic criterion. In addition to checklist measures, validity and utility of an innovative diagnostic interview, the Primary Care Evaluation of Mental Disorders (PRIME-MD), administered using computerized automated telephone interview (ATI) will also be investigated. Studies have validated both in-person and ATI versions of PRIME-MD in psychiatric and medical patients, 28-31 but this will be the first to study its utility in cance survivors. Analysis will focus on identifying case-rules for study measures to optimize identification of survivors with clinically significant depression and anxiety on the SCID. The study will also assess whether survivors are more comfortable disclosing sensitive information regarding sexual and suicidal symptoms using ATI compared to written forms, with the goal of determining if ATI enhances reporting of these important but often neglected symptoms. By examining the criterion validity of these measures, and identifying best methods for using them to detect survivors with clinically significant psychological symptoms, this study will greatly enhance the value of these measures and provide new approaches for research and clinical care of YA survivors. Although this research takes place in the context of YA cancer survivorship, results will be informative for developing best practices for enhancing PRO measures of psychological distress and sensitive behaviors in other populations. PUBLIC HEALTH RELEVANCE: Young adult cancer survivors experience significant disruptions in their physical and emotional development, leaving them at risk for psychological distress even many years after treatment. Research to uncover the risk factors for these psychological late-effects, and to identify and treat affected survivors has been hampered by a lack of self-report distress measures that have been validated in this population. By identifying the best methods for using self-report measures to detect young adult survivors with clinically significant psychological distress, this study makes an important contribution to research and clinical care of young adult cancer survivors.