Assessment of the Edmonton Symptom Assessment System depression item accuracy for classifying depression severity in individuals with cancer and pain

Depression is prevalent in individuals with cancer-related pain, impacting quality of life and survival. The Edmonton Symptom Assessment System (ESAS) includes a single depression item (ESAS-D) used to screen for depressive symptoms in this population. While promising for detecting Major Depressive Disorder (MDD) in those with cancer-related pain, its ability to assess depression severity remains unclear. The Montgomery–Asberg Depression Rating Scale (MADRS) is a standard tool used by trained clinicians to assess depression severity and is used to classify individuals as having none, mild, moderate, and severe depression. This study aimed to evaluate the validity of different cutoffs for the ESAS-D for classifying depression severity using the MADRS. Forty-nine individuals with cancer pain completed the ESAS-D. Within two weeks, a psychiatrist interviewed the participants to complete the clinician-rated MADRS to assess depression severity, as well as to determine if the participants did or did not meet the criteria for MDD based on the DSM-5 criteria. Twenty participants met DSM-5 criteria for MDD. An ESAS-D score ≥ 3 yielded the best balance between sensitivity (81%) and specificity (82%) for identifying moderate depression on the MADRS. An ESAS-D score ≥ 5 yielded a sensitivity of 100% and specificity of 74% for identifying individuals with severe depression on the MADRS. The ESAS-D item appears to be valid for classifying depression levels in individuals with cancer-related pain at a single point in time. The thresholds identified in this study could prove valuable in initial screening and guiding the management of depression in the cancer pain population. The ESAS-D’s responsiveness to clinical changes over time warrants further longitudinal investigation.