Measurement of Depression in Breast Cancer Patients by Using a Mobile Application : A Feasibility and Reliability Study

Yoojin Sim; Guiyun Sohn; Byung Ho Son; Sei Hyun Ahn; Jong Won Lee; Yong-Wook Shin

doi:10.4306/jknpa.2016.55.3.234

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Sim, Sohn, Son, Ahn, Lee, and Shin: Measurement of Depression in Breast Cancer Patients by Using a Mobile Application : A Feasibility and Reliability Study

Original Article

Journal of Korean Neuropsychiatric Association 2016; 55(3): 234-244.

Published online: 31 August 2016

DOI: https://doi.org/10.4306/jknpa.2016.55.3.234

Measurement of Depression in Breast Cancer Patients by Using a Mobile Application : A Feasibility and Reliability Study

Yoojin Sim, MD¹, Guiyun Sohn, MD², Byung Ho Son, MD, PhD², Sei Hyun Ahn, MD, PhD², Jong Won Lee, MD, PhD², Yong-Wook Shin, MD, PhD¹

¹Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

²Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Address for correspondence: Yong-Wook Shin, MD, PhD. Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel +82-2-3010-3413, Fax +82-2-485-8381, shaman_korea@mac.com

Address for correspondence: Jong Won Lee, MD, PhD. Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel +82-2-3010-5603, Fax +82-2-474-9027, jongwonlee116@gmail.com

Received 21 March 2016 Revised 15 May 2016 Accepted 26 June 2016

Abstract

Objectives

This study examined feasibility and reliability of a mobile application to measure depression in breast cancer patients.

Methods

Forty-two breast cancer patients from the Department of Surgery at Asan Medical Center were included in the study. The Beck Depression Inventory (BDI), EuroQol Five Dimensional Questionnaire, and EuroQol Visual Analogue Scale were assessed at baseline and twice after surgery at regular intervals. The Patient Health Questionnaire-9 (PHQ-9) was delivered by as a push notification via mobile application every two weeks for 12 months. Feasibility was calculated using number of respondents and total number of PHQ-9 completed. Reliability was calculated from the relationship between PHQ-9 and BDI scores obtained within each two week period. Agreement between PHQ-9 and BDI scores in the diagnosis of depression was evaluated by kappa statistic and McNemar's test.

Results

One thousand and ninety-two notifications for PHQ-9 were sent, and 622 responses were reported (compliance rate=57%). The compliance rate was not related to demographic factors except for the date of the first use of the application. Pearson's r between PHQ-9 and BDI scores was 0.599 (p<0.001), and kappa analysis demonstrated moderate level of agreement in diagnosis of depression (κ=0.431).

Conclusion

The compliance rate for patients reporting their symptoms by mobile application is high and the scores of PHQ-9 and BDI are correlated, which suggests that the mobile data measuring depression is reliable. However, this is a preliminary study and further study is needed to determine other factors that influence compliance rate.

Keywords: Depression, Breast cancer, Mobile applications, Feasibility studies, Reliability

Figures and Tables

Fig. 1

Pit-a-Pat application showing psychological status. A: Sleep. B: Mood. C: Anxiety. All contents are in Korean. English caption is added for foreign readers.

Fig. 2

PHQ-9 in Pit-a-Pat application. All contents are originally in Korean. English caption is added for foreign readers. PHQ-9 : Patient Health Questionnaire-9.

Fig. 3

The process flowchart for selecting the study participants.

Fig. 4

Histogram of numbers of PHQ-9 completed. PHQ-9 : Patient Health Questionnaire-9.

Fig. 5

Changes in number of respondents to the PHQ-9 with time. PHQ-9 : Patient Health Questionnaire-9.

Fig. 6

Scatter plot showing the relationship between total scores of the BDI and PHQ-9. A : Total assessments (n=88, Pearson's r=0.599), B : 1st assessment (n=42, Pearson's r=0.653), C : 2nd assessment (n=28, Pearson's r=0.594), D : 3rd assessment (n=18, Pearson's r=0.351). BDI : Beck Depression Inventory, PHQ-9 : Patient Health Questionnaire-9.

Table 1

Patients' demographic and clinical characteristics

SD : Standard deviation, BDI : Beck Depression Inventory, EQ-5D : EuroQol Five Dimensional Questionnaire, EQ-VAS : EuroQol Visual Analogue Scale

Table 2

Demographic and clinical characteristics of patients with good vs. poor compliance

^*: Significant (p<0.01). PHQ-9 : Patient Health Questionnaire-9, BDI : Beck Depression Inventory, EQ-5D : EuroQol Five Dimensional Questionnaire, EQ-VAS : EuroQol Visual Analogue Scale, SD : Standard deviation

Table 3

Correlation and agreement between PHQ-9 and BDI scores

^*: p<0.01, ^†: p<0.001. PHQ-9 : Patient Health Questionnaire-9, BDI : Beck Depression Inventory, SD : Standard deviation

Notes

^{Conflicts of Interest} The authors have no financial conflicts of interest.

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