A three-tier process for screening depression and anxiety among children and adolescents with cancer

Maya Yardeni, Gadi Abebe Campino, Shira Bursztyn, Anat Shamir, Ehud Mekori – Domachevsky, Amos Toren, Doron Gothelf*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: To establish and to evaluate the effectiveness of a three-tier screening process of depressive and anxiety disorders among children and adolescents with cancer based on questionnaires (first tier), semistructured psychiatric interviews (second tier), and referral for psychiatric assessment and recommendations for treatment (third tier). We also aimed to determine the rates of depressive and anxiety disorders among participants. Methods: Participants and their parents completed the Patient Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety modules. Then, they were interviewed separately using the semistructured Affective and Anxiety Modules of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). PROMIS cutoff values for diagnosing depressive and anxiety disorders, based on the K-SADS, were calculated by receiver-operating characteristics (ROCs). Results: Of 91 participants 34 (37.4%) aged 7 to 21 years with cancer met the K-SADS criteria for depressive and/or anxiety disorders. The results of the ROC analyses were stronger for depressive disorders than for anxiety disorders and for more severe cases. The cutoff of 13 on the child-reported PROMIS for a major depressive episode had a sensitivity of 0.80 and a specificity of 0.82, and a cutoff of 14 on the parent-reported PROMIS for generalized anxiety disorder had a sensitivity of 0.78 and a specificity of 0.79. Conclusions: Using the K-SADS, we found that anxiety and depressive disorders are very common in youngsters with cancer. The three-tier screening process we developed for depression and anxiety in this population provides practical cutoff values for identifying depressive and anxiety disorders in children with cancer.

Original languageEnglish
Pages (from-to)2019-2027
Number of pages9
Issue number12
StatePublished - Dec 2020


FundersFunder number
Abraham Rothstein fund
Foundation Dora
Gesner Foundation for Medical Research
Glenn Foundation for Medical Research
John Randolph and Dora Haynes Foundation
Israel Cancer Association


    • PROMIS
    • anxiety
    • cancer
    • depression
    • oncology
    • receiver-operating characteristics
    • screening


    Dive into the research topics of 'A three-tier process for screening depression and anxiety among children and adolescents with cancer'. Together they form a unique fingerprint.

    Cite this