Date of Award

January 2021

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Melinda Irwin


Clinical depression and distress are prevalent in cancer patients and are often unrecognized by clinicians. However, patient-reported outcomes, or PROs, can facilitate provider assessment of oncology treatment plans by detecting depressive and distress symptoms early in a patient’s cancer trajectory. Since PROs capture patients’ subjective experience, they provide invaluable insight into patient satisfaction, quality of life, and mental health. In April 2019, leadership at Smilow Cancer Hospital at Yale New Haven Health implemented a new, electronic workflow that widely disseminated PHQ-9 and NCCN Distress questionnaires to patients seen in three Smilow Cancer Hospital Care Centers. The objective of this pilot study was to improve early detection of depression and distress in cancer patients through PROs. Prevalence of distress, depression, and self-harm was analyzed across age, sex, race, gender, time since diagnosis, and cancer center, and statistically significant differences were validated with a chi-square analysis. 18.6% of patients had positive distress and 5.3% had positive PHQ-9 Scores indicating depression. For those with depression, 1.67%, 1.69%, 0.92%, and 0.34% had mild, moderate, moderately severe, and severe depression, respectively. All patients were referred to appropriate interventions. Additionally, an unconditional logistic regression was performed to understand significant predictors of self-harm and suicidal ideation. 1.00% of patients suffered from suicidal ideation and self-harm. Moderately severe depression and severe depression were statistically significant predictors for self-harm. Moreover, this study recognized clinical distress and depression and provided interventions to these patients. Future implementation of PROs of distress and depression surveys in cancer patients should consider incorporating culturally sensitive questions, acknowledging language barriers, and making accommodations for patients with cognitive impairments.


This is an Open Access Thesis.

Open Access

This Article is Open Access