Agreement between the EQ-5D-5L anxiety/depression dimension and GAD-7/PHQ-9 for psychological distress assessment in patients with hematologic malignancies

BACKGROUND: Patients with hematologic malignancies (HMs) often experience psychological distress, significantly impairing health-related quality of life (HRQoL) and deteriorating clinical prognosis. Although the widely used instrument EuroQol 5-Dimension 5-Level (EQ-5D-5L) has been validated in the general population for accurately identifying the psychological symptoms, its performance in HM patients remains unclear. We aimed to investigate whether the EQ-5D-5L questionnaire anxiety/depression (A/D) dimension, when already collected for HRQoL assessment, correlates with anxiety and depression symptoms and may potentially flag patients who may warrant further psychiatric evaluation. METHODS: Enrolled HM patients were invited to complete the EQ-5D-5L questionnaire. The anxiety/depression symptoms were additionally assessed using the symptom-specific tools Generalized Anxiety Disorder 7-item scale (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Spearman correlation analysis was performed to examine the correlation between the EQ-5D-5L A/D dimension and GAD-7/PHQ-9. The sensitivity and specificity of the A/D dimension were evaluated using GAD-7/PHQ-9 as a comparative measure. The associations between patient characteristics and responses on the A/D dimension were explored. RESULTS: The A/D dimension exhibited moderate-to-strong correlations with GAD-7 grade (r = 0.607, P < 0.001), PHQ-9 grade (r = 0.579, P < 0.001), and combined GAD-7/PHQ-9 grade (r = 0.603, P < 0.001). For identifying the presence of anxiety/depression, the A/D dimension showed high specificity (94.3-98.6%) but relatively low sensitivity (47.2-60.0%). A subset of patients classified as having anxiety or depression according to the GAD-7/PHQ-9 reported no emotional problems on the A/D dimension. Further analysis revealed that patients with higher education level tended to report lower symptom severity on the A/D dimension. CONCLUSIONS: The EQ-5D-5L A/D dimension showed moderate-to-strong correlation with GAD-7 and PHQ-9 among HM patients. Based on its limited sensitivity but high specificity, it may serve as a supplementary indicator within routine HRQoL assessments rather than a standalone screening tool. Due to the relatively small sample size and exploratory design of our study, further multicenter investigations with larger sample sizes are needed to validate our findings.