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The Sickness Behavior Inventory-Revised: Sickness behavior and its associations with depression and inflammation in patients with metastatic lung cancer

Published online by Cambridge University Press:  23 November 2020

Daniel C. McFarland Open the ORCID record for Daniel C. McFarland [Opens in a new window] ,
Leah E. Walsh Open the ORCID record for Leah E. Walsh [Opens in a new window] ,
Rebecca Saracino ,
Christian J. Nelson ,
William Breitbart  and
Barry Rosenfeld
Daniel C. McFarland*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Leah E. Walsh
Affiliation:
Department of Psychology, Fordham University, Bronx, NY
Rebecca Saracino
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Christian J. Nelson
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
William Breitbart
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Barry Rosenfeld
Affiliation:
Department of Psychology, Fordham University, Bronx, NY
*
Author for correspondence: Daniel C. McFarland, Department of Psychiatry, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, New York, NY10022, USA. E-mail: mcfarld1@mskcc.org
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Abstract

Background

Inflammation may contribute to the high prevalence of depressive symptoms seen in lung cancer. “Sickness behavior” is a cluster of symptoms induced by inflammation that are similar but distinct from depressive symptoms. The Sickness Behavior Inventory-Revised (SBI-R) was developed to measure sickness behavior. We hypothesized that the SBI-R would demonstrate adequate psychometric properties in association with inflammation.

Method

Participants with stage IV lung cancer (n = 92) were evaluated for sickness behavior using the SBI-R. Concomitant assessments were made of depression (Patient Hospital Questionniare-9, Hospital Anxiety and Depression Scale) and inflammation [C-reactive protein (CRP)]. Classical test theory (CTT) was applied and multivariate models were created to explain SBI-R associations with depression and inflammation. Factor Analysis was also used to identify the underlying factor structure of the hypothesized construct of sickness behavior. A longitudinal analysis was conducted for a subset of participants.

Results

The sample mean for the 12-item SBI-R was 8.3 (6.7) with a range from 0 to 33. The SBI-R demonstrated adequate internal consistency with a Cronbach's coefficient of 0.85, which did not increase by more than 0.01 with any single-item removal. This analysis examined factor loadings onto a single factor extracted using the principle components method. Eleven items had factor loadings that exceeded 0.40. SBI-R total scores were significantly correlated with depressive symptoms (r = 0.78, p < 0.001) and CRP (r = 0.47, p < 0.001). Multivariate analyses revealed that inflammation and depressive symptoms explained 67% of SBI-R variance.

Significance of results

The SBI-R demonstrated adequate reliability and construct validity in this patient population with metastatic lung cancer. The observed findings suggest that the SBI-R can meaningfully capture the presence of sickness behavior and may facilitate a greater understanding of inflammatory depression.

Keywords

C-reactive proteinDepressionInflammationLung cancerSickness Behavior Inventory
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 3 , June 2021 , pp. 312 - 321
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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