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. 2021 Jun;19(3):312-321.
doi: 10.1017/S1478951520001169.

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

Daniel C McFarland  1 , Leah E Walsh  2 , Rebecca Saracino  1 , Christian J Nelson  1 , William Breitbart  1 , Barry Rosenfeld  2
Affiliations

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

Daniel C McFarland et al. Palliat Support Care. 2021 Jun.

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 protein; Depression; Inflammation; Lung cancer; Sickness Behavior Inventory.

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Conflict of interest statement

Conflict of interests. The authors have no conflict of interest.

Figures

Fig. A1.
Fig. A1.
Scatterplot of SBI-R and CRP log-transformed.
Fig. A2.
Fig. A2.
Scatterplot of SBI-R and depression (PHQ-9).
Fig. 1.
Fig. 1.
ROC curve of the SBI-R predicting for inflammation: CRP >1 mg/dL.
Fig. 2.
Fig. 2.
ROC curve of the SBI-R predicting for depression: PHQ-9 >10.
See this image and copyright information in PMC

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