Drawing Test Form for Depression: The Development of Drawing Tests for Predicting Depression Among Breast Cancer Patients.

The aim of this study is to develop a drawing test form and it's scoring system for measuring depressive symptoms of breast cancer patients. We enrolled 95 breast cancer patients in this study which was conducted from September 2016 to May 2018. First, we observed items of the Diagnostic Drawing Series (DDS) which were significantly different between patients with and without depression, and also we reviewed previous studies on the drawing style of Korean women with depression. Second, we developed the Drawing Test Form for Depression (DTF-D) by composition of those drawing styles observed significant items in previous literatures and formative elements of DDS which was significantly different between depressed and non-depressed group. The receiver operating characteristic (ROC) curve analysis was used to define the appropriate score of the DTF-D in accordance with the depression measured with Patient Health Questionnaire-9 (PHQ-9) score >9. We developed the DTF-D by compositing 8 items including Harmony, Tilt, Symbol, Space utilization, Surrounded, Description, Pen pressure, and Quality of line. The ROC analysis revealed the optimal cut-off score of 7 points of DTF-D in accordance with the clinical depression (PHQ-9 score >9) with the area under the receiver operating characteristics curve showed good discrimination (0.82), sensitivity (0.85), and specificity (0.64). The DTF-D is expected to serve as an evaluative projective drawing test from for identifying depression in breast cancer patients.