Performance of the Hospital Anxiety and Depression Scale as a screening tool for major depressive disorder in cancer patients

Walker, Jane; Postma, Kirstine; McHugh, Gillian S; Rush, Robert; Coyle, Brian; Strong, Vanessa; Sharpe, Michael

doi:10.1016/j.jpsychores.2007.01.009

Cited by 126 publications

(104 citation statements)

References 41 publications

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“…The point prevalence of depression among this group of breast cancer survivors is much lower than reported in some previous studies [20], but at 9%, it is in line with rates in primary care settings of 5-10% [21] and rates reported in some studies of cancer outpatients [3,22]. There is some evidence that after an initial rise, the prevalence of depression decreases over time following the diagnosis of breast cancer [1].…”

Section: Discussionsupporting

confidence: 81%

Evaluation of screening instruments for depression and anxiety in breast cancer survivors

Alexander

Palmer

Stone

2009

Breast Cancer Res Treat

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Although cases of anxiety and depression postbreast cancer can be reliably identified using a structured psychiatric interview, such interviews are time consuming for both practitioner and patient and effective screening tools would increase detection rates. The purpose of this study was to evaluate the effectiveness of the Edinburgh Depression Scale (EDS) and the Hospital Anxiety and Depression Scale (HADS) in screening for depression and anxiety in a population of breast cancer survivors. For this purpose, The Structured Clinical Interview for the Diagnostic and Statistical Manual of mental disorders was administered to 200 breast cancer survivors to identify those suffering from an anxiety and/or depressive disorder. All study participants also completed the EDS and the HADS. Using the recommended cut-off score of [12 to screen for depression, the sensitivity and specificity of the EDS were found to be 72 and 90%, respectively. Lowering the cut-off score to [9 resulted in a sensitivity of 94% and a specificity of 78%. At the recommended cut-off score of [10, the HADS had a sensitivity of 50% and a specificity of 97% for depression, and a sensitivity of 71% and a specificity of 86% when screening for anxiety. A HADS total score (HADS-T) of [13 and an EDS of [9 had sensitivities of 96 and 91% and specificities of 74 and 84%, respectively, in screening for anxiety and/or depression. In conclusion, the study demonstrated that both the EDS and HADS can be used reliably as screening tests for anxiety and depression in this cohort. In both cases, a lower cut-off score than normally recommended delivers optimal screening properties.

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Section: Discussionsupporting

confidence: 81%

Evaluation of screening instruments for depression and anxiety in breast cancer survivors

Alexander

Palmer

Stone

2009

Breast Cancer Res Treat

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“…Similar results were obtained with the HADS-D: 81 to 100 percent of participants who endorsed depression on the HADS-D met criteria for depression and 69 to 82 percent of individuals scoring in the nonclinical range on the HADS-D did not meet criteria for depression. Similar diagnostic validity statistics have been found in samples of patients with medical disorders [22,[29][30][31][32][33] and mixed psychiatric disorders [21,34].…”

Section: Introductionsupporting

confidence: 76%

Reliability and factor structure of the Hospital Anxiety and Depression Scale in a polytrauma clinic

et al. 2016

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Abstract-The Hospital Anxiety and Depression Scale (HADS) is a brief self-report measure of anxiety and depression symptoms. This study examined the internal consistency and factor structure of the HADS among Veterans in a polytrauma/traumatic brain injury clinic. The sample consisted of 312 Veterans. A confirmatory factor analysis of the depression and anxiety subscales showed, not surprisingly, that the two factors were highly correlated (r = 0.70). Goodness of fit statistics for the two-factor model were acceptable (root mean square error of approximation = 0.06, comparative fit index = 0.94). The HADS demonstrated very good reliability overall (alpha = 0.89) and for the individual subscales (alpha = 0.84). This study supports the use of the HADS as a screen for depression and anxiety in the assessment of mild traumatic brain injury in a Veteran population.

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“…On the one hand, it is known that a third of all cancer patients receiving oncological treatment, and half of the patients who have advanced cancer, suffer from mental distress, to an extent that they can be diagnosed with a psychiatric disorder (Derogatis et al, 1983;Härter et al, 2000;Atesci et al, 2004;Miovic and Block, 2007;Singer et al, 2007;Walker et al, 2007). On the other hand, physicians and nurses often fail to identify distressed patients (Newell et al, 1998;Fallowfield et al, 2001;Söllner et al, 2001;Keller et al, 2004), resulting in under-treatment in 40 -90% of the cases (Flatten et al, 2003;Singer et al, 2005).…”

mentioning

confidence: 99%

Hospital anxiety and depression scale cutoff scores for cancer patients in acute care

et al. 2009

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The aim of this study was to determine optimal cutoff scores for the Hospital Anxiety and Depression Scale (HADS) when used in evaluating cancer patients in acute care. A total of 689 cancer patients were assessed during their first days of in-patient treatment, using the structured clinical interview for DSM and the HADS. Statistical analysis was performed using ROC curves. A total of 222 patients (32%) had a mental disorder. The area under the curve was the best in the total scale of the HADS, namely 0.73. With a score of X13, it is possible to detect 76% of the cases with a specificity of .60, whereas 95% of the cases can be detected with a score of X6 (specificity 0.21). With scores of X16 and X22, recommended by the test authors for primary care, only 59 and 30% of the comorbid cancer patients are indicated. Lower HADS cutoff scores when preferable when evaluating cancer patients than are recommended for use in primary care. When using HADS in clinical practice and epidemiological studies, it is important to decide whether, for the task at hand, high detection rates of affected patients or low misclassification rates are more important.

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Performance of the Hospital Anxiety and Depression Scale as a screening tool for major depressive disorder in cancer patients

Cited by 126 publications

References 41 publications

Evaluation of screening instruments for depression and anxiety in breast cancer survivors

Evaluation of screening instruments for depression and anxiety in breast cancer survivors

Reliability and factor structure of the Hospital Anxiety and Depression Scale in a polytrauma clinic

Hospital anxiety and depression scale cutoff scores for cancer patients in acute care

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