Screening for depression in people with cancer: the accuracy of the hospital anxiety and depression scale

Morse, Rachel; Kendell, Kate; Barton, Stephen

doi:10.1016/j.cein.2006.08.012

Cited by 27 publications

(21 citation statements)

References 39 publications

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“…Y en caso de grupos de intervención o tratamiento: ¿son útiles los puntos de corte según la población? Esta variabilidad de los puntos de corte no es exclusiva de la muestra española y como citábamos en la introducción varias las revisiones señalan esta cuestión (Bjelland et al, 2002;Brennan et al, 2009;Hinz y Brähler, 2011;Morse et al, 2005).…”

Section: Discussionunclassified

Revisión de estudios de la Escala de Ansiedad y Depresión Hospitalaria (HAD) en muestras españolas.

2015

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Resumen:Introducción: La escala de Ansiedad y Depresión Hospitalaria (HADS-Hospital Anxiety and Depression Scale, Zigmond y Snaith, 1983) se ha convertido en un popular instrumento clínico diseñado para evaluar ansiedad y depresión, encontrándose evidencias de que aplicado a diversas poblaciones parece tener tan buenas propiedades de detección cómo otros instrumentos. Numerosos trabajos en muestra española comprueban sus propiedades psicométricas y puntos de corte. Nuestro objetivo es unificar los resultados de estudios realizados en muestras españolas para concretar directrices que orienten en la aplicabilidad e interpretación de sus puntuaciones. Método: Revisión bibliográfica. Resultados: Se seleccionaron 15 artículos, a) se confirma que las propiedades psicométricas del HAD en diferentes muestras son óptimas, b) se presenta cierta variabilidad de puntos de corte para cada población y c) determinados ítems muestran débil carga factorial e ítem-test. Discusión: se plantea qué ítems deben reconsiderarse para un HAD abreviado. Se sugiere valorar la escala total de distrés. Palabras clave: HAD; Hospital Anxiety and Depression Scale; revisión; propiedades psicométricas; puntos de corte.Title: Hospital Anxiety and Depression Scale (HADS) review in Spanish Samples. Abstract. Introduction: The Hospital Anxiety and Depression Scale (HADS, Zigmond and Snaith, 1983) has become a popular clinical instrument designed to assess anxiety and depression. Evidence of HADS' good screening properties applied to several samples has been found. HADS seems to be as good screening properties as other tools. Different studies in Spanish sample tested its psychometric properties, including also their cut-offs points, specificity and sensitivity. Our aim is to unify the results of studies in Spanish population specifying guidelines regarding their applicability and interpretation of their cut-off points. Material and method: bibliographic review. Results: 15 articles were selected, a) HADS confirms its optimal psychometric properties in different groups, b) HADS shows some variability in proposed cut-off points for different groups, c) A number of items shown weak factor loading and item-test. Discussion: These items should be reconsidered for new proposals of a shortened final scale. We suggest attending at distress total scale.

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Section: Discussionunclassified

Revisión de estudios de la Escala de Ansiedad y Depresión Hospitalaria (HAD) en muestras españolas.

2015

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“…The EDS delivered an acceptable level of sensitivity at the recommended cut-off, but lowering the cut-off from [12 to [9 produced the optimum performance of 94% sensitivity and 78% specificity. The low sensitivity of 50% delivered by the HADS-D at a cut-off of[10 would be unlikely to be acceptable in clinical practice, and it may be that the need to apply lower cut-off levels to achieve greater detection rates, as evidenced by studies on cancer in-patients [12], may also apply to this population.…”

Section: Discussionmentioning

confidence: 99%

“…It is a brief and effective screening tool for symptoms of depression and anxiety in patients with physical illness and has been found to be appropriate for use in primary care, somatic, psychiatric, and general population samples [10,11]. However, when screening for depression in cancer patients, studies suggest that the HADS-D should be used with caution due to the variability in optimal cut-off scores [12]. Although not recommended by the original authors, HADS-A and HADS-D can be combined to produce a total score (HADS-T), used as a screen for general psychological distress [13][14][15].…”

Section: The Hadsmentioning

confidence: 99%

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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“…As suggested by Morse et al (2005), lower thresholds should be used for cancer patients. The best trade between sensitivity and specificity for the total scale was a X13 score, for example, instead of the X16 score recommended by Zigmond and Snaith (1983).…”

Section: Discussionmentioning

confidence: 99%

“…These scores, however, were conceived for evaluating primary care patients. It has been shown (Morse et al, 2005) that these thresholds might be too high for cancer patients, resulting in underrecognition of 'cases'. Therefore, lower thresholds may be required without necessarily compromising specificity.…”

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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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Screening for depression in people with cancer: the accuracy of the hospital anxiety and depression scale

Cited by 27 publications

References 39 publications

Revisión de estudios de la Escala de Ansiedad y Depresión Hospitalaria (HAD) en muestras españolas.

Revisión de estudios de la Escala de Ansiedad y Depresión Hospitalaria (HAD) en muestras españolas.

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

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

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