Hospital Anxiety And Depression Scale Cutoff Score Research Articles

Association of Insomnia with Anxiety and Depression in Type 2 Diabetic Patients: A Cross-Sectional Study.

Type 2 diabetes mellitus (T2DM) is associated with sleep disorders, which in turn may lead to anxiety and depression. Sleep deprivation impairs glucose metabolism causing a decrease in insulin sensitivity and glucose tolerance. The present study aimed to determine the association of insomnia with anxiety and depression in patients with T2DM. A cross-sectional study was conducted in 2020 at the Endocrinological Department of City Clinical Hospital №1, affiliated with Astana Medical University (Astana, Kazakhstan). A total of 376 patients with decompensated T2DM were included in the study. Insomnia was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Multivariable logistic regression was used to assess the association of insomnia with anxiety and depression. All patients showed signs of sleep disturbances. Based on the HADS cutoff score >8, anxiety and depression were observed in 48 (12.80%) and 46 (12.20%) patients, respectively. PSQI, ISI, and HADS indicators were associated with an increased risk of anxiety and depression symptoms. In terms of anxiety, the adjusted odds ratio for PSQI and ISI scores were 1.09 (P=0.08) and 1.07 (P=0.01), respectively. These for depression were 1.10 (P=0.06) and 1.07 (P=0.01), respectively. Sleep quality is an important indicator of psychological health in patients with T2DM, especially those who exhibit signs of anxiety and depression.

Keeping it simple: mental health assessment in the Gastroenterology Department - using the Hospital Anxiety and Depression Scale (HADS) for IBD patients in Israel.

Background:Depression and anxiety are common among inflammatory bowel disease (IBD) patients. Not only do they worsen quality of life, but also worsen the prognosis of the IBD. Yet, there are no widely accepted guidelines for screening for depression or anxiety in this population. The Hospital Anxiety and Depression Scale (HADS) is a self-administered questionnaire designed to measure anxiety and depression in the physically ill. The purpose of this study was to establish the utility of the HADS as a screening tool in IBD patients.Methods:Seventy-nine IBD patients (age 29.86 ± 8.36, 51.9% female, 77.2% Crohn’s disease) were recruited consecutively at the day treatment unit, Gastroenterology Department, Sheba Medical Center. They were asked to complete the HADS, the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory (STAI). The scores of the HADS depression and anxiety subscales were correlated with the BDI and STAI scores, and the rates of above-threshold scores were calculated and compared between the three questionnaires and findings from previous studies.Results:The two HADS subscales significantly correlated with and the BDI (rs = .69, p < 0.001) and STAI state and trait anxiety (rs = .853, p < 0.001; rs = .744, p < 0.001, respectively). The usual HADS cut-off scores yielded adequate rate of anxiety but lower than expected depression rates.Conclusions:Our findings suggest the HADS as a valid screening tool for anxiety and depression in IBD patients. We recommend administering it routinely in gastrointestinal (GI) follow-ups using a lower cut-off score for depression than anxiety (greater than 7 vs greater than 11, respectively).

Depression and anxiety in multiple sclerosis patients: The role of genetic variability of interleukin 1β

BackgroundMood disorders, as depression and anxiety, are frequent in Multiple Sclerosis (MS) patients. High pro-inflammatory cytokine levels (e.g. IL-1β) have been reported in depressed individuals. ObjectiveWe aimed to investigate the role of the rs16944 (IL-1β-511 C>T) polymorphism in the development of anxiety and depression symptoms in a Portuguese cohort of MS patients. Methods393 MS patients answered the Hospital Anxiety and Depression Scale (HADS) at T1. This questionnaire was reapplied to a subgroup of 175 MS patients approximately three years later (T2). HADS cut-off scores for anxiety and depression were respectively ≥11 and ≥8. ResultsAt T1, anxiety was found in 106 MS patients (27.0%) and 11 controls (16.7%); whereas depression was identified in 116 (29.5%) MS patients and 9 controls (13.6%). Persistent anxiety and depression were respectively recorded in 12% and 20% of MS patients. The rs16944TT genotype was found to be a susceptibility factor for the occurrence of depression at T1 (OR = 3.16, p=0.002) and the development of persistent depression (OR = 5.63, p=0.003) in MS. ConclusionStudy results support the hypothesis that inflammation is a significant factor in psychopathology development.

The efficiency of distress thermometer in the determination of supporting needs for cancer inpatients

ABSTRACT Psychological distress scale is highly recommended for cancer patients’ care. Several psychological scales have been implemented in cancer outpatient clinics. However, the use of the psychological distress scale, particularly distress thermometer (DT), in the inpatient has not been reported. In this study, we report the efficacy of DT in the determination of cancer inpatients’ supporting needs. A total of 170 inpatients diagnosed with cancer have been enrolled in this study. Only 132 patients matched the inclusion criteria, while other cases were excluded because of other diseases associated with cancer. The standardized problem list (PL) and Hospital Anxiety and Depression Scale (HADS) were implemented in comparison with DT. Then, the cut-off score of DT was performed to identify clinically significant differences. The analysis of the receiver operating characteristic (ROC) curve revealed that a DT cut-off score of 4 displayed 0.76 under the ROC curve. Sensitivity showed 0.86 sensitivity for cut-off score 4 and a specificity of 0.56 relative to the HADS cut-off score (≥15). DT scores were found independent of medical variables such as cancer type and stage, recurrence, or metastasis. Clinical ECOG-SP showed a significant association with the DT cut-off score (P ≤ 0.05). Regarding PL, patients with scores above DT cut-off were suffering 21 of 40 problems in all categories. Furthermore, patients that scored above the DT cut-off significantly showed an association with high support needs. DT scale showed significant performance in the evaluation of psychological distress among cancer inpatients through the efficient determination of their support needs.

P106 Depressive symptoms and anxiety and their screening in IBD patients: performance of the distress thermometer in Italian IBD patients

Abstract Background Roughly 50% of patients with IBD have symptoms of psychological distress (Mikocka-Walus et al. 2019) but only 15.2% receive attention for their mental health although the effect on disease severity can be profound. It is necessary to have an easy-to-administer psychological distress screening tool. The distress thermometer (DT) is a single-item distress screening scale with 11-likert response widely used in oncological patients. The aim of study was to determine whether the single-item DT compared favourably with IBD clinical indices and time consuming measures currently used to screen for distress. Methods Two hundered and twenty IBD patients (51.43% male) who were recruited in eight Italian hospitals completed the DT and identified the presence or absence of 34 problems using standardised problem list (PL). They completed the 14-item Hospital Anxiety and Depression Scale (HADS) and the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ). Disease clinical indices have been collected for each patient (Mayo score, Harvey–Bradshaw Index–HBI, years of illness, and exacerbation in the last year). Using receiver operating characteristic (ROC) analyses validated the use of the DT in Italian IBD population. Results 47.6% reported anxiety and depression symptoms (HADS ≥15) and needs emotional care. Anxiety is much more associated (43.8%) than depressive problems (26.2%). Data are confirmed by responses to DT and PL: 44.5% of patients reported moderate–severe emotional distress (TD ≥ 5), 43.1% of patients report nervousness and worry, 27.1% reported depression. We observed a strong positive correlation between IBDQ and HADS (r = 0.74, p &amp;lt; 0.001) and DT (r = 0.58, p &amp;lt; 0.001), while there was a slightly smaller association with Mayo score (r = 0.46, p &amp;lt; 0.001) and HBI (r = 0.39, p &amp;lt; 0.001). There was not a statistical significant correlation between disease indices and the emotional distress as measured by HADS or DT. ROC analyses showed that a DT cutoff score of 5 or higher had optimal sensitivity (83%) and specificity (68%) relative to the HADS score as ‘gold’ standard. DT scores yielded area under the curve estimates relative to the HADS cutoff score indicative of good overall accuracy (AUC = 0.81–95% CI: 0.77–0.85). Conclusion Our study confirms that anxiety and depression symptoms are associated with IBD. This is the first study that demonstrated that DT is an easy-to-administer screening tool of psychosocial distress in IBD population. We propose that gastroenterologists use DT to identify patients with psychological distress: an early psychological support and a multidisclinar equipe can determinate a patient’s better disease course (Mawdsley et al. 2005). Our analyses indicated that using a DT’s cutoff of 5 to indicate high levels of distress.

Psychometric properties of the Hospital Anxiety and Depression Scale in an inpatient video-monitoring epilepsy cohort

BackgroundPeople with epilepsy (PWE) have high rates of comorbid anxiety disorders and depressive disorders, from 25% in general population cohorts to rates of 55% in people with treatment resistant epilepsy. High rates are also seen in patients with psychogenic nonepileptic seizures (PNES). Depressive disorders and anxiety disorders in PWE are associated with decreased quality of life measures and are the strongest risk factors for increased suicidality, rates of which are markedly elevated in PWE, at 12%, compared to the general Australian population (1.8%). The Hospital Anxiety and Depression Scale (HADS) is one of the more commonly used screening tools in medical populations. Past studies of the HADS in general outpatient populations with epilepsy have demonstrated promising validity for detecting depression. ObjectivesThe following were the objectives of the study:1. To examine the validity of HADS in detecting depressive disorders and anxiety disorders in an inpatient population of patients admitted for video monitoring. 2. To investigate the measurement structure of the HADS across the diagnosis groups of epilepsy subtypes and PNES. MethodsThis was a retrospective cohort study of 485 patients admitted to a tertiary epilepsy video electroencephalography (EEG) monitoring unit. All patients received clinical neurological, neuropsychiatric, and neuroimaging assessments to arrive at consensus epilepsy and psychiatric diagnoses. Clinical psychiatric diagnosis of depressive disorders and anxiety disorders, based on the assessment of a neuropsychiatrist, were compared to accepted HADS cutoff scores for these conditions. FindingsOf the 485 patients, 229 patients were with epilepsy, 28 had both epilepsy and PNES, and 121 had PNES. In 107 cases, no definite diagnosis could be made. At a cutoff score of 7 HADS was able to significantly classify patients with depression (area under the curve [AUC] = 0.79, 95% confidence interval [CI] = 0.72–0.82) with a sensitivity of 70% and a specificity of 83%. A similar result was observed for anxiety disorders; a cutoff score of 7 (AUC = 0.75, 95% CI = 0.72–0.81) was able to significantly classify anxiety disorders in patients with a sensitivity of 88% and specificity of 54%. ConclusionsThis study has found that HADS measures two separate, yet correlated, constructs of anxiety disorders and depressive disorders. Our results indicate that while the HADS is sensitive to distress in this population, relatively low cutoff scores would be required to achieve highly sensitive screening. This sample includes patients with a diagnosis of epilepsy and/or PNES, and thus, the findings have clinical applicability to screening in tertiary epilepsy video-EEG monitoring units where both these conditions frequently co-occur.

1811P - Accuracy of distress thermometer to measure cancer-related mood disorders in Chinese patients with cancer

BackgroundScreening and management of distress are essential. The Distress thermometer (DT) is a common screening tool. However, it’s cutoff score and the accuracy properties such as sensitivity and specificity is still unclear in Chinese cancer patients. MethodsIn this cross-sectional study, DT was compared against the Hospital Anxiety and Depression Scale (HADS) in 784 heterogeneous cancer inpatients. The HADS cutoff score ≥15, ≥6, and ≥9 were used to define distress, anxiety, and depression respectively. Receiver operating characteristic (ROC) analysis was applied to determine the discriminative accuracy of DT against each scale. ResultsWhen DT was compared against HADS-T, ROC showed an excellent area under the curve (AUC) of 0.903. The optimal cutoff score of 4 yielded sensitivity (SE)=89.3%, specificity (SP)=85.8%, positive predictive value (PPV)=89.9%, negative predictive value (NPV)=85.0%, screening utility (UI-)=.729, and case-finding utility (UI+)=.802. Furthermore, compared With HADS subscales, AUC=0.801 with a cutoff score 3 on DT optimally detected SE=80.7%, SP=64.5% PPV=89.4%, NPV=47.3%, UI-=.369, andUI+=.721 for anxiety and AUC=0.802 with a cutoff score of 4 on DT optimally detected SE=88.3%, SP=65.3%, PPV=66.4%, NPV=87.8%, UI-=.573 and UI+=.586 for depression respectively. DT Scores were moderately correlated with HADS-Total, HADS-Anxiety, andHADS-Depression. Female gender, low education level, advanced cancer stage, no exercise habit, suicidal ideation and months since diagnosis more than 12 were found to be associated with distress. ConclusionsFor Chinese patients with cancer, DT is an efficacious screening and case finding a tool for distress. Among the subscales, DT performed well in both screening and case finding for depression, however, although the case finding was good it carried a poor screening ability for anxiety. Legal entity responsible for the studyThe author. FundingHas not received any funding. DisclosureThe author has declared no conflicts of interest.

Validity and feasibility of the Arabic version of distress thermometer for Saudi cancer patients.

BackgroundThe distress thermometer (DT) has been studied and validated as an effective screening instrument for identifying distress among cancer patients worldwide. This study aims to evaluate the validity of the Arabic version of the DT in Saudi cancer patients, to define the optimal cutoff point of the Arabic DT for detecting clinically significant distress and to determine whether there is any correlation between clinically significant distress and other demographic and Problem List variables.MethodsThe original form of the DT was translated to Arabic using a forward and backward translation method. Then, a group of 247 cancer patients who were followed up at the Outpatient Oncology Clinic at King Saud Medical City in Riyadh, Saudi Arabia, completed a socio-demographic and clinical status questionnaire, the DT and the Problem List scale, and the Hospital Anxiety and Depression Scale (HADS).ResultsReceiver operating characteristic (ROC) curve analyses picked out an area under the curve of 0.76 when compared with a HADS cutoff score of 15. The DT had the best sensitivity (0.70) and specificity (0.63) with cutoff score of 4. A DT score of 4 or more was found to have a statistically significant correlation with female gender, advanced cancer stages and most of the Problem List items, including child care, work or school, treatment decision, dealing with children and partners, depression, fears, nervousness, sadness, loss of interest in usual activity, religious concerns, appearance, bathing/dressing, breathing, diarrhea, fatigue, feeling swollen, fever, getting around, indigestion, memory and concentration, nausea, dry nose, pain, and sexual problems. In contrast, a multivariate regression analysis confirmed only advanced cancer stages, treatment decision, depression, fear, sadness, worry, breathing, feeling swollen, fever, indigestion, memory and concentration, dry nose and congestion, pain and sleep as independent factors associated with distress in cancer patients.ConclusionsWe found the Arabic version of the DT to be a valid instrument for screening distress in Saudi patients with cancer. Our study proposes using a cutoff score of 4 as an indicator of clinically significant distress in this population.

The Distress Thermometer as an ultra-short screening tool: A first validation study for mixed-cancer outpatients in Singapore

IntroductionResearch has shown that single-item tools, like the Distress Thermometer (DT), are comparable to longer ones, like the Hospital Anxiety and Depression Scale (HADS). In this study, we tested the validity of the DT in a population of Singapore cancer outpatients, and determined the cut-off scores on the DT for clinically relevant distress and an impaired quality of life (QOL). We also documented the prevalence of anxiety, depression, and QOL impairments in this population. MethodsOne hundred and five patients (Mdn age=51–60years, 64% female, and 71% Chinese) diagnosed with various cancers participated in this study. They completed a standard socio-demographic form, the DT and the Problem List, the HADS, and the EuroQOL Quality of Life Scale (EQ-5D). ResultsAlmost a third of patients had clinically significant emotional distress, with 15%–16% having probable levels of anxiety and depression. Almost half (41%–55%) had an impaired QOL compared to Singapore population norms. Receiver operating characteristic curve analyses identified an area under the curve of 0.89 (SE=0.36, 95% CI [0.82, 0.96], p<.001) when compared to the HADS cut-off score of 15. A cut-off score of 5 on the DT had the best sensitivity (0.88) and specificity (0.81). Participants above the DT cut-off score of 5 reported significantly more emotional problems (worry, nervousness, depression, sadness), insurance/finance-related problems, and sleep problems. They also scored significantly lower on EQ-5D, with more QOL impairments in the domains of carrying out their usual activities and anxiety/depression. ConclusionLevels of distress, anxiety, depression, and QOL impairments are high in this population. The DT was found to be a valid tool for distress screening in the Singapore cancer population, with a recommended cut-off score of 5.

The Distress Thermometer and Its Validity: A First Psychometric Study in Indonesian Women with Breast Cancer

PurposeThis study aims to translate the Distress Thermometer (DT) into Indonesian, test its validity in Indonesian women with breast cancer and determine norm scores of the Indonesian DT for clinically relevant distress.MethodsFirst, the original version of the DT was translated using a forward and backward translation procedure according to the guidelines. Next, a group of 120 breast cancer patients who were treated at the Outpatient Surgical Oncology Clinic in Hasan Sadikin Hospital in Indonesia completed a standard socio-demographic form, the DT and the Problem List, the Hospital Anxiety and Depression Scale (HADS) and the WHO Quality of Life (WHOQOL-BREF).ResultsReceiver operating characteristic (ROC) curve analyses identified an area under the curve = 0.81 when compared to the HADS cutoff score of 15. A cutoff score of 5 on the DT had the best sensitivity (0.81) and specificity (0.64). Patients who scored above this cutoff reported more problems in the practical, family, emotional, spiritual/religious and physical domains (30 out of 36 problems, p-value<0.05) than patients below the cutoff score. Patients at advanced stages of cancer experienced more emotional and physical problems. Patient's distress level was negatively correlated with overall quality of life, general health and all quality of life domains.ConclusionsThe DT was found to be a valid tool for screening distress in Indonesian breast cancer patients. We recommend using a cutoff score of 5 in this population.

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

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 ⩾13, 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 ⩾6 (specificity 0.21). With scores of ⩾16 and ⩾22, 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.

Anxiety and depression symptoms in patients with diabetes

To identify the prevalence and major determinants of anxiety and depression symptoms in patients with diabetes. A cross-sectional study of 2049 people with Types 1 and 2 diabetes, selected from patients experiencing three different models of care in Ireland: (i) traditional mixed care; (ii) hospital/general practitioner (GP) shared care; (iii) structured GP care. Anxiety and depression symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS). Analyses were conducted primarily using logistic regression with adjustment for relevant confounders. The overall response rate was 71% (n = 1456). Based on the HADS, there was evidence of high levels of anxiety and depression symptoms in patients with diabetes; 32.0% (95% confidence interval = 29.5-34.6%) exceeded the HADS cut-off score of 'mild to severe' anxiety and 22.4% (95% confidence interval = 20.2-24.7%) exceeded the HADS cut-off score of 'mild to severe' depression. Diabetes complications, smoking, uncertainty about glycaemic control and being an ex-drinker or a heavy drinker were risk factors for both higher anxiety and depression scores in multivariate analysis. Female gender and poor glycaemic control were risks factors associated only with higher anxiety scores. Higher socio-economic status and older age were protective factors for lower anxiety and depression scores. Type of diabetes, insulin use, marital status and models of care were not significant predictors of anxiety and depression scores. The prevalence of anxiety and depression symptoms in patients with diabetes is considerably higher than in general population samples. These data serve as a benchmark for the prevalence of anxiety and depression symptoms in patients with diabetes.

Screening for psychological distress in two French cancer centers: Feasibility and performance of the adapted distress thermometer

Little is known about the prevalence of psychiatric disorders in French cancer patients. This study aimed to assess the feasibility of a screening procedure using the Psychological Distress Scale (PDS). The PDS is a French adaptation of the National Comprehensive Cancer Network Distress Thermometer. The screening performance of the PDS was assessed by comparison with the established clinical case threshold on the Hospital Anxiety and Depression Scale (HADS). Among 598 consecutive cancer outpatients recruited in two cancer centers in Paris, 561 (94%) agreed to complete the PDS, the HADS, the European Organisation for Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30), and study-specific psychosocial questions. A receiver operating characteristic (ROC) analysis was performed, using a HADS cutoff score of 15 or greater to identify patients with psychological distress. This yielded a PDS cutoff score of 3, giving 76% sensitivity and 82% specificity. With this cutoff score, the prevalence of psychological distress was 38%. PDS scores were significantly related to scores from the HAD total scale (r=.64), HAD anxiety (r=.61) and HAD depression (r=.39) subscales, and EORTC QLQ-C30 emotional functioning (r=.56) and global health state (r=.44). In multivariate analyses, factors associated with psychological distress were female gender, taking analgesics, receiving professional psychological help, perceived psychosocial difficulties and lack of social support. Using the PDS appeared feasible, acceptable and effective for psychological distress screening in French ambulatory cancer care settings.

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

Objectives (1) To assess the overall performance of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument to identify cases of major depressive disorder (MDD) in mixed cancer outpatients. (2) To determine the sensitivity and specificity of various HADS cut-off scores. (3) To recommend an optimal HADS cut-off score for use in this population. Methods A cross-sectional questionnaire and interview survey of consecutive patients attending outpatient clinics in a regional cancer centre in Edinburgh, Scotland, United Kingdom. Results Thirty (8.3%) of 361 patients met criteria for MDD at interview. With the use of the total HADS score to identify these cases of MDD, the area under the receiver operating characteristic curve was 0.94 (95% CI, 0.91–0.97). A cut-off of 14/15 gave a sensitivity of 0.87 (95% CI, 0.70–0.95), a specificity of 0.85 (95% CI, 0.81–0.89), and a positive predictive value of 0.35, and was considered optimal. Conclusion The HADS can be used effectively as an initial screening tool for the detection of MDD in outpatients attending mixed cancer clinics.

Screening for psychological distress in Turkish cancer patients

The distress thermometer (DT) is a useful measure of psychological distress in cancer patients. Our objective was to investigate distress impact on oncology patients in Turkey and determine the optimal cut-off score on the DT for identifying clinically significant distress. One hundred and eighty two cancer patients completed the DT, Problem List (PL), and Hospital Anxiety and Depression scale (HADS), The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 version 3.0). The receiver operating characteristic (ROC) curve analyses of DT scores yielded an estimated area under the curve of 0.66 when compared to the HADS cut-off score, suggesting the DT is an effective scale to discriminate between classified cancer patients both with and without clinically significant distress. The DT cut-off score of 4 yielded the optimal combination of sensitivity and specificity. Scores on the DT were moderately correlated to the HADS (p<0.01) and EORTC QLQ-C30. Based on the significant correlations, we conclude that the DT has acceptable criterion validity.

Anxiety and depression in primary care patients: Predictors of symptom severity and developmental correlates

Objective A study in a German general practice used the Hospital Anxiety and Depression Scale (HADS) to determine the prevalence of anxiety and depression in 242 consecutive patients. The study had two additional goals: (1) to identify indicators of symptom severity and (2) to validate the HADS by relating it to measures of developmental psychopathology. Methods In addition to the HADS, clinical/sociodemographic data were collected. Patients filled up additional questionnaires measuring attachment characteristics, recalled parental rearing behavior, resilience, adverse childhood experiences, and physical complaints. Results Using HADS cutoff scores of ≥11 in total, we found that 21.1% of the patients showed clinically relevant anxiety levels; the rate for depression was 12.0%, that for anxiety or depression was 26.1%, and that for anxiety and depression combined was 7%. With the exception of psychiatric disorders, the HADS did not differentiate between subgroups with different somatic diseases. HADS scores were shown to be predicted by the patients' sex, family status, number of consultations, and subjective physical complaints. Patients with higher HADS scores also indicated lower resilience, more insecure attachment, and negative recalled parental rearing behavior. Resilience, attachment security, and specific parental behavior (control/warmth) independently predicted anxiety, depression, and physical complaints. Conclusion This study provides further support for the usefulness of the HADS as a measure for routine screening for anxiety and depression and its relationship with constructs from developmental psychopathology. We recommend the use of the HADS in combination with potential indicators of symptom severity (fatigue, cardiovascular symptoms, high number of consultations) to identify patients needing psychosocial support.

Screening for psychologic distress in ambulatory cancer patients

Based on evidence that psychologic distress often goes unrecognized although it is common among cancer patients, clinical practice guidelines recommend routine screening for distress. For this study, the authors sought to determine whether the single-item Distress Thermometer (DT) compared favorably with longer measures currently used to screen for distress. Patients (n = 380) who were recruited from 5 sites completed the DT and identified the presence or absence of 34 problems using a standardized list. Participants also completed the 14-item Hospital Anxiety and Depression Scale (HADS) and an 18-item version of the Brief Symptom Inventory (BSI-18), both of which have established cutoff scores for identifying clinically significant distress. Receiver operating characteristic (ROC) curve analyses of DT scores yielded area under the curve estimates relative to the HADS cutoff score (0.80) and the BSI-18 cutoff scores (0.78) indicative of good overall accuracy. ROC analyses also showed that a DT cutoff score of 4 had optimal sensitivity and specificity relative to both the HADS and BSI-18 cutoff scores. Additional analyses indicated that, compared with patients who had DT scores < 4, patients who had DT scores > or = 4 were more likely to be women, have a poorer performance status, and report practical, family, emotional, and physical problems (P < or = 0.05). Findings confirm that the single-item DT compares favorably with longer measures used to screen for distress. A DT cutoff score of 4 yielded optimal sensitivity and specificity in a general cancer population relative to established cutoff scores on longer measures. The use of this cutoff score identified patients with a range of problems that were likely to reflect psychologic distress.