Hospital Anxiety And Depression Scale Scale Research Articles

Validity of the Depression Anxiety Stress Scales in assessing depression and anxiety following traumatic brain injury

BackgroundAnxiety and depression following traumatic brain injury (TBI) are associated with poorer outcomes. A brief self-report questionnaire would assist in identifying those at risk, however validity of such measures is complicated by confounding symptoms of the injury. This study investigated the validity of the Depression Anxiety Stress Scales (DASS) and Hospital Anxiety and Depression Scale (HADS), in screening for clinical diagnoses of anxiety and mood disorders following TBI. MethodsOne hundred and twenty-three participants with mild to severe TBI were interviewed using the SCID (Axis I) and completed the DASS and HADS. ResultsThe DASS, DASS21 and HADS scales demonstrated validity compared with SCID diagnoses of anxiety and mood disorders as measured by Area Under ROC Curve, sensitivity and specificity. Validity of the DASS depression scale benefited from items reflecting symptoms of devaluation of life, self-deprecation, and hopelessness that are not present on the HADS. Validity of the HADS anxiety scale benefited from items reflecting symptoms of tension and worry that are measured separately for the DASS on the stress scale. LimitationsParticipants were predominantly drawn from a rehabilitation centre which may limit the extent to which results can be generalized. Scores for the DASS21 were derived from the DASS rather than being administered separately. ConclusionsThe DASS, DASS21 and HADS demonstrated validity as screening measures of anxiety and mood disorders in this TBI sample. The findings support use of these self-report questionnaires for individuals with TBI to identify those who should be referred for clinical diagnostic follow-up.

The Hyperacusis Questionnaire, loudness discomfort levels, and the Hospital Anxiety and Depression Scale: A cross-sectional study

Objective: The aim of this study was to compare hyperacusis measurement tools often used in audiological practice in order to determine the most valid measure for assessing hyperacusis. Another aim was to examine the mean value for the Hyperacusis Questionnaire (HQ) in this patient group. Design: This was a cross-sectional study to compare the HQ with loudness discomfort levels (LDL), the Hospital Anxiety and Depression Scale (HADS), and items from a clinical interview dealing with hyperacusis symptoms. Sixty-two patients between the ages of 18 and 61 years were evaluated. All patients were diagnosed with hyperacusis. Results: There were significant negative correlations between the HQ and nearly all LDL scores for the right ear, but no significant correlations could be found for the left ear. LDLs were significantly correlated with the anxiety subscale of the HADS while there were no significant correlations between the HQ and either of the HADS scales. Of the 62 patients, 41 scored above and 21 scored below the previously recommended cut-off for the HQ. Conclusion: We suggest that clinicians should use the HQ and HADS in combination with a clinical interview to diagnose hyperacusis, and propose that the cut-off for the Swedish version of the HQ should be lowered.

ALGORITHM FOR SCREENING OF DEPRESSION IN INSULIN-DEPENDENT DIABETES

Objective: to evaluate the possible risk factors of development of depression in insulin-dependent diabetes and to develop a screening algorithm for this depression. Material and methods. The study involved 163 patients with insulin-dependent diabetes mellitus (DM), of them, 93 men and 70 women aged 18-65. The average age of the patients was 41,15 [34,65; 46,66], the experience of diabetes was 11.18 [4,28; 22,33] years. To identify the common risk factors of depression development, we conducted a survey according to a specially designed questionnare. For verification of depression, the Hospital Anxiety and Depression Scale (HADS) was used. Depression was diagnosed at 8-21 points according to the HADS. To diagnose hidden hypoglycaemia states, twenty-four-hour glycemia dynamics was studied within 72 hours with the help of diurnal glucose monitoring of intercellular fluid (CGMS) by «Medtronik MINIMED» (USA). The detection of homocysteine (HC) content in the blood serum was performed using sets of ARCHITECT Homocysteine Reagent Kit (1L71) on the biochemical analyzer «Architect c8000» («AVVOTT», USA). The data were statistically processed using «Statistica», 6.0 for Windows and SPSS «Statistics», 17.0. Results . The results of the survey using the HADS showed symptoms of depression in 28.2 % of the patients in the study group. Depression was detected in 30 women, or 18.4 %, and 16 men (9,8 %). The study revealed a statistically significant direct correlation between the HADS depression level and age (r = 0,17; r < 0,05), and it also found that the risk of depression in insulin-dependent diabetes is associated with age over 40 (OR = 1,06; p < 0,05; 95 % CI 0,99-1,13). It was ascertained that disability is a risk factor for depression (OR = 2,41; p = 0,01; 95 % CI 1,16-4,19). The assessment of the risk of depression development according to HbA1C level showed that the possible risk of depression is associated with the HbA1C level of 7,5 % or more (OR = 0,89; p = 0,03; 95 % CI 0,30-0,48). The risk of depression is also associated with DR (OR = 10,72; p < 0,001; 95 % CI 3,14-36,55) and with the presence of DN (OR = 3,79; p < 0,001; 95 % CI 1,84-7,82). The study found the dependence of the prevalence of hidden hypoglycemic reactions and the level of depression according to the scale of HADS (OR = 1,12; p = 0,0024; 95 % CI 1,02-1,24). It was also ascertained that the risk of depression in the patients with type I diabetes is associated with the level of more than 15.39 HС mmol/L (OR = 6,82; p = 0,001; 95 % CI 2,19-21,20). Conclusion . The risk for the development of depression in I type diabetes is associated with the female sex, age over 40, presence of disability, DR and/or НС serum level more than 15,39 mmol/L, and the HbA level of ≥ 7,5 %. In addition, the risk for the development of depression is associated with hidden hypoglycemic episodes. The developed algorithm for screening of depressive states in insulin-dependent DM can be used to diagnose depression as on both out-patient and in-patient phase of treatment of the patients with I type diabetes.

LADASTEN INFLUENCE ON ASTHENIA DEGREE AND QUALITY OF LIFE IN TICK-BORNE BORRELIOSIS RECONVALESCENTS

Aim. To assess the influence of ladasten on the degree of postinfectious asthenia and quality of life in tick-borne borreliosis reconvalescents. Materials and methods. Two groups of patients with postinfectious somatogenic asthenia were investigated. Group 1 consisted of 36 reconvalescents receiving the preparation ledestan in the dose of 100 mg during 25 days. Group 2, the group of comparison, included 37 reconvalescents who did not apply drugs. Before and after treatment, examination using visual analog asthenia scale, inquire for revealing signs of vegetative changes, score subjective sleep disturbance questionnaire, quality of life questionnaire MOS SF-36, hospital anxiety and depression scale (HADS) was carried out. Results. After taking ladasten, patients had significant dynamics of decreasing scores by visual analog asthenia scale. Reconvalescents of group 1 after treatment had a significant increase in indices by all SF-30 questionnaire scales ( p =0,001). When analyzing HADS scale data for «depression» parameter, it was established that in the first group there was a positive dynamics of this index after treatment ( p =0,001) which was not registered in the second group ( p =0,931). During ladasten therapy, manifestation of vegetative disorders in the first group decreased ( p =0,001). Analysis of subjective evaluation of sleep disturbance detected normalization of this index after therapeutic course ( p =0,001) as compared to the control ( p =0,146). Conclusion. Efficiency of ladasten in borreliosis reconvalescents is displayed by antiasthenic, anxiolytic, vegetostabilizing properties, normalization of sleep, improvement of quality of life indices. Ladasten in the day dose of 100 mg can be recommended during rehabilitation period for patients after borreliosis with residual effects in the form of postinfectious somatogenic asthenia.

Methodological artifacts in dimensionality assessment of the Hospital Anxiety and Depression Scale (HADS)

ObjectiveThe Hospital Anxiety and Depression Scale (HADS) is a brief, self-administered questionnaire for the assessment of anxiety and depression in hospital patients. A recent review [7] discussed the disagreement among different studies with respect to the dimensionality of the HADS, leading Coyne and Van Sonderen [8] to conclude from this disagreement that the HADS must be abandoned. Our study argues that the disagreement is mainly due to a methodological artifact, and that the HADS needs revision rather than abandonment. MethodWe used Mokken scale analysis (MSA) to investigate the dimensionality of the HADS items in a representative sample from the Dutch non-clinical population (N=3643) and compared the dimensionality structure with the results that Emons, Sijtsma, and Pedersen [11] obtained in a Dutch cardiac-patient sample. ResultsWe demonstrated how MSA can retrieve either one scale, two subscales, or three subscales, and that the result not only depends on the data structure but also on choices that the researcher makes. Two 5-item HADS scales for anxiety and depression seemed adequate. Four HADS items constituted a weak scale and contributed little to reliable measurement. ConclusionsWe argued that several psychometric methods show only one level of a hierarchical dimensionality structure and that users of psychometric methods are often unaware of this phenomenon and miss information about other levels. In addition, we argued that a theory about the attribute may guide the researcher but that well-tested theories are often absent.

Family-based associations in measures of psychological distress and quality of life in a cardiac screening clinic for inheritable cardiac diseases: a cross-sectional study

BackgroundFamily-based cardiac screening programmes for persons at risk for genetic cardiac diseases are now recommended. However, the psychological wellbeing and health related quality of life (QoL) of such screened patients is poorly understood, especially in younger patients. We sought to examine wellbeing and QoL in a representative group of adults aged 16 and over in a dedicated family cardiac screening clinic.MethodsProspective survey of consecutive consenting patients attending a cardiac screening clinic, over a 12 month period. Data were collected using two health measurement tools: the Short Form 12 (version 2) and the Hospital Anxiety and Depression Scale (HADS), along with baseline demographic and screening visit-related data. The HADS and SF-12v.2 outcomes were compared by age group. Associations with a higher HADS score were examined using logistic regression, with multi-level modelling used to account for the family-based structure of the data.ResultsThere was a study response rate of 86.6%, with n=334 patients providing valid HADS data (valid response rate 79.5%), and data on n=316 retained for analysis. One-fifth of patients were aged under 25 (n=61). Younger patients were less likely than older to describe significant depression on their HADS scale (p<0.0001), although there were overall no difference between the prevalence of a significant HADS score between the younger and older age groups (18.0% vs 20.0%, p=0.73). Significant positive associates of a higher HADS score were having lower educational attainment, being single or separated, and being closely related to the family proband. Between-family variance in anxiety and depression scores was greater than within-family variance.ConclusionsHigh levels of anxiety were seen amongst patients attending a family-based cardiac screening clinic.Younger patients also had high rates of clinically significant anxiety. Higher levels of anxiety and depression tends to run in families, and this has implications for family screening and intervention programmes.

Sedation with midazolam in flexible bronchoscopy – A prospective study

IntroductionSedatives have been increasingly used to improve patient comfort during flexible bronchoscopy (FOB). Due to its rapid-onset, anxiolytic and amnestic properties, midazolam is one of the most commonly used sedatives. ObjectivesTo evaluate the effect of sedation with midazolam, including patient tolerance, complications and its potential use on a daily routine basis. MethodsA multi-centre, prospective, randomized, placebo-controlled study was made on 100 patients submitted to FOB in two Pulmonology Departments. Midazolam (0.05mg/kg) was administered to patients in Group 1 and saline solution (0.9% NaCl) to patients in Group 2, 5min before the procedure. The Hospital Anxiety and Depression Scale (HADS-A) was used to determine patient anxiety level. Subjective questionnaires concerning main fears and complaints were answered before and after FOB. ResultsMean age was 56.0±14.1 years; 66% were male. Most (65%) patients had low score (<7) in HADS-A scale with no difference between groups. No significant differences were seen between groups concerning FOB duration, procedures, lidocaine dosage and complications. Systolic blood pressure during and after FOB was significantly higher (p<0.003) in Group 2.Patients in Group 1 experienced less cough (32% vs 56%; p=0.03) and dyspnoea (2% vs 34%; p<0.001) than in Group 2, while nausea (6% vs 18%; p>0.05) and pain (4% vs 12%; p>0.05) were not statistically different.Willingness to repeat the exam was reported in all patients in Group 1 and in 82% in Group 2 (p=0.003). ConclusionSedation with midazolam in FOB improved patient's comfort and decreased complaints, without significant haemodynamic changes. It should be offered to the patient on a routine basis.

Sedação com midazolam na broncofibroscopia – estudo prospetivo

IntroductionSedatives have been increasingly used to improve patient comfort during flexible bronchoscopy (FOB). Due to its rapid-onset, anxiolytic and amnestic properties, midazolam is one of the most commonly used sedatives. ObjectivesTo evaluate the effect of sedation with midazolam, including patient tolerance, complications and its potential use on a daily routine basis. Material and methodsA multi-centre, prospective, randomized, placebo-controlled study was made on 100 patients submitted to FOB in two Pulmonology Departments. Midazolam (0.05mg/kg) was administered to patients in Group 1 and saline solution (0,9% NaCl) to patients in Group 2, five minutes before the procedure. The Hospital Anxiety and Depression Scale (HADS-A) was used to determine patient anxiety level. Subjective questionnaires concerning main fears and complaints were answered before and after FOB. ResultsMean age was 56.0 ± 14.1 years; 66% male. Most (65%) patients had low score (<7) in HADS-A scale with no difference between groups. No significant differences were seen between groups concerning FOB duration, procedures, lidocaine dosage and complications. Systolic blood pressure during and after FOB was significantly higher (p<0.003) in Group 2. Patients in Group 1 experienced less cough (32% vs 56%; p=0.03) and dyspnea (2% vs 34%; p<0.001) than in Group 2, while nausea (6% vs 18%; p>0.05) and pain (4% vs 12%; p>0.05) were not statistically different. Willingness to repeat the exam was reported in all patients in Group 1 and in 82% in Group 2 (p=0.003). ConclusionSedation with midazolam in FOB improved patient's comfort and decreased complaints, without significant haemodynamic changes. It should be offered to the patient on a routine basis.

Project onward: an innovative e‐health intervention for cancer survivors

This study examined the feasibility and acceptability of an Individual Internet Intervention (III) embedded and integrated into an Internet Support Group (ISG) with the ultimate goal of enhancing adherence and learning, compared with an individual internet invention alone. Thirty-one posttreatment cancer survivors were randomized in groups of seven to nine to either the 8-week III + ISG intervention or the 8-week III condition. Seventeen participants met the Hospital Anxiety and Depression Scale (HADS) criteria for depressive symptoms (HADS ≥ 8). Among all participants, the mean number of logins over 8 weeks was 20.8 ± 17.7 logins for the III + ISG compared with 12.5 ± 12.5 in III-only (p = 0.15). Two participants in the III + ISG dropped out, compared with five in III (p = 0.39). Among the 17 participants with depressive symptoms at baseline, both the Onward and the III-only condition showed large reductions in the depression scale of HADS (d = 1.27 and 0.89, respectively). Improvement over time and time x treatment effects only reached trend significance levels (ps = 0.07 & 0.12) as this pilot was not powered to detect these differences. Both the III + ISG and III-only demonstrated pre-post reductions in depressive symptoms and high rates of utilization compared with other web-based treatments for depression. Although it is premature to make any determination as to the efficacy of the interventions tested in this feasibility study, these results indicate that pursuing the III + ISG model, as well as standard IIIs, may be fruitful areas of future research.

Translation and validation of Korean Functional Assessment of Cancer Therapy-Esophageal (FACT-E) scale with squamous cell carcinoma and chemoradiation-only patients

The Functional Assessment of Cancer Therapy-Esophageal (FACT-E) Scale version 4 has been used to assess quality of life in patients with squamous cell carcinoma undergoing chemoradiation. We sought to determine whether this scale can be used to assess quality of life in Korean patients with esophageal cancer undergoing chemoradiation. The FACT-E scale version 4 was cross-culturally translated into Korean. Its reliability and validity were assessed in a group of 146 esophageal cancer patients who were scheduled for neoadjuvant chemoradiation (CRT). This procedure was followed by esophagectomy that took place between 2007 and 2010 at Asan Medical Center. All patients completed the FACT-E, Hospital Anxiety and Depression Scale (HADS) and Functional Living Index-Cancer (FLIC) questionnaires at baseline (pre-treatment) and 1month after two cycles of induction chemotherapy followed by CRT. In validating the FACT-E, we found high internal consistency coefficients ranging from 0.72 to 0.91. Good convergent and divergent validities were demonstrated by the FLIC and HADS scales. The FACT-E showed good clinical validity and effectively differentiated between patient groups with different performance status ratings and stages. Changes in clinical status were reflected by changes in FACT-E scores, demonstrating responsiveness to neoadjuvant CRT. The FACT-E has been shown to be a reliable and valid instrument that can now be used to prospectively evaluate the quality of life of Korean patients with esophageal cancer.

Relationship between quality of life and distress in infertility: a validation study of the Dutch FertiQoL

This study examined the relationship between emotional distress as measured by the Hospital Anxiety and Depression Scale (HADS) and the Fertility Quality of Life (FertiQoL) questionnaire. The FertiQoL and HADS were distributed to a random sample of 785 patients attending 29 Dutch clinics for medically assisted reproduction. FertiQoL was psychometrically tested for reliability. Pearson's correlations were calculated between subscales of FertiQoL and HADS. Using an independent t-test, differences between patient subgroups were computed for both instruments. The threshold for clinically meaningful depression/anxiety on the HADS subscales was used to ascertain the critical threshold for high distress on the FertiQoL scales. FertiQoL and HADS were completed by 583 patients (response 74%). Reliability of FertiQoL scales was high (reliability coefficient between 0.72 and 0.91). Significant negative correlations were found between FertiQoL subscales and HADS scores for anxiety and depression, ranging from -0.29 to -0.71. Means on FertiQoL scales and HADS scales of couples undergoing an assisted reproductive technology (ART) treatment and a non-ART treatment did not differ significantly. Patients scoring above the HADS threshold for pathology on anxiety had an average FertiQoL score of 58.8, whereas patients exceeding the HADS depression threshold had a FertiQoL total score of 51.9 (range 0-100). Our study confirms the expected negative relation between quality of life as measured by FertiQoL and anxiety and depression. The data support that FertiQoL reliably measures QoL in women facing infertility. FertiQoL enables clinicians to tailor care more specifically to the patient in a comprehensive way.

Reliability and Validity of the Ethiopian Version of the Hospital Anxiety and Depression Scale (HADS) in HIV Infected Patients

BackgroundThe hospital anxiety and depression scale (HADS) is a widely used instrument for evaluating psychological distress from anxiety and depression. HADS has not yet been validated in Ethiopia. The aim of this study was to evaluate the reliability and validity of the Amharic (Ethiopian language) version of HADs among HIV infected patients.MethodsThe translated scale was administered to 302 HIV/AIDS patients on follow up for and taking anti-retroviral treatment. Consistency assessment was conducted using Cronbach's alpha, test-retest reliability using intra-class correlation coefficients (ICC). Construct validity was examined using principal components analysis (PCA). Parallel analysis, Kaiser's criterion and the scree test were used for factor extraction.ResultsThe internal consistency was 0.78 for the anxiety, 0.76 for depression subscales and 0.87 for the full scale of HADS. The intra-class correlation coefficient (ICC) was 80%, 86%, and 84% for the anxiety and depression subscales, and total score respectively. PCA revealed a one dimensional scale.ConclusionThis preliminary validation study of the Ethiopian version of the HADs indicates that it has promising acceptability, reliability and validity. The adopted scale has a single underlying dimension as indicated by Razavi's model. The HADS can be used to examine psychological distress in HIV infected patients. Findings are discussed and recommendations made.

Detecting depressive and anxiety disorders in distressed patients in primary care; comparative diagnostic accuracy of the Four-Dimensional Symptom Questionnaire (4DSQ) and the Hospital Anxiety and Depression Scale (HADS)

BackgroundDepressive and anxiety disorders often go unrecognized in distressed primary care patients, despite the overtly psychosocial nature of their demand for help. This is especially problematic in more severe disorders needing specific treatment (e.g. antidepressant pharmacotherapy or specialized cognitive behavioural therapy). The use of a screening tool to detect (more severe) depressive and anxiety disorders may be useful not to overlook such disorders. We examined the accuracy with which the Four-Dimensional Symptom Questionnaire (4DSQ) and the Hospital Anxiety and Depression Scale (HADS) are able to detect (more severe) depressive and anxiety disorders in distressed patients, and which cut-off points should be used.MethodsSeventy general practitioners (GPs) included 295 patients on sick leave due to psychological problems. They excluded patients with recognized depressive or anxiety disorders. Patients completed the 4DSQ and HADS. Standardized diagnoses of DSM-IV defined depressive and anxiety disorders were established with the Composite International Diagnostic Interview (CIDI). Receiver Operating Characteristic (ROC) analyses were performed to obtain sensitivity and specificity values for a range of scores, and area under the curve (AUC) values as a measure of diagnostic accuracy.ResultsWith respect to the detection of any depressive or anxiety disorder (180 patients, 61%), the 4DSQ and HADS scales yielded comparable results with AUC values between 0.745 and 0.815. Also with respect to the detection of moderate or severe depressive disorder, the 4DSQ and HADS depression scales performed comparably (AUC 0.780 and 0.739, p 0.165). With respect to the detection of panic disorder, agoraphobia and social phobia, the 4DSQ anxiety scale performed significantly better than the HADS anxiety scale (AUC 0.852 versus 0.757, p 0.001). The recommended cut-off points of both HADS scales appeared to be too low while those of the 4DSQ anxiety scale appeared to be too high.ConclusionIn general practice patients on sick leave because of psychological problems, the 4DSQ and the HADS are equally able to detect depressive and anxiety disorders. However, for the detection of cases severe enough to warrant specific treatment, the 4DSQ may have some advantages over the HADS, specifically for the detection of panic disorder, agoraphobia and social phobia.

Psychiatric morbidity among dental patients attending a tertiary hospital in Lagos

Objective: It has been noted that oral health conditions have significant relationships with mental illnesses. In Nigeria, a large number of individuals with psychological morbidity also visit dental health practitioners regularly and few psychopathological studies have been carried out to determine the prevalence of psychopathology in dental patients in Lagos. The aim of this study was to determine the general psychological wellbeing, symptoms of anxiety and depression among patients who were attending the dental clinic for restorative and oral surgery in Lagos. Method: One hundred and three consecutive dental patients who were attending the dental clinic of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos were recruited for this study. Patients were administered with the 12th version of the General Health Questionnaire (GHQ), and Hospital Anxiety and Depression Scale (HADS). Result: One hundred and three patients (50 males and 53 females) aged 20-61 years (mean age 38.3+ 10.7 years) participated in the study. The reasons for attending the dental clinic ranged from unbearable pain 81(78.6%), filling of teeth 9(8.7%), extraction 6(5.8%), check-up 4(3.9%) and fixing of braces 3(3.0%). Subjects who scored more than 3 in the GHQ were 17.5 %. On the HADS scale, 28.2 % had a high score in anxiety while 14.6 % scored high in depression. Conclusion: This study shows that a high percentage of dental patients also suffer from psychopathology especially anxiety and depression. These findings have been observed to constitute complex psycho-social problems with far reaching social and medical consequences among dental patients. The acquisition of psychotherapeutic tools by dental surgeons for assessing and managing dental patients with psychopathology will enhance the quality of practice and service delivery of dental surgeons. Keywords: psychiatry, morbidity, dental patientsNigerian Dental Journal Vol. 16 (1) 2008: pp. 22-25

Association between depression and the Gln460Arg polymorphism of P2RX7 Gene: A dimensional approach

The P2RX7 gene (coding for P2X7 purinergic receptor) has been suggested as a novel candidate gene for major depressive disorder (MDD) and bipolar disorder (BPD). The proposed risk allele (G-allele) of the rs2230912 polymorphism results in an amino acid change at the 460th position, marking this genetic variation a possibly functional one. Here we present a case-control analysis of 171 patients diagnosed with MDD or BPD and 178 controls, as well as a dimensional approach using the Hospital Anxiety and Depression Scale (HADS) for studying the Gln460Arg polymorphism of the P2RX7 gene as a genetic risk factor in depression. While case-control analysis did not show significant difference between the groups, a significant association was found between the P2RX7 polymorphism and the HADS scales in the clinical group (MANOVA P = 0.001). Both anxiety and depression scores increased as the number of G-allele increased in the genotype groups (ANOVA for HADS-anxiety: P = 0.01, HADS-depression: P < 0.001). A significant interaction of clinical status and the P2RX7 polymorphism was also found for the depression scale (MANOVA P = 0.025, subsequent ANOVA for anxiety: P = 0.252; depression: P = 0.002). Whereas patients with G-allele-present genotypes showed more elevated depression scores, level of depression in the control group was not affected by the P2RX7 genotype. In conclusion, case-control analysis did not reveal significant results, but using a symptom severity scale we could support the association between depressive disorder and the G-allele of the Gln460Arg polymorphism in the P2RX7 gene.

An evaluation of use of the HADS scale to screen for post-stroke depression in practice

Widely differing methods of diagnosis and definition mean that the incidence of post-stroke depression has been reported at between 30% and 60%. Despite this apparent disparity, these statistics reveal that depression after stroke is common and that the symptoms may cause a great deal of distress to both the patient and his/her family. Post-stroke depression may also limit rehabilitation and have a profound impact on outcome and quality of life. The National Service Framework for Older People and the Royal College of Physicians' National Clinical Guidelines for Stroke stipulate that stroke patients should be screened for depression within 1 month of stroke, and that the patient's mood should be kept under review. A number of difficulties are encountered in screening patients for depression after stroke and a number of different screening tools are available. The aim of the pilot described here was to evaluate the use of one of these tools, the Hospital Anxiety and Depression Scale (HADS), to screen patients for post-stroke depression in practice. The HADS was found to be an effective screening method for those patients who can self-assess or require minimal assistance. A number of recommendations are made for monitoring depression in stroke patients in line with national guidelines.

Screening for mental disorders in cancer patients – discriminant validity of HADS and GHQ‐12 assessed by standardized clinical interview

AbstractThe detection and classification of comorbid mental disorders has major implications in cancer care. Valid screening instruments for different diagnostic specifications are therefore needed. This study investigated the discriminant validity of the German versions of the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire (GHQ‐12). A total of 188 cancer patients participated in the examination, consisting first of the assessment of psychological distress and, second, of the diagnosis of mental disorders according to DSM‐IV by clinical standardized interview (CIDI). Discriminant validity of the two instruments regarding the diagnosis of any mental disorder, anxiety, depression and multiple mental disorders was compared using ROC analysis.Overall, the total HADS scale shows a better screening performance than the GHQ‐12, especially for the detection of depressive and anxiety disorders. Best results are achieved for depressive disorders with an area under the curve (AUC) of 0.80, a sensitivity of 79% and a specificity of 76% (cut‐off point = 17). For the ability of the instruments to detect patients with mental disorders in general, the GHQ‐12 (AUC: 0.68) shows a similar overall accuracy to the HADS (AUC: 0.70). The screening performance of both scales for comorbid mental disorders is comparable.The HADS is a valid screening instrument for depressive and anxiety disorders in cancer care. The GHQ‐12 can be considered as an alternative to the HADS when diagnostic specifications are less detailed and the goal of screening procedures is to detect patients with single or multiple mental disorders in general. Limitations of conventional screening instruments are given through the differing methodological approaches of screening tests (dimensional approach) and diagnosis according to DSM‐IV (categorical approach). Copyright © 2001 Whurr Publishers Ltd.

Comparing OASIS, FIM, and MDS in assessing disability

Chronic disease carries the risk of emotional disorders among adolescents. It is important to observe early signs to implement treatment. One commonly used screening tool is Hospital Anxiety and Depression Scale (HADS), which has Polish adaptation for adults. Although there are publications presenting the validation of a scale for use in adolescents, in Poland this study has not yet been conducted. The aim of the present study was to evaluate the use of Anxiety and Depression Scale among Polish healthy and CF adolescents.Anxiety and Depression Scale was examined in 142 adolescents, including 65 patients with CF in Cystic Fibrosis Centre at the Institute of Mother and Child, as well as in 77 healthy students. Scale accuracy has been verified by comparing the State-Trait Anxiety Inventory STAI and the Center for Epidemiological Study for Depression CES-D.The relatively high HADS scale reliability (Cronbach's α = 0.83) and good stability in test-retest analysis (ρ = 0.75 for the depression subscale and ρ = 0.67 for the anxiety subscale) was reported. Correlations item–scale were statistically significant and ranged from r = 0.32 to r = 0.74. χ2 test showed a link between anxiety subscale HADS-A and the two subscales STAI (anxiety as a state and as a trait) and between subscale HADS-D and CES-D.Our study achieved satisfactory indicators of reliability, stability and validity of the test. The test could be useful in adolescents with cystic fibrosis, due to the limited number of questions concerning the somatic symptoms that may result from the underlying disease.

A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects.

Research on the dimensional structure and reliability of the Hospital Anxiety and Depression Scale (HADS) and its relationship with age is scarce. Moreover, its efficacy in determining the presence of depression in different patient groups has been questioned. Psychometric properties of the HADS were assessed in six different groups of Dutch subjects (N = 6165): (1) a random sample of younger adults (age 18-65 years) (N = 199); (2) a random sample of elderly subjects of 57 to 65 years of age (N = 1901); (3) a random sample of elderly subjects of 66 years or older (N = 3293); (4) a sample of consecutive general practice patients (N = 112); (5) a sample of consecutive general medical out-patients with unexplained somatic symptoms (N = 169); and (6) a sample of consecutive psychiatric out-patients (N = 491). Evidence for a two-factor solution corresponding to the original two subscales of the HADS was found, although anxiety and depression subscales were strongly correlated. Homogeneity and test-retest reliability of the total scale and the subscales were good. The dimensional structure and reliability of the HADS was stable across medical settings and age groups. The correlations between HADS scores and age were small. The total HADS scale showed a better balance between sensitivity and positive predictive value (PPV) in identifying cases of psychiatric disorder as defined by the Present State Examination than the depression subscale in identifying cases of unipolar depression as defined by ICD-8. The moderate PPV suggests that the HADS is best used as a screening questionnaire and not as a 'case-identifier' for psychiatric disorder or depression.

9 - New Approaches to Immunological Contraception

Skin conditions may have a major impact on the psychologic well-being of patients, ranging from depression to anxiety. The Dermatology Life Quality Index (DLQI) is the most commonly used quality of life tool in dermatology, though it has yet to be correlated with psychiatric measures used in clinical therapeutic trials. We conducted a systematic review to determine whether there is any correlation between the DLQI and psychiatric measure scores, potentially allowing the DLQI to be used as a surrogate measure for depression or psychiatric screening. Six databases were searched using the following keywords: “DLQI,” “Dermatology Life Quality Index,” “Psych*,” “depression,” “anxiety,” “stress,” and “trial*.” All randomized trials where full DLQI and psychiatric scores were provided were included. PRISMA guidelines were followed. In all, 462 records were screened, but only seven met inclusion criteria. Hospital Anxiety and Depression Scale (HADS) was the most commonly used psychiatric measure; the “depression” component score changes correlated strongly with the DLQI (r = 0.715). There needs to be guidance on psychiatric measurement and reporting in clinical trials. Although the DLQI correlated well with the “depression” domain of the HADS scale, interviews and screening for depression are still vital for full assessment of patient psychologic well-being.