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

Background:

The Hospital Anxiety and Depression Scale (HADS) [Zigmond, A.S., and Snaith, R.P., 1983. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandanavia 67, 361–370] is the most widely used instrument in oncology settings, however, its accuracy as a screening tool for minor and major depression is unclear.

Methods:

A comprehensive search of the literature was conducted in order to identify primary studies examining the sensitivity and specificity of the HADS-Depression (HADS-D) subscale, when compared to a ‘gold standard’ interview to obtain psychiatric diagnosis.

Results:

Ten studies were identified. Estimates of sensitivity and specificity varied across the studies reflecting the heterogeneity of study populations and methodology. However, results suggest that [Zigmond, A.S., and Snaith, R.P., 1983. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandanavia 67, 361–370] recommended threshold of 11 for detecting ‘probable’ depression may need to be revised. Depending on disease and treatment status, lower threshold scores may be necessary for adequately detecting ‘caseness’ without necessarily compromising specificity.

Conclusion:

The HADS-D should be used as a screening tool with caution, since recommended cut-off thresholds may result in under-recognition of depression among cancer patients. An integrated patient-centred approach is needed if screening for depression in cancer patients is to be truly effective.