Supportive Care in Cancer

, Volume 7, Issue 3, pp 121–127

Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale

Authors

  • M. Costantini
    • Unit of Clinical Epidemiology and Trials, National Cancer Institute, L.go R. Benzi 10, I-16132 Genoa, Italy e-mail: costantini@ermes.cba.unige.it Tel.: +39–010–5737482 Fax: +39–010–354103
  • Marco Musso
    • Department of Psychology, National Cancer Institute, Genoa, Italy
  • Paola Viterbori
    • Unit of Clinical Epidemiology and Trials, National Cancer Institute, L.go R. Benzi 10, I-16132 Genoa, Italy e-mail: costantini@ermes.cba.unige.it Tel.: +39–010–5737482 Fax: +39–010–354103
  • Francesca Bonci
    • Department of Medical Oncology, Pisa, Italy
  • Lucia Del Mastro
    • Department of Medical Oncology I, National Cancer Institute, Genoa, Italy
  • Ornella Garrone
    • Department of Medical Oncology I, National Cancer Institute, Genoa, Italy
  • Marco Venturini
    • Department of Medical Oncology I, National Cancer Institute, Genoa, Italy
  • Gabriella Morasso
    • Department of Psychology, National Cancer Institute, Genoa, Italy
ORIGINAL ARTICLE

DOI: 10.1007/s005200050241

Cite this article as:
Costantini, M., Musso, M., Viterbori, P. et al. Support Care Cancer (1999) 7: 121. doi:10.1007/s005200050241

Abstract

The psychometric properties of the Italian version of the Hospital Anxiety and Depression Scale and its utility as a screening instrument for anxiety and depression in a non-psychiatric setting were evaluated. The questionnaire was administered twice to 197 breast cancer patients randomised in a phase III adjuvant clinical trial: before the start of chemotherapy and at the first follow-up visit. The presence of psychiatric disorders was evaluated at the follow-up visit using the Structured Clinical Interview for DSM-III-R in 132 patients. Factor analyses identified two strictly correlated factors. Crohnbach's alpha for the anxiety and depression scales ranged between 0.80 and 0.85. At follow-up, 50 patients (38%) were assigned a current DSM-III-R diagnosis, in most cases adjustment disorders (24%) or major depressive disorder (10%). Receiver operating characteristics (ROC) analysis was used to test the discriminant validity for both anxiety and depressive disorders. The comparison of the areas under the curve (AUC) between the two scales did not show any difference in identifying either anxiety (P=0.855) or depressive disorders (P=0.357). The 14-item total scale showed a high internal consistency (alpha=0.89 and 0.88) and a high discriminating power for all the psychiatric disorders (AUC=0.89; 95% CI=0.83–0.94). The cut-off point that maximised sensitivity (84%) and specificity (79%) was 10. These results suggest that the total score is a valid measure of emotional distress, so that the Italian version of HADS can be used as a screening questionnaire for psychiatric disorders. The use of the two subscales as a 'case identifier' or as an outcome measure should be considered with caution.

Key words CancerAnxietyDepressionHospital Anxiety and Depression ScalePsychological screening

Copyright information

© Springer-Verlag Berlin Heidelberg 1999