Advertisement

Breast Cancer Research and Treatment

, Volume 122, Issue 2, pp 573–578 | Cite as

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

  • Susanna Alexander
  • Clare Palmer
  • Patrick C. StoneEmail author
Brief Report

Abstract

Although cases of anxiety and depression post-breast 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.

Keywords

Breast neoplasms Depression Anxiety Mass screening Sensitivity and specificity 

Notes

Acknowledgements

We would like to thank Dr. Janine Mansi, Mr. D. Banerjee, Mr. A. Sharma, Sue Lownes, RGN, Joe Diffley, RGN, Dr. Catherine Cole- man, Dr. Charlotte Rees, and Sarah White. This study was funded by Cancer Research UK (CRUK), Grant Number 11075/A7143.

References

  1. 1.
    Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A (2005) Depression and anxiety in women with early breast cancer: five year observational cohort study. Br Med J 330:702–705CrossRefGoogle Scholar
  2. 2.
    Pirl WF, Greer J, Temel JS, Yeap BW, Gilman SE (2009) Major depressive disorder in long-term cancer survivors: Analysis of the National Comorbidity Survey replication. J Clin Oncol 27(25):4130–4134CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Sharpe M, Strong V, Allen K, Rush R, Potsma TM, House A, Ramirez CA (2004) Major depression in outpatients attending a regional cancer centre; screening and unmet treatment needs. Br J Cancer 80:1770–1780Google Scholar
  4. 4.
    Schairer C, Morris Brown L, Chen BE, Howard R, Lynch CF, Hall P, Storm H, Pukkala E, Anderson A, Joensuu H, Fosså SD, Ganz PA, Travis LB (2006) Brief communications: Suicide after breast cancer: an international population-based study of 723810 women. J Natl Cancer Inst 98(19):1416–1419CrossRefPubMedGoogle Scholar
  5. 5.
    Minton O, Stone P (2008) How common is fatigue in disease-free breast cancer survivors? A systematic review of the literature. Breast Cancer Res Treat 112:5–13CrossRefPubMedGoogle Scholar
  6. 6.
    Cella D et al (1998) Progress toward guidelines for the management of fatigue. Oncology 12(11A):369–377PubMedGoogle Scholar
  7. 7.
    Alexander S, Minton O, Stone P (2009) Evaluation of screening instruments for Cancer-Related Fatigue Syndrome (CRFS) in breast cancer survivors. J Clin Oncol 27(8):1197–1201CrossRefPubMedGoogle Scholar
  8. 8.
    Alexander S et al (2009) A comparison of the characteristics of disease-free breast cancer survivors with or without cancer-related fatigue syndrome. Eur J Cancer 45(3):384–392CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67(6):361–370CrossRefPubMedGoogle Scholar
  10. 10.
    Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale; an updated literature review. J Psychosom Res 52:69–77CrossRefPubMedGoogle Scholar
  11. 11.
    Hermann C (1997) International experience with the Hospital Anxiety and Depression Scale. A review of validation data and clinical results. J Psychosom Res 42:17–41CrossRefGoogle Scholar
  12. 12.
    Morse R, Kendell K, Barton S (2005) Screening for depression in people with cancer: the accuracy of the hospital anxiety and depression scale. Clin Eff Nurs 9:188–196CrossRefGoogle Scholar
  13. 13.
    Ravazi D, Devaux N, Farvacques C, Robaye E (1990) Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiatry 156:78–83Google Scholar
  14. 14.
    Crawford JR, Henry JD, Crombie C, Taylor EP (2001) Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol 40(Pt4):429–434CrossRefPubMedGoogle Scholar
  15. 15.
    Singer S, Kuhnt S, Götze H, Hauss J, Hinz A, Liebmann A, Krau Β, Lehmann A, Schwarz R (2009) Hospital anxiety and depression scale cutoff scores for cancer patients in acute care. Br J Cancer 100:908–912CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786CrossRefPubMedGoogle Scholar
  17. 17.
    Matthey S, Henshaw C, Elliott S, Barnett B (2006) Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale—implications for clinical and research practice. Arch Womens Ment Health 9:309–315. doi: 10.1007/s00737-006-0152-x CrossRefPubMedGoogle Scholar
  18. 18.
    Cox JL, Chapman G, Murray D, Jones P (1996) Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. J Affect Disord 39(3):185–189CrossRefPubMedGoogle Scholar
  19. 19.
    Lloyd-Williams M, Friedman T, Rudd N (2000) Criterion validation of the Edinburgh Postnatal Depression Scale as a screening tool for depression in patients with advanced metastatic cancer. J Pain Symptom Manage 20(4):259–265CrossRefPubMedGoogle Scholar
  20. 20.
    Kim SH, Son BH, Hwang SY, Han W, Yang JH, Lee S, Yun YH (2008) Fatigue and depression in disease-free breast cancer survivors: prevalence, correlates, and association with quality of life. J Pain Symptom Manage 35:644–655CrossRefPubMedGoogle Scholar
  21. 21.
    Semple D, Smyth R (2009) Oxford handbook of psychiatry, 2nd edn. Oxford University Press, OxfordCrossRefGoogle Scholar
  22. 22.
    Walker J, Potsma K, McHugh GS, Rush R, Coyle B, Strong V, Sharpe M (2007) Performance of the Hospital Anxiety and Depression Scale as a screening tool for major depressive disorder in cancer patients. J Psychosom Res 63:83–91CrossRefPubMedGoogle Scholar
  23. 23.
    Guedeney N, Fermanian J, Guelfi JD, Kumar RC (2000) The Edinburgh Postnatal Depression Scale (EDS) and the detection of major depressive disorders in early postpartum: some concerns about false negatives. J Affect Disord 61(1–2):107–112CrossRefPubMedGoogle Scholar
  24. 24.
    Hurria A, Hudis C (2003) Follow up care of breast cancer survivors. Crit Rev Oncol Hematol 48:89–99CrossRefPubMedGoogle Scholar
  25. 25.
    Maunsell E, Brisson J, Deschenes L (1992) Psychological distress after initial treatment of breast cancer. assessment of potential risk factors. Cancer 70(1):120–125CrossRefPubMedGoogle Scholar
  26. 26.
    Schag CA, Ganz PA, Polinsky ML, Fred C, Hirji K, Petersen L (1993) Characteristics of women at risk for psychosocial distress in the year after breast cancer. J Clin Oncol 11(4):783–793PubMedGoogle Scholar
  27. 27.
    Lloyd-Williams M, Shiels C, Dowrick C (2007) The development of the Brief Edinburgh Depression Scale (BEDS) to screen for depression in patients with advanced cancer. J Affect Disord 99(1–3):259–264CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Susanna Alexander
    • 1
  • Clare Palmer
    • 1
  • Patrick C. Stone
    • 1
    Email author
  1. 1.Division of Mental HealthSt George’s University of LondonLondonUK

Personalised recommendations