Rheumatology International

, Volume 37, Issue 12, pp 1999–2004 | Cite as

Assessment of the Hospital Anxiety and Depression Scale (HADS) performance for the diagnosis of anxiety in patients with systemic lupus erythematosus

  • Eduardo de Almeida MacêdoEmail author
  • Simone Appenzeller
  • Lilian Tereza Lavras Costallat
Validation Studies


Neuropsychiatric lupus (NPSLE) is described in 12–95% of patients with systemic lupus erythematosus (SLE). Anxiety disorders are among the most frequent manifestations of NPSLE, occurring in 4–85% of these patients. Several diagnostic tools, such as Hospital Anxiety and Depression Scale (HADS), have been used to assess anxiety in clinical studies in SLE, but there is a lack of data on the performance of these questionnaires in the disease. This study aimed to assess the performance of HADS for the detection of anxiety in male and female patients with SLE, also investigating possible gender differences in this aspect. This study included 54 male SLE patients and 54 female SLE patients. The Diagnostic Criteria for Generalized Anxiety Disorder of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders was used as gold-standard method to assess the performance of HADS for detecting anxiety in SLE patients. HADS presented sensitivity of 88.9% and specificity of 92.6%, with positive and negative predictive values of 80.0 and 96.1%, respectively. The HADS accuracy in total sample was 92.6%, with Kappa coefficient equal to 0.5794 (95% CI 0.3894–0.7695). No significant differences were observed between female and male groups regarding the performance of HADS for diagnosing anxiety.


Systemic lupus erythematosus Anxiety Hospital Anxiety and Depression Scale 


Compliance with ethical standards

Conflict of interest

Eduardo de Almeida Macêdo: the author declares that he has no conflict of interest. Simone Appenzeller: the author declares that she has no conflict of interest. Lilian Tereza Lavras Costallat: the author declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of MedicineHospital de Clínicas da Universidade Estadual de Campinas (UNICAMP)-Disciplina de ReumatologiaCampinasBrazil

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