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Hospital Anxiety and Depression Scale (HADS) accuracy in cancer patients

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Abstract

Purpose

The Hospital Anxiety and Depression Scale (HADS) is a self-report questionnaire designed to screen anxious and depressive states in patients in non-psychiatric settings. In spite of its large use, no agreement exists in literature on HADS accuracy in case finding. The present research addresses the issue of HADS accuracy in cancer patients, comparing its two subscales (HADS-A and HADS-D) against tools not in use in psychiatry, which are able to detect prolonged negative emotional states.

Methods

2121 consecutive adult cancer inpatients were administered the HADS together with the State Anxiety subscale of State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Scale on Depression. Receiver operating characteristic (ROC) curves were computed to identify a cut-off for anxious and depressive states in cancer patients. All indicators were computed together with their corresponding 95% confidence interval (95% CI).

Results

Data of 1628 and 1035 participants were used to assess the accuracy in case finding of HADS-A and HADS-D, respectively. According to the ROC analysis, the optimal cut-off was > 9 units for the HADS-A and > 7 units for the HADS-D. The area under the ROC curve was 0.90 for HADS-A (95% CI 0.88–0.91) and 0.84 for HADS-D (95% CI 0.81–0.86).

Conclusions

This study suggested that risk scores of anxious and depressive states above specific HADS cut-offs are useful in identifying anxious and depressive states in cancer patients, and they may thus be applicable in clinical practice.

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Acknowledgments

The authors wish to thank Ms. Luigina Mei for her editorial assistance.

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Authors and Affiliations

  1. Unit of Oncological Psychology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Via F. Gallini, 2, 33081, Aviano, PN, Italy

    Maria Antonietta Annunziata, Barbara Muzzatti, Cristiana Flaiban, Francesca Bomben, Marika Piccinin, Katiuscia Maria Gipponi, Giulia Mariutti, Sara Busato & Sara Mella

  2. Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy

    Ettore Bidoli

Authors
  1. Maria Antonietta Annunziata
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  2. Barbara Muzzatti
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  4. Cristiana Flaiban
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  5. Francesca Bomben
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  9. Sara Busato
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  10. Sara Mella
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Corresponding author

Correspondence to Maria Antonietta Annunziata.

Ethics declarations

All participants gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of the Centro di Riferimento Oncologico di Aviano (CRO) IRCCS (CRO-2011-27).

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The authors declare that they have no conflict of interest.

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Maria Antonietta Annunziata and Barbara Muzzatti should be considered joint first author.

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Annunziata, M.A., Muzzatti, B., Bidoli, E. et al. Hospital Anxiety and Depression Scale (HADS) accuracy in cancer patients. Support Care Cancer 28, 3921–3926 (2020). https://doi.org/10.1007/s00520-019-05244-8

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  • DOI: https://doi.org/10.1007/s00520-019-05244-8

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