Comparison of the accuracy of the 7-item HADS Depression subscale and 14-item total HADS for screening for major depression: A systematic review and individual participant data meta-analysis

The seven-item Hospital Anxiety and Depression Scale Depression subscale (HADS-D) and the total score of the 14-item HADS (HADS-T) are both used for major depression screening. Compared to the HADS-D, the HADS-T includes anxiety items and requires more time to complete. We compared the screening accuracy of the HADS-D and HADS-T for major depression detection. We conducted an individual participant data meta-analysis and fit bivariate random effects models to assess diagnostic accuracy among participants with both HADS-D and HADS-T scores. We identified optimal cutoffs, estimated sensitivity and specificity with 95% confidence intervals, and compared screening accuracy across paired cutoffs via two-stage and individual-level models. We used a 0.05 equivalence margin to assess equivalency in sensitivity and specificity. 20,700 participants (2,285 major depression cases) from 98 studies were included. Cutoffs of ≥7 for the HADS-D (sensitivity 0.79 [0.75, 0.83], specificity 0.78 [0.75, 0.80]) and ≥15 for the HADS-T (sensitivity 0.79 [0.76, 0.82], specificity 0.81 [0.78, 0.83]) minimized the distance to the top-left corner of the receiver operating characteristic curve. Across all sets of paired cutoffs evaluated, differences of sensitivity between HADS-T and HADS-D ranged from -0.05 to 0.01 (0.00 at paired optimal cutoffs), and differences of specificity were within 0.03 for all cutoffs (0.02-0.03). The pattern was similar among outpatients, although the HADS-T was slightly (not nonequivalently) more specific among inpatients. The accuracy of HADS-T was equivalent to the HADS-D for detecting major depression. In most settings, the shorter HADS-D would be preferred. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis

OBJECTIVES

Validated diagnostic interviews are required to classify depression status and estimate prevalence of disorder, but screening tools are often used instead. We used individual participant data meta-analysis to compare prevalence based on standard Hospital Anxiety and Depression Scale - depression subscale (HADS-D) cutoffs of ≥8 and ≥11 versus Structured Clinical Interview for DSM (SCID) major depression and determined if an alternative HADS-D cutoff could more accurately estimate prevalence.

METHODS

We searched Medline, Medline In-Process & Other Non-Indexed Citations via Ovid, PsycINFO, and Web of Science (inception-July 11, 2016) for studies comparing HADS-D scores to SCID major depression status. Pooled prevalence and pooled differences in prevalence for HADS-D cutoffs versus SCID major depression were estimated.

RESULTS

6005 participants (689 SCID major depression cases) from 41 primary studies were included. Pooled prevalence was 24.5% (95% Confidence Interval (CI): 20.5%, 29.0%) for HADS-D ≥8, 10.7% (95% CI: 8.3%, 13.8%) for HADS-D ≥11, and 11.6% (95% CI: 9.2%, 14.6%) for SCID major depression. HADS-D ≥11 was closest to SCID major depression prevalence, but the 95% prediction interval for the difference that could be expected for HADS-D ≥11 versus SCID in a new study was -21.1% to 19.5%.

CONCLUSIONS

HADS-D ≥8 substantially overestimates depression prevalence. Of all possible cutoff thresholds, HADS-D ≥11 was closest to the SCID, but there was substantial heterogeneity in the difference between HADS-D ≥11 and SCID-based estimates. HADS-D should not be used as a substitute for a validated diagnostic interview.

Exploring bereavement care in inpatient settings

This paper compares the attitudes and practices of health professionals to the provision of family-centred bereavement care in different Australian inpatient settings: palliative care services, acute care and long stay residential aged care settings. Semi-structured interviews (88) were conducted with doctors, nurses, pastoral carers and allied health staff. Comprehensive bereavement care was not being provided or resourced in the acute and aged care hospitals to the same level as that provided in palliative care services. Residential care provided continuity of care and good support for grieving relatives and other residents. A structured bereavement program is needed in all inpatient settings with palliative care patients, along with resource and education support for health professionals.

A preliminary investigation into the emotion self-confidence model of suicidal ideation in adolescents

This study explored implications of the emotion self-confidence model of suicidal ideation (ESC-SI Model; Deeley & Love, 2012 ) in adolescents. Referencing stress-coping principles, the model implies that high levels of negative emotionality coupled with low expectations for coping with, or changing, this experience (low emotion self-confidence) would predispose towards thoughts of suicide. The hypothesis was examined in 136 community adolescents using questionnaire methodology in a cross-sectional, correlational design. Regression analysis showed the model of best fit was a direct-effects (cumulative) model in which negative emotionality and emotion self-confidence each contributed to suicidal ideation through both shared and unique variance. Results supported the ESC-SI Model's validity, though its generalizability will only be confirmed through replication and further empirical research.

Cognitive Existential Couple Therapy for newly diagnosed prostate cancer patients and their partners: a descriptive pilot study

OBJECTIVE

This paper aims to describe 'Cognitive Existential Couple Therapy' (CECT), a novel couples-based intervention for men with early stage prostate cancer (PCa) and their partners, and to report preliminary findings from a pilot study that investigated the acceptability and feasibility of the intervention and the measures to be used in a subsequent randomised controlled trial.

METHODS

A manualised CECT programme was delivered to 12 couples facing a diagnosis of PCa within the previous 12 months by psychiatrists and clinical psychologists. Participants completed measures of psychological distress, marital function and coping pattern before and after CECT. Semi-structured interviews were conducted with nine couples shortly after the completion of CECT.

RESULTS

The application of CECT was both feasible and acceptable as indicated by favourable participant compliance (10 of the 12 couples attended all six designated sessions), completion of measures before and after CECT and participation in semi-structured interviews by nine couples. Preliminary results included reduced levels of avoidance and hyperarousal after the programme, with this effect stronger in partners than in patients. Interviews demonstrated that couples valued the therapist's contribution to their overall care.

CONCLUSIONS

Previous research suggests that a couple-focused psychological intervention is desirable in the context of early stage PCa. This pilot study has established that CECT is acceptable, feasible and valued by couples facing a recent PCa diagnosis and demonstrates a potential for reduced psychological distress following CECT. A randomised controlled trial is currently being undertaken to validate the efficacy of this novel approach.

Predictors of psychosocial distress 12 months after diagnosis with early and advanced prostate cancer

OBJECTIVE

To assess psychosocial distress in patients with early (localised) and advanced (metastatic) prostate cancer (PCA) at diagnosis (Time 1) and 12 months later (Time 2), and identify psychosocial factors predictive of later distress.

DESIGN, PARTICIPANTS AND SETTING

Observational, prospective study of 367 men with early (211) or advanced (156) PCA recruited as consecutive attendees at clinics at seven public hospitals and practices in metropolitan Melbourne between 1 April 2001 and 30 December 2005. Both groups completed questionnaires at Time 1 and Time 2.

MAIN OUTCOME MEASURES

Health-related quality of life as assessed by the Short Form 36-item Health Survey; psychological distress, including depression and anxiety as assessed by the Brief Symptom Inventory; and coping patterns as assessed by the Mini-Mental Adjustment to Cancer scale.

RESULTS

Over the 12 months, both the early and advanced PCA group showed reduced vitality and increased depression and anxiety; this effect was greater in the advanced PCA group. Mental health, social functioning and role-emotional functioning also deteriorated in the advanced group. Predictors of depression at Time 2 for the early PCA group were depression, vitality and a fatalistic coping pattern at Time 1; anxiety at Time 2 was predicted by anxiety and vitality at Time 1. In the advanced PCA group, depression at Time 2 was predicted by depression and mental health at Time 1; anxiety at Time 2 was predicted by anxiety, mental health, cognitive avoidance and lower anxious preoccupation at Time 1.

CONCLUSIONS

Men with early PCA experience decreasing vitality and increasing psychological distress over the 12 months following diagnosis; this trend is accelerated after diagnosis with advanced PCA. A fatalistic coping pattern at diagnosis of early PCA predicts later depression while cognitive avoidance and lower anxious preoccupation at diagnosis of advanced PCA predict later anxiety.

Does asking adolescents about suicidal ideation induce negative mood state?

Two studies examined the potential for negative mood induction through participating in suicidal ideation questionnaire research. Items immediately preceding mood state measures were hypothesized to influence mood state in a negative or positive direction, depending on their emotional content. Study 1 involved 129 adolescents. Mood state decreased nonsignificantly following items on suicidal-type ideation and significantly improved following a series of positive affect items. Study 2 followed up 71 of the original participants 3 years later using a briefer version of the original questionnaire. Here no significant differences in mood state were found at any measurement point. In both studies, the salience of items preceding the mood measure explained a significant proportion of variance in mood state. We concluded that negative mood induction effects were minimal. Ethical implications are discussed.

Psychosocial adaptation in female partners of men with prostate cancer

The objective was to explore the psychosocial adaptation of female partners living with men with a diagnosis of either localized or metastatic prostate cancer. Semi-structured qualitative interviews were conducted with 50 women at two time points (baseline and 6 months later). The interviews examined emotions, experiences, attitudes to sexual and continence issues and treatment decision making. As part of a larger prospective observational study, demographic data and scores for depression and anxiety were collected. Initial analysis demonstrated that the group of 11 women assessed as distressed on the anxiety and depression measures described reduced coping skills and poorer adaptation after 6 months. In contrast, the 39 women in the non-distressed group reported emotional adaptation that fitted the Lazarus and Folkman pattern of coping through appraisal of the impact of the diagnosis on their partner and themselves, appraisal of coping strategies and reappraisal of the situation. A surprise finding was the high level of resilience displayed by majority of these women. Results suggest that a psychosocial intervention could strengthen healthy adaptation and provide better coping skills for distressed couples.

The psychological aftermath of prostate cancer treatment choices: a comparison of depression, anxiety and quality of life outcomes over the 12 months following diagnosis

OBJECTIVE

To assess the psychological impact of the different treatments for localised prostate cancer (PCA).

DESIGN, PARTICIPANTS AND SETTING

Observational, prospective study of consecutive patients with PCA attending clinics in public hospitals and private practices in metropolitan Melbourne between 1 April 2001 and 30 December 2005. Data were collected at initial diagnosis of histologically confirmed localised PCA, and close to the commencement of definitive treatment (Time 1), and 12 months later (Time 2). Patients were stratified according to treatment type (radical prostatectomy [RP], hormone therapy [HT] or other early treatment including radiation therapies [OET]). Patients who elected to undergo active surveillance/watchful waiting (WW) rather than active treatment were treated as a naturalistic control group.

MAIN OUTCOME MEASURES

Levels of depression and anxiety were assessed by the Brief Symptom Inventory, and physical and psychosocial aspects of health-related quality of life (HRQOL) were assessed by the 36-item Short-Form Health Survey.

RESULTS

211 patients with PCA were recruited; 193 completed the Time 1 questionnaires (38 RP, 56 HT, 38 OET and 61 WW); and 172 completed the Time 2 questionnaires (33 RP, 51 HT, 33 OET and 55 WW). At Time 1, the three active treatment groups all reported greater dysfunction in work role and daily activities compared with the WW group. The RP group also reported worse social and emotional role functioning, while the HT and OET groups reported poorer vitality levels. The HT group reported significantly higher depression scores. At Time 2, the RP and OET groups did not differ from the WW group on either HRQOL or psychological status. By contrast, the HT group reported significantly worse HRQOL (physical functioning, role-physical and vitality domains) and greater psychological distress compared with the WW group.

CONCLUSIONS

Compared with the other active treatments for localised PCA, HT appears to be associated with poorer HRQOL and greater psychological distress 12 months after commencing treatment.

Imagery and craving in alcohol dependent persons

There is limited evidence supporting the effectiveness of imagery techniques in exposure-based treatments for alcohol dependence. Changes in craving for alcohol following imagery instruction, measured by cognitive and physiological indices, have not been demonstrated. Furthermore, the influence of different imagery script content has not been investigated. This study compared levels of craving elicited, measured by self-report and salivation, under control and imagery conditions, in subjects receiving treatment for alcohol dependence. Imagery script content was varied across three levels. Participants generally reported forming good quality images with strong affective components. Significant effects of imagery treatment were found for changes in self-reported craving levels, but not for the salivation measure. Significant decay in levels of self-reported craving was also observed. No differences in effectiveness between the three script types were discovered. Implications of the results for therapy approaches such as cue exposure are considered.

Psychosocial adjustment in newly diagnosed prostate cancer

OBJECTIVE

To examine the psychological and social adjustment of men with early or advanced stage prostate cancer and to compare them with a matched group of cancer-free community volunteers.

METHODS

A longitudinal observational study in which 367 men recently diagnosed with early (n=211) or advanced stage (n=156) prostate cancer were compared to 169 cancer-free men from the community, of similar age and residential area, using self-report measures of psychosocial adjustment.

RESULTS

On the mental health subscales of the Short-Form 36-item Health Survey, men with advanced disease had lower vitality and social functioning than the other two groups, and lower mental health scores than the comparison group. Both patient groups had lower role-emotional scores than the comparison group. With regard to the Brief Symptom Inventory, the advanced disease group had higher somatization scores, and lower interpersonal sensitivity and paranoid ideation scores than the early stage group and the community comparison group. In terms of psychiatric morbidity, there were higher rates of anxiety disorders but not depressive disorders in both patient groups although overall diagnosis rates were low. No differences were found in terms of couple or family functioning.

CONCLUSIONS

There is impairment in psychosocial function in men with prostate cancer, particularly those with advanced disease, but no increase in the rate of formal psychiatric disorder or adverse effects on the couples and families. This suggests directions for psychosocial interventions with these patient groups.

Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial

BACKGROUND

Mixed reports exist about the impact of supportive-expressive group therapy (SEGT) on survival.

METHODS

From 485 women with advanced breast cancer recruited between 1996-2002, 227 (47%) consented and were randomized within an average 10 months of cancer recurrence in a 2:1 ratio to intervention with 1 year or more of weekly SEGT plus three classes of relaxation therapy (147 women) or to control receiving three classes of relaxation therapy (80 women). The primary outcome was survival; psychosocial well-being was appraised secondarily. Analysis was by intention-to-treat.

RESULTS

SEGT did not prolong survival (median survival 24.0 months in SEGT and 18.3 in controls; univariate hazard ratio for death 0.92 [95% CI, 0.69-1.26]; multivariate hazard ratio, 1.06 [95% CI, 0.74-1.51]). Significant predictors of survival were treatment with chemotherapy and hormone therapy (p<0.001), visceral metastases (p<0.001) and advanced disease at first diagnosis (p<0.05). SEGT ameliorated and prevented new DSM-IV depressive disorders (p = 0.002), reduced hopeless-helplessness (p = 0.004), trauma symptoms (p = 0.04) and improved social functioning (p = 0.03).

CONCLUSIONS

SEGT did not prolong survival. It improved quality of life, including treatment of and protection against depression.

Relationships Between Stressors, Work Supports, and Burnout Among Cancer Nurses

This pilot study investigated the relationships between stressors, work supports, and burnout among cancer nurses. One hundred and one registered nurses, employed at a major specialist oncology, metropolitan Australian hospital, completed self-report questionnaires measuring these constructs and provided responses to open-ended questions. The 50 listed stressors were experienced as sources of stress by more than 50% of the sample; most work support came from peers, rather than supervisor and organizational supports; and the overall level of burnout for the sample was moderate to low. Significant positive correlations were found between Stressors and the Emotional Exhaustion and Depersonalization subscales of the Maslach Burnout Inventory and a significant weak positive correlation between Peer Support and Personal Accomplishment (intensity). Findings are discussed in relation to developing strategies for reducing stress and burnout among cancer nurses, and directions for further study are suggested.

Screening for depression in women with metastatic breast cancer: a comparison of the Beck Depression Inventory Short Form and the Hospital Anxiety and Depression Scale

OBJECTIVE

To compare two self-report questionnaires for identifying possible depression in women with metastatic breast cancer.

METHOD

We conducted structured psychiatric interviews and administered the Beck Depression Inventory Short Form (BDI-SF) and Hospital Anxiety and Depression Scale (HADS) to 227 women with stage IV breast cancer. The accuracy for identifying DSM-IV-defined major and minor depression was examined. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated and receiver operating characteristic curves plotted.

RESULTS

Seventy-four (32.6%) patients satisfied DSM-IV criteria for a depressive disorder. With a cut-off of 4, the BDI-SF had a sensitivity of 0.84, specificity of 0.63, and PPV of 0.52. A cut-off of 11 on the HADS-Depression scale (HADS-D) resulted in sensitivity, specificity, and PPV of 0.16, 0.97, and 0.75, respectively. For major depression alone, the BDI-SF with a cut-off of 5 had excellent sensitivity but poor PPV; the HADS, with a cut-off of 7, had weak sensitivity and PPV.

CONCLUSIONS

Overall, the two scales perform similarly in identifying major depression, while the BDI-SF is the more useful in screening for DSM-IV major or minor depression categories in this clinical group.

Diagnostic efficiency of the Hospital Anxiety and Depression Scale in women with early stage breast cancer

OBJECTIVE

To investigate the diagnostic efficiency of the Hospital Anxiety and Depression Scale (HADS) inpatients with breast cancer.

METHODS

Women (303) recently diagnosed with stage I or II breast cancer completed the HADS and were psychiatrically assessed. Recommended cut-off scores for Depression (D) and Anxiety(A) Scales identified probable caseness and the accuracy was compared with DSM-IV diagnoses. Cut-off scores were varied to establish optimal accuracy.

RESULTS

One hundred and eleven (36.6%)met criteria for depressive disorders and 25 (8.3%) met criteria for anxiety disorders. At the recommended cut-off score of 11 for the D scale, positive and negative predictive values were.75 and.64, respectively, while sensitivity and specificity were.05 and.99, respectively. For the A scale, positive predictive value(PPV) was.15; negative predictive value (NPV),.90; sensitivity,.08; and specificity,.87. Reducing the cut-off score to 5 produced PPV of.63, NPV of.74, sensitivity of.49 and specificity of .83 for the D scale;.14,.94,.75 and.45, respectively, for the A scale. Composite scores (cut-off of 22) had a PPV of.92, NPV of.57, sensitivity of.09 and specificity of.99.

CONCLUSIONS

Recommended cut-off scores for the HADS may result in under-reporting of psychiatric morbidity among women with early stage breast cancer. These results are consistent with other recent studies of the HADS. The type of constructs measured by the scale is the likely explanation for its limited utility when screening for psychiatric morbidity in early stage breast cancer.

The effect of a moderate dose of alcohol on the traffic hazard perception profile of young drink-drivers

Hazard perception latency has been identified as one source of individual differences in road accidents, but alcohol's effects on hazard perception has not been addressed thoroughly. Furthermore, individuals convicted of driving while impaired (DWI), in comparison with other drink-drivers, have been found to possess a poor driving record, suggesting that they may also respond poorly to hazards. Therefore, this research studied young drivers across the spectrum of drink-driving practices, from non drink-drivers to DWI offenders. It examined alcohol's effects on their hazard perception profile, including aspects of both driving skill (hazard perception latency) and driving style (the perceived level of risk in hazards). Thirty-two subjects aged 18-25 years underwent two experimental conditions in a counterbalanced design: no alcohol and moderate alcohol. Alcohol was found to affect both driving skill and driving style. With a 0.05% BAC subjects took longer to detect hazards and responded to them in a more abrupt manner and these effects were particularly pronounced for DWI offenders. The results also supported a distinction between active hazards (hazards arising from the driver's own actions) and passive hazards (hazards arising from the actions of other road users). Irrespective of their drink-driving practices, subjects perceived active hazards as less dangerous than passive hazards. Furthermore, compared with other drink-drivers, DWI offenders perceived less risk during passive hazards (with a 0.05% BAC) and active hazards (when sober). It is suggested that these effects may underlie, at least in part, the increase in accident risk associated with impaired driving.

The Driving Expectancy Questionnaire: development, psychometric assessment and predictive utility among young drink-drivers

OBJECTIVE

The primary objective of this research was to develop a Driving Expectancy Questionnaire (DEQ) that reflects a model in which a distinction is made between driving skill and driving style. The second objective was to study young drivers across the spectrum of drink-driving practices, from non-drivers to convicted drink-drivers, and to examine the relationship between their expectancies about driving and their drink-driving practices.

METHOD

The data from two separate samples, recruited through availability sampling, were used for the purpose of exploratory (n = 224; 122 men) and confirmatory factor analyses (n = 191; 101 men), respectively.

RESULTS

The results revealed two factors of expectancies, driving skill and driving style, supporting the proposed model. The reliability, internal validity and relative independence of the factors were largely confirmed. Furthermore, criterion-related validity was demonstrated: expectancies about driving varied with drink-driving practices. Expectancies also contributed additional predictive power in relation to drink-driving practices beyond that afforded by several well-validated variables.

CONCLUSIONS

The results are encouraging in terms of the ability of the DEQ to identify individual differences in expectancies about driving skill and driving style that are closely related to variations in drink-driving practices. The practical implications of these findings, as well as the potential research possibilities, are discussed.

Attributional style of depressed chronic low back patients

This study used the Attributional Style Questionnaire to study the attributional styles of depressed and nondepressed chronic low back pain patients (N = 91) in order to test the Revised Learned Helplessness model's prediction of differences between the two. The results partly supported the hypothesis; an internal, stable, global style for negative events distinguished the depressed group from the nondepressed, but there were no differences in attributional style for positive events. The findings are consistent with recent reviews of the literature that have reported general support for the negative outcome style, but consistent failure to confirm the predictions associated with positive outcome style. In addition, the attributional style was not common to all subjects in the depressed group, which suggested that other factors may be involved in the development of different subtypes of depression. Implications for studying attributional aspects of depression and chronic low back pain are discussed.

Depression in chronic low back pain patients: diagnostic efficiency of three self-report questionnaires

Three self-report questionnaires (the Beck Depression Inventory, the MMPI-D scale, and the depression subscale of the Middlesex Hospital Questionnaire) were examined to see how accurately they could identify chronic low back pain patients who were suffering depression, as defined by DSM-III criteria. According to these criteria, 25% of a sample of 68 patients currently were depressed, a rate comparable to those reported by other studies that have used standardized criteria. On the basis of relative conditional probability ratios, the BDI was shown to be the most efficient instrument for identifying these cases and represents an excellent screening device for depression with this population. The individual items of the BDI then were examined, and the conditional probability ratios revealed that several may be helpful as indicators of possible depression among chronic low back pain patients. The relationship between depression and chronic pain is reconsidered in the light of these results.

The MMPI and psychological factors in chronic low back pain: a review

The Minnesota Multiphasic Personality Inventory (MMPI) is widely used in the psychological assessment of patients with chronic low back pain (LBP). Patients' profiles have been used in a number of ways: in attempts to discriminate between cases; as predictors of both medical treatment and pain management program outcomes; and in attempts to assess degree of disability. Studies reviewed here indicate that the concept of psychological etiology of chronic LBP, despite widespread use, has failed to differentiate patients and to reliably predict response to specific treatment. A promising alternative approach has emerged in recent years: profile distinctions between different types of psychological response to chronic LBP. These subgroups are associated with different pain-related behaviors and may show differential response to various treatments, although further work remains to be done to specify the relationships more precisely. Methodological difficulties that continue to appear in the literature are addressed and recommendations for further developments in the use of the MMPI with this patient population are made.