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).

Validation of the emotion thermometers and hospital anxiety and depression scales in Singapore: Screening cancer patients for distress, anxiety and depression.

AIM: To validate the emotion thermometer (ET) and hospital anxiety and depression scales (HADS) in Singapore, screening cancer patients for distress, anxiety and depression. METHODS: Three hundred fifteen cancer patients from National Cancer Centre and Singapore General Hospital participated in the study. Interviews and assessments were conducted in English, assessing patients' sociodemographic data and screening for emotional symptoms using the ET, HADS and Mini-International Neuropsychiatric Interview (MINI) tools. RESULTS: Fifty-three patients (16.83%) fulfilled the MINI criteria for major depressive disorder and 30 patients (12.77%) for generalized anxiety disorder. The ET depression thermometer correlated positively with HADS depression subscale, r = 0.645 (P < 0.01), with area under curve (AUC) value being 0.76, when cutoff score is 3. The ET anxiety thermometer correlated positively with HADS anxiety subscale, r = 0.632 (P < 0.01), with an AUC value of 0.76, when cutoff score is 4. The ET distress thermometer correlated positively with HADS depression subscale, r = 0.506 (P < 0.01), with AUC value being 0.72, when cutoff score is 2, the ET distress thermometer also correlated positively with HADS anxiety subscale, r = 0.652 (P < 0.01), with the AUC value being 0.77, when cutoff score is 4. Using MINI diagnoses for anxiety and depression as the gold standard, cutoff score for HADS depression scale is 7, which yielded an AUC of 0.826. The cutoff score for HADS anxiety scale is 5, yielding an AUC of 0.779. CONCLUSION: Results from the study support the use of both ET and HADS as valid and reliable instruments assessing for distress, anxiety and depression in cancer patients.