This is a 15min talk as part of IPOS psycho-oncology conference 2009, Vienna Austria. Subject is a meta-analysis of the Hospital Anxiety and Depression scale in cancer settings

1. IPOS2009 – Talks 27:1
IPOS2009 – Talks 27:1
How Accurate is the HADS as a Screen for
How Accurate is the HADS as a Screen for
Emotional Complications of Cancer?
Emotional Complications of Cancer?
A Meta-analysis against Robust Psychiatric Interviews
A Meta-analysis against Robust Psychiatric Interviews
Alex Mitchell alex.mitchell@leicspart.nhs.uk
Leicester Royal Infirmary UK
Individual Lecture 2; 24 June 2009: 3.30pm-4.30pm; Session 27 Lecture Nr.1

2. Background
Background

3. Methods to Evaluate Depression
Unassisted Clinician Conventional Scales
Untrained Trained Short (5-10) Long (10+)
Ultra-Short (<5)
Other/Uncertain Other/Uncertain
9% 9%
ICD10/DSMIV ICD10/DSMIV
Other/Uncertain 0% 0%
9%
ICD10/DSMIV Short QQ Short QQ
0% 3% 3%
Short QQ
3%
1,2 or 3 Sim ple 1,2 or 3 Sim ple
QQ QQ
15% 15%
1,2 or 3 Simple
QQ
15% Clinical Skills Clinical Skills
Alone Alone
73% 73%
Clinical Skills
Alone
73%
Verbal Questions Visual-Analogue Test
PHQ2 Distress Thermometer
WHO-5 Depression Thermometer
Whooley/NICE
=> Table scales

5. [handout 3]
=> accuracy

7. HADs Limitations
HADs Limitations

8. HADS Validity vs Structured Interview
METHODS Against depression
9x studies of the HADS-D
5x of the HADS-T
2x of the HADS-A were identified.
Studies reported results at almost all possible cut-points
with little consistency of approach. Only 8 authors used
an ROC curve to calculate an optimal cut-point.

9. Results vs Affective Disorder
Against affective disorders, there appeared to be
advantage for the HADS-D and a relatively poor
performance for the HADS-A. The HADS-T occupied an
intermediate position. The clinical utility index (UI+,
UI-) was 0.364 and 0.724 for the HADS-D.
Sensitivity Specificity PPV NPV Fraction Correct
HADS-D 60.3% 85.1% 60.3% 85.1% 78.3%
HADS-A 51.2% 77.9% 65.4% 66.2% 65.9%
HADS-T 53.3% 81.6% 59.6% 77.5% 72.6%

10. HADS Validity vs Depression
RESULTS
HADS-T = HADS-D = HADS-A
The clinical utility index (UI+, UI-) was 0.214 and 0.789
for the HADS-D
Sensitivity Specificity PPV NPV FC
HADS-D 51.4% 86.9% 41.6% 90.8% 81.4%
HADS-A 82.4% 81.7% 35.9% 97.4% 81.8%
HADS-T 77.7% 84.3% 44.5% 95.9% 83.4%

11. 1.00
Post-test Probability
0.90
0.80
0.70
0.60
0.50
0.40
HADS-T Positive (N=5)
HADS-T Negative (N=5)
0.30
Baseline Probability
HADS-A Positive (N=2)
HADS-A Negative (N=2)
0.20
HADS-D Positive (N=9)
HADS-D Negative (N=9)
0.10
Pre-test Probability
0.00
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

12. HADs Validity
HADs Validity

13. HADS vs Clinician

14. 1.00
0.90 Post-test Probability
0.80
0.70
0.60
0.50
0.40
Clinician Positive (Fallowfield et al, 2001)
0.30
Clinician Negative (Fallowfield et al, 2001)
Baseline Probability
0.20
HADS-D Positive (Mata-analysis)
HADS-D Negative (Meta-analysis)
0.10
Pre-test Probability
0.00
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

15. HADS vs Other Scales
96 studies
13 tools

16. 1.00
Post-test Probability
0.90
0.80
0.70
0.60 HADS+ HADS- Baseline Probability
GDS30+ GDS30- GDS15+
GHQ28+ HDRS+ ZUNG+
GDS15- GHQ28- HDRS-
0.50
ZUNG- PHQ9+ PHQ9-
WHOOLEY2Q+ WHOOLEY2Q- BDI+
BDI- BDI-SF+ BDI-SF-
0.40 CESD+ CESD- 1Q+
1Q- GHQ12+ GHQ12-
0.30
0.20
0.10
Pre-test Probability
0.00
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

17. Poster session 3 (25
June 2009) Poster
category 7 (Methods
and Measurements)
Poster Nr. 20

20. 1.00
0.90
0.80
Ten
0.70 Nine
Eight
0.60 Seven
Six
0.50
Five
Four
0.40
Three
Two
0.30
One
0.20
Zero
0.10
0.00
Distress Anxiety Depression Anger
Thermometer Thermometer Thermometer Thermometer

21. [handout 9]
ET vs DT (n=130)
Of 63% DT low scorers
51% recorded emotional
difficulties on the new Emotion
Thermometers (ET) tool
Out of those with any
emotional complication
93.3% would be recognised
using the AnxT alone
vs 54.4% who would be
recognised using the DT alone.

22. Vs DT DepT
HADS-A
AUC:
DT=0.82
DepT=0.84
AnxT=0.87 AnxT AngT
AngT=0.685

23. Vs DT DepT
HADS-D
AUC:
DT=0.67
DepT=0.75
AnxT=0.62 AnxT AngT
AngT=0.69

24. Credits & Acknowledgments
Elena Baker-Glenn University of Nottingham
Paul Symonds Leicester Royal Infirmary
Chris Coggan Leicester General Hospital
Burt Park University of Nottingham
Lorraine Granger Leicester Royal Infirmary
Mark Zimmerman Brown University, Rhode Island
Brett Thombs McGill University Canada
James Coyne University of Pennsylvania
Nick Meader National Collaborative Centre MH
For more information www.psycho-oncology.info