title: A validity study of the Hospital Anxiety and Depression Scale in general hospital units and a community sample in Nigeria.
abstract: BACKGROUND
  The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depressive disorders in non-psychiatric units (medical & surgical wards; gynaecology & antenatal clinics of a teaching hospital) and a community sample in Nigeria was investigated.
  
  
  METHODS
  A two-stage screening procedure was employed. This involved the use of GHQ-12/GHQ-30 and HADS against the criteria of a standardised (PSE schedule) psychiatric interview, with psychiatric diagnosis assigned in accordance with ICD-9 criteria.
  
  
  RESULTS
  Sensitivity for the anxiety sub-scale ranged from 85.0% in the medical and surgical wards to 92.9% in the ante-natal clinic, while sensitivity for the depression sub-scale ranged from 89.5% in the community sample to 92.1% in the gynaecology clinic. Specificity for the anxiety sub-scale ranged from 86.5% in the gynaecology clinic to 90.6% in the community sample, while specificity for the depression sub-scale ranged from 86.6% in the medical and surgical wards to 91.1% in the ante-natal clinic and community sample. Misclassification rates ranged from 9.9% in the community sample to 13.2% in the medical and surgical wards. Relative Operating Characteristic (ROC) analyses showed the HADS and the GHQ-12 to be quite similar in ability to discriminate between cases (anxiety and depression) and non-cases.
  
  
  CONCLUSIONS
  The HADS is valid for use as a screening instrument in non-psychiatric units and although initially developed for use in hospital settings, it could be usefully employed in community settings of developing countries to screen for mental morbidity.
authors.affiliation: Faculty of Health Sciences, University of Ilorin, Kwara State, Nigeria.
authors.forename: O A
authors.initials: OA
authors.lastname: Abiodun
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003906:Developing Countries; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D009549:Nigeria / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011247:Pregnancy; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D012372:ROC Curve; D015203:Reproducibility of Results; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology