title: Use of the hospital anxiety and depression scale as a screening tool for patients with headache.
abstract: BACKGROUND
  The Hospital Anxiety and Depression Scale (HADS) is becoming widely used in medical settings to screen for anxiety or depressive disorders. It has been shown to be a good screening instrument in different ethnic and disease populations. The objective of this study was to evaluate the validity and reliability of HADS in patients with headache at a headache clinic.
  
  
  METHODS
  Consecutive new patients to a headache clinic at the Taipei Veterans General Hospital from September to December, 1998, were recruited in the study. The participants completed the HADS questionnaire and underwent a psychiatric semistructured interview according to the Diagnostic and Statistical Manual (4th revision). The reliability and validity of the HADS were evaluated with respect to headache.
  
  
  RESULTS
  A total of 62 patients (21 men, 41 women) completed the study. The HADS had a good internal consistency when applied to patients suffering from headache, with a Cronbach's alpha coefficient of 0.84 and a split-half reliability of 0.84. Factor analysis in this sample revealed four factors: anxiety, depression, panic and somatic factors. A total of 48 patients (77%) had a psychiatric diagnosis. The frequency of depressive disorders was 57% and anxiety disorders 31%. A total HADS score of 10 or more was the optimal cut-off point for depressive disorders. The sensitivity was 85.7%, and the specificity 33.3%. A total score of at least 13 was the optimal cut-off point for anxiety disorder. The sensitivity was 84.2%, while the specificity was 41.9%.
  
  
  CONCLUSIONS
  Depression and anxiety were quite common among patients with headache in a headache clinic. The HADS can be used as a screening instrument for depressive and anxiety disorders. Because of the low specificity, the HADS should not be used solely as an indicator of psychiatric comorbidity among patients with headache in a headache clinic. This is the first study that verifies the use of the HADS as a psychiatric screening tool in patients with headache by comparing the scores of the HADS with psychiatric diagnoses.
authors.affiliation: Department of Psychiatry, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: K D
authors.initials: KD
authors.lastname: Juang
authors.forename: S J
authors.initials: SJ
authors.lastname: Wang
authors.forename: C H
authors.initials: CH
authors.lastname: Lin
authors.forename: J L
authors.initials: JL
authors.lastname: Fuh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006261:Headache / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity