title: The ineffectiveness of the Hospital Anxiety and Depression Scale for diagnosis in an Omani traumatic brain injured population.
abstract: BACKGROUND
  The rehabilitation of the traumatic brain injury (TBI) patient is especially challenging in non-western populations as the phenotypic indicators as well as the neurobehavioral assessments for the survivors of brain injury are limited.
  
  
  OBJECTIVE
  The study screened for the prevalence of anxiety and depressive states among patients with TBI and examined the validity of the Hospital Anxiety and Depression Scale (HADS) to identify TBI patients with comorbid affective dysfunctions, specifically anxiety and depressive disorders, in an Omani population.
  
  
  METHODS
  Sixty-eight survivors of TBI were screened with the semi-structured, Composite International Diagnostic Interview (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score.
  
  
  RESULTS
  The semi-structured interview revealed the prevalence rate of 57.4% for depressive disorder and 50% for anxiety disorder. The sensitivity (53.8%) and specificity 75.9%, gave the best compromise using the cut-off score of 4, suggesting HADS is not a useful screening tool for this particular population.
  
  
  CONCLUSIONS
  Phenotypic indicators as detected by CIDI revealed that prevalence of affective dysfunctionality is common among this TBI population. Although the HADS is the most widely used screening instrument in other clinical populations, it does not appear to be a reliable resource in identifying depression and anxiety in people with traumatic brain injury in Oman.
authors.affiliation: Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman. adawi@squ.edu.om
authors.forename: Samir
authors.initials: S
authors.lastname: Al-Adawi
authors.forename: Atsu S S
authors.initials: AS
authors.lastname: Dorvlo
authors.forename: Aziz
authors.initials: A
authors.lastname: Al-Naamani
authors.forename: Mel B
authors.initials: MB
authors.lastname: Glenn
authors.forename: Nasser
authors.initials: N
authors.lastname: Karamouz
authors.forename: Heechin
authors.initials: H
authors.lastname: Chae
authors.forename: Ziad A J
authors.initials: ZA
authors.lastname: Zaidan
authors.forename: David T
authors.initials: DT
authors.lastname: Burke
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology; D001930:Brain Injuries / Q000523:psychology*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009850:Oman; D015995:Prevalence; D011581:Psychological Tests; D012372:ROC Curve; D015203:Reproducibility of Results