title: Performance of the Hospital Anxiety and Depression Scale as a screening tool for major depressive disorder in cancer patients.
abstract: OBJECTIVE
  (1) To assess the overall performance of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument to identify cases of major depressive disorder (MDD) in mixed cancer outpatients. (2) To determine the sensitivity and specificity of various HADS cut-off scores. (3) To recommend an optimal HADS cut-off score for use in this population.
  
  
  METHODS
  A cross-sectional questionnaire and interview survey of consecutive patients attending outpatient clinics in a regional cancer centre in Edinburgh, Scotland, United Kingdom.
  
  
  RESULTS
  Thirty (8.3%) of 361 patients met criteria for MDD at interview. With the use of the total HADS score to identify these cases of MDD, the area under the receiver operating characteristic curve was 0.94 (95% CI, 0.91-0.97). A cut-off of 14/15 gave a sensitivity of 0.87 (95% CI, 0.70-0.95), a specificity of 0.85 (95% CI, 0.81-0.89), and a positive predictive value of 0.35, and was considered optimal.
  
  
  CONCLUSIONS
  The HADS can be used effectively as an initial screening tool for the detection of MDD in outpatients attending mixed cancer clinics.
authors.affiliation: Psychological Medicine and Symptoms Research Group, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, Scotland, United Kingdom. jane.walker@ed.ac.uk
authors.forename: Jane
authors.initials: J
authors.lastname: Walker
authors.forename: Kirstine
authors.initials: K
authors.lastname: Postma
authors.forename: Gillian S
authors.initials: GS
authors.lastname: McHugh
authors.forename: Robert
authors.initials: R
authors.lastname: Rush
authors.forename: Brian
authors.initials: B
authors.lastname: Coyle
authors.forename: Vanessa
authors.initials: V
authors.lastname: Strong
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012606:Scotland