title: The Hospital Anxiety and Depression Scale: a diagnostic meta-analysis of case-finding ability.
abstract: OBJECTIVE
  To quantify the accuracy of the Hospital Anxiety and Depression Scale (HADS) as a case-finding instrument for anxiety and depressive disorders.
  
  
  METHODS
  MEDLINE, PSYCHINFO, EMBASE, CINAHL, BNI, and AMED were searched from January 1983 to June 2006. Studies were included that administered the HADS, used a standardized psychiatric interview to establish a diagnosis of anxiety or depression, and provided sufficient data on sensitivity and specificity (N=41). Summary sensitivity, specificity, likelihood ratios, and diagnostic odds ratios were calculated for each study. Random effects meta-analytic pooling across studies at the recommended clinical (7/8) and research (10/11) cutoff points was undertaken and summary receiver operating characteristic curves constructed.
  
  
  RESULTS
  For major depressive disorders, a cut point of ≥8 gave a sensitivity of 0.82 (95% CI, 0.73-0.89) and a specificity of 0.74 (95% CI, 0.60-0.84) and a cut point ≥11 gave a sensitivity of 0.56 (95% CI, 0.40-0.71) and a specificity of 0.92 (95% CI, 0.79-0.97).
  
  
  CONCLUSIONS
  Many studies have shown that the HADS is a useful screening tool to identify emotional distress in nonpsychiatric patients. However, it does not appear to be superior to other screening instruments in terms of identifying specific mental disorders in physical health settings.
authors.affiliation: Institute of Health Sciences, University of Leeds, UK. c.a.brennan@leeds.ac.uk
authors.forename: Cathy
authors.initials: C
authors.lastname: Brennan
authors.forename: Anne
authors.initials: A
authors.lastname: Worrall-Davies
authors.forename: Dean
authors.initials: D
authors.lastname: McMillan
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.forename: Allan
authors.initials: A
authors.lastname: House
mesh_terms: D001007:Anxiety / Q000175:diagnosis*; D001008:Anxiety Disorders / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis*; D006801:Humans; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity