title: The Hospital Anxiety and Depression Scale: low sensitivity for depression screening in demented and non-demented hospitalized elderly.
abstract: BACKGROUND
  We currently use the depression subscale (HADD) of the Hospital Anxiety and Depression Scale (HADS) for depression screening in elderly inpatients. Given recent concerns about the performance of the HADD in this age group, we performed a quality-control study retrospectively comparing HADD with the diagnosis of depression by a psychiatrist. We also studied the effect of dementia on the scale's performance.
  
  
  METHODS
  HADS produces two 7-item subscales assessing depression or anxiety. The HADD was administered by a neuropsychologist. As "gold standard" we considered the psychiatrist's diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Patients older than 65 years, assessed by both the HADD and the psychiatrist, with a clinical dementia rating (CDR) score lower than 3, were included. The effect of dementia was assessed by forming three groups according to the CDR score (CDR0-0.5, CDR1, and CDR2). Simple and multiple logistic regression models were applied to predict the psychiatrist's depression diagnosis from HADD scores. Areas under the receiver operating characteristics curve (AUC) were plotted and compared by χ(2) tests.
  
  
  RESULTS
  On both univariate and multiple analyses, HADD predicted depression diagnosis but performed poorly (univariate: p = 0.009, AUC = 0.60 (95% confidence interval (CI) = 0.53-0.66); multiple: p = 0.007, AUC = 0.65 (95% CI = 0.58-0.71)), regardless of cognitive status. Because mood could have changed between the two assessments (they occurred at different points of the hospital stay), the multiple analyses were repeated after limiting time interval at 28, 21, and 14 days. No major improvements were noted.
  
  
  CONCLUSIONS
  The HADD performed poorly in elderly inpatients regardless of cognitive status. It cannot be recommended in this population for depression screening without further study.
authors.affiliation: Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland. nikolassamaras@hotmail.com
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Samaras
authors.forename: François R
authors.initials: FR
authors.lastname: Herrmann
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Samaras
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Lang
authors.forename: Alessandra
authors.initials: A
authors.lastname: Canuto
authors.forename: Alexandre
authors.initials: A
authors.lastname: Forster
authors.forename: Henriette
authors.initials: H
authors.lastname: Hilleret
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gold
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology; D003704:Dementia / Q000523:psychology*; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012680:Sensitivity and Specificity