title: Comparison of the hospital anxiety and depression scale and the center for epidemiological studies depression scale for detecting depression in women with breast or gynecologic cancer.
abstract: OBJECTIVE
  Depression is common in cancer patients but frequently undetected. Consensus regarding validity and optimal thresholds of screening measures is lacking. We investigated the validity of the Hospital Anxiety and Depression Scale (HADS-D) and Center for Epidemiological Studies Depression Scale (CES-D) relative to a referent diagnostic standard in women with breast or gynecologic cancer.
  
  
  METHODS
  Participants were 100 patients who completed the CES-D and HADS-D within a larger study. The Mini International Neuropsychiatric Interview was the criterion standard. Sensitivity, specificity, predictive values and likelihood ratios for various thresholds were calculated using receiver operating characteristics. Participants were assigned to two diagnostic groups: 'major depressive disorder' or 'any depressive disorder'.
  
  
  RESULTS
  Separate analyses were conducted whereby participants found to be receiving depression/anxiety treatment at the time of validation (n=28) were excluded. Both measures had good internal consistency and criterion validity. There were no statistical differences in global accuracy between the measures for detecting either group. For optimal sensitivity and specificity in both groups, generally recommended thresholds were lowered for the HADS-D. For the CES-D, the threshold was lowered for 'any depressive disorder' and raised for 'major depressive disorder'. Negative predictive values associated with our recommended cutoffs were excellent, but positive predictive values were poor.
  
  
  CONCLUSIONS
  The HADS-D and CES-D have acceptable properties and are equivalent for detecting depression in this population. Depending on the purpose of screening, the CES-D may be more suitable for identifying major depression. Threshold choice may have serious implications for screening program effectiveness, and the use of generally recommended thresholds should be cautious.
authors.affiliation: Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Australia. Electronic address: Lesley.stafford@thewomens.org.au.
authors.forename: Lesley
authors.initials: L
authors.lastname: Stafford
authors.affiliation: Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia; Department of Psychiatry, University of Melbourne, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Judd
authors.affiliation: Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia.
authors.forename: Penny
authors.initials: P
authors.lastname: Gibson
authors.affiliation: Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Komiti
authors.affiliation: Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Oncology and Dysplasia Unit, Royal Women's Hospital, Parkville, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Quinn
authors.affiliation: The Breast Service, Royal Women's and Royal Melbourne Hospitals, Parkville, Australia; Department of Surgery, University of Melbourne, Australia.
authors.forename: G Bruce
authors.initials: GB
authors.lastname: Mann
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology*; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000523:psychology*; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000295:instrumentation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Cancer; Depression; Oncology; Screening; Validity