title: Accuracy of the Hospital Anxiety and Depression Scale for identifying depression in chronic obstructive pulmonary disease patients.
abstract: Psychological morbidity is common in chronic respiratory diseases. The diagnostic accuracy of the Hospital Anxiety and Depression Scale (HADS) and risk factors for comorbid depression in chronic obstructive pulmonary disease (COPD) are addressed. Consecutive COPD patients (GOLD stage I-IV, 40-75 years old) were enrolled in a multicentre, cross-sectional cohort study. Diagnosis of depression was ascertained through clinical records. Lung function, HADS score, 6-minute walking test (6-MWT), MRC dyspnoea score, and COPD Assessment Test (CAT) were evaluated. Two hundred fifty-nine COPD patients (mean age 62.5 years; 32% female; mean FEV1 48% predicted) were included. Patients diagnosed with depression (29/259; 11.2%) had significantly higher HADS-D and HADS-Total scores than nondepressed patients (median (quartiles) HADS-D 6 [4; 9] versus 4 [2; 7], median HADS-Total 14 [10; 20] versus 8 [5; 14]). Receiver-operating characteristic plots showed moderate accuracy for HADS-D, AUC 0.662 (95%CI 0.601-0.719), and HADS-Total, AUC 0.681 (95%CI 0.620-0.737), with optimal cut-off scores of >5 and >9, respectively. Sensitivity and specificity were 62.1% and 62.6% for HADS-D compared to 75.9% and 55.2% for HADS-Total. Age, comorbidities, sex, and lower airflow limitation predicted depression. The HADS exhibits low diagnostic accuracy for depression in COPD patients. Younger men with comorbidities are at increased risk for depression.
authors.affiliation: Division of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland ; Medical Sciences Department, Uppsala University, 75237 Uppsala, Sweden.
authors.forename: Christoph
authors.initials: C
authors.lastname: Nowak
authors.affiliation: Division of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.
authors.forename: Noriane A
authors.initials: NA
authors.lastname: Sievi
authors.affiliation: Division of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Clarenbach
authors.affiliation: Division of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.
authors.forename: Esther Irene
authors.initials: EI
authors.lastname: Schwarz
authors.affiliation: Division of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlatzer
authors.affiliation: Division of Pulmonology, Cantonal Hospital of Glarus, 8750 Glarus, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brack
authors.affiliation: Division of Pulmonology, Cantonal Hospital of St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Brutsche
authors.affiliation: Division of Pulmonology, Clinical Barmelweid, 5017 Barmelweid, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Frey
authors.affiliation: Division of Pulmonology, Cantonal Hospital of Aarau, 5000 Aarau, Switzerland.
authors.forename: Sarosh
authors.initials: S
authors.lastname: Irani
authors.affiliation: University Clinic of Internal Medicine, Cantonal Hospital Baselland and University of Basel, 4031 Basel, Switzerland.
authors.forename: Jörg D
authors.initials: JD
authors.lastname: Leuppi
authors.affiliation: Division of Pulmonology, Cantonal Hospital of St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Jochen
authors.initials: J
authors.lastname: Rüdiger
authors.affiliation: Division of Pulmonology, Cantonal Hospital of Münsterlingen, 8596 Münsterlingen, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Thurnheer
authors.affiliation: Division of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Kohler
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000523:psychology*; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D012720:Severity of Illness Index