title: Pragmatic detection of anxiety and depression in a prospective cohort of voice outpatient clinic attenders.
abstract: OBJECTIVE
  To evaluate diagnostic performance of the emotional domain of the VoiSS questionnaire compared with the Hospital Anxiety and Depression Scale (HADS).
  
  
  METHODS
  Cross-sectional questionnaire study.
  
  
  METHODS
  Tertiary referral centre voice clinic.
  
  
  METHODS
  210 consecutive voice clinic patients.
  
  
  METHODS
  Screening with VoiSS and HADS questionnaires. Paired comparison, correlation, multinomial logistic regression and receiver-operating characteristic (ROC) curve analysis.
  
  
  RESULTS
  A total of 177 returned complete data sets. Ninety-six patients (54.2%) had functional dysphonia, and 81 (45.8%) had organic laryngeal disorders. Mean total VoiSS score = 39.7/120 (standard deviation (sd) 22.2). Mean emotional VoiSS subscale = 7.6/22 (sd 7.5). Mean HADS anxiety = 6.5/21 (sd 5.2) and depression mean = 7.1/21 (sd 4.8). There were 35 (20%) borderline anxiety and/or depression scores and 30 (17%) scores considered positive for 'caseness'. There was strong correlation between emotional VoiSS and HADS anxiety (Spearman's Rho = 0.68, P < 0.001) and HADS depression (Spearman's Rho = 0.62, P < 0.001). ROC curve analysis exhibited significant association between emotional VoiSS and HADS 'caseness' (area under curve = 0.88). In addition, functional dysphonia patients had lower mean VoiSS and HADS scores than patients with identifiable laryngeal abnormalities.
  
  
  CONCLUSIONS
  The VoiSS emotional subscale strongly correlates with HADS anxiety and depression scores and could be used as a measure of psychological distress. This could allow targeted psychological strategies, without additional psychometric questionnaires. Functional dysphonia has less association with psychological distress than certain organic laryngological disorders.
authors.affiliation: Department of Otolaryngology, Head and Neck surgery, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: J
authors.initials: J
authors.lastname: Montgomery
authors.affiliation: Department of Otolaryngology, Head and Neck surgery, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hendry
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Freeman Hospital, University of Newcastle, Newcastle upon Tyne, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Wilson
authors.affiliation: MRC Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK.
authors.forename: I J
authors.initials: IJ
authors.lastname: Deary
authors.affiliation: Department of Otolaryngology, Head and Neck surgery, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: K
authors.initials: K
authors.lastname: MacKenzie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000150:complications*; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications*; D055154:Dysphonia / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000150:complications* / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D011795:Surveys and Questionnaires; D055815:Young Adult