title: Identification of Distress in Oncology Patients: A Comparison of the Hospital Anxiety and Depression Scale and a Thorough Clinical Assessment.
abstract: BACKGROUND
  Screening is recommended to identify cancer patients with distress, anxiety, and depression. The ability of current methods to identify distress in oncology patients is of high importance.
  
  
  OBJECTIVE
  We compared the Hospital Anxiety and Depression Scale (HADS) with a thorough clinical assessment. Furthermore, we explored the agreement of HADS with clinical assessment outcomes as a function of age, sex, and treatment intention.
  
  
  METHODS
  One hundred forty-six oncology patients, representing both sexes, different ages (<65/≥ 65 years), and treatment intention (curative/palliative), completed the HADS before the clinical assessment. Two study team members (blind to the HADS results) completed clinical assessments of anxiety, depression, and distress analogous to categories used in the HADS.
  
  
  RESULTS
  The HADS identified 49 participants and the clinical assessment 71 participants as having anxiety, depression, or distress. The overall agreement between the HADS and the clinical assessment was moderate. The greatest differences were found to be a function of participant sex and age. Agreement between the methods was better for females than for males in relation to distress and anxiety and better for the older (≥ 65 years) than younger participants in relation to depression. By treatment intention, agreement was equal for all domains.
  
  
  CONCLUSIONS
  Especially male and young participants appear to have potential problems that the HADS fails to identify.
  
  
  CONCLUSIONS
  When the HADS is used for screening, nurses must be aware of psychosocial problems perceived by patients that are not covered by the HADS. Many patients identified as having distress have resources to manage problems without additional support.
authors.affiliation: Author Affiliations: Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology (Drs Thalén-Lindström, Glimelius, and Johansson) and Neurosciences (Dr Thalén-Lindström), Uppsala University, Sweden.
authors.forename: Annika M
authors.initials: AM
authors.lastname: Thalén-Lindström
authors.forename: Bengt G
authors.initials: BG
authors.lastname: Glimelius
authors.forename: Birgitta B
authors.initials: BB
authors.lastname: Johansson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D009730:Nursing Assessment; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D013315:Stress, Psychological / Q000175:diagnosis*; D055815:Young Adult