title: Discriminant validity of the Hospital Anxiety and Depression Scale, Beck Depression Inventory (II) and Beck Anxiety Inventory to confirmed clinical diagnosis of depression and anxiety in patients with chronic obstructive pulmonary disease.
abstract: The objective of this study was to investigate the discriminant validity of commonly used depression and anxiety screening tools in order to determine the most suitable tool for patients with chronic obstructive pulmonary disease (COPD). COPD patients (n = 56) completed the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). These scores were compared to confirmed clinical diagnoses of depression and anxiety using the Mini Neuropsychiatric Interview. HADS depression subscale (HADS-D) sensitivity/specificity was 78/81%; BDI-II 89/77%; HADS anxiety subscale (HADS-A) 71/81%; and BAI 89/62%. HADS-D sensitivity/specificity was improved (100/83%) with the removal of Q4 'I feel as if I am slowed down' and adjusted cut-off (≥5). Removal of BDI-II Q21 'Loss of interest in sex' with adjusted cut-off ≥12 resulted in similar improvement (100/79%). No problematic items were identified for HADS-A or BAI. Previously reported low sensitivity/specificity of the HADS for COPD patients was not replicated. Furthermore, simple modifications of the HADS-D markedly improved sensitivity/specificity for depression.BDI-II, HADS-A and BAI produced acceptable sensitivity/specificity unmodified. Pending further research for COPD patients we recommend continued use of the HADS-A with standard cut-off (≥8) and removal of Q4 of the HADS-D with lower cut-off ≥5.
authors.affiliation: School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia t.phan@ecu.edu.au.
authors.forename: Tina
authors.initials: T
authors.lastname: Phan
authors.affiliation: Office of the Deputy Vice-Chancellor (Strategic Partnerships), Edith Cowan University, Joondalup, Western Australia, Australia.
authors.forename: Owen
authors.initials: O
authors.lastname: Carter
authors.affiliation: School of Arts and Humanities, Edith Cowan University, Joondalup, Western Australia, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Adams
authors.affiliation: Royal Perth Hospital and School of Medicine and Pharmacology, The University of Western Australia, Royal Perth Hospital, Perth, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Waterer
authors.affiliation: Respiratory Medicine, Fiona Stanley Hospital, Palmyra DC, Western Australia, Australia.
authors.forename: Li Ping
authors.initials: LP
authors.lastname: Chung
authors.affiliation: Clinical Psychology, Clear Health Partners, Perth, Australia.
authors.forename: Maxine
authors.initials: M
authors.lastname: Hawkins
authors.affiliation: Office of the Deputy Vice-Chancellor (Strategic Partnerships), Edith Cowan University, Joondalup, Western Australia, Australia.
authors.forename: Cobie
authors.initials: C
authors.lastname: Rudd
authors.affiliation: School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Mel
authors.initials: M
authors.lastname: Ziman
authors.affiliation: Office of the Deputy Vice-Chancellor (Strategic Partnerships), Edith Cowan University, Joondalup, Western Australia, Australia School of Paediatrics and Child Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Strobel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000523:psychology; D012372:ROC Curve; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Chronic obstructive pulmonary disease (COPD); anxiety; depression; screening tools; validity