Background: Anxiety and depression are often found in cardiac patients, but also in the general population. Therefore, evaluation of these symptoms in patients requires a comparison with norm values. The purpose of this study was to explore differences between cardiac patients and the general population in age dependency of anxiety and depression, and to discuss possible reasons for these differences. Methods: A sample of German cardiac patients (n = 2,696) and a sample of the German general population (n = 2,037) were tested using the Hospital Anxiety and Depression Scale (HADS). Results: While we confirmed a linear age trend of anxiety and depression in the general population, we observed an inverted U-shaped age dependency in the patient sample. Young patients are especially affected by anxiety and depression. Five items of the HADS that mainly contributed to the age differences were identified. Formal characteristics of these 5 items could not explain the age differences. Concerning the meaning of the items, however, most of the items refer to worrying about the future. Conclusions: The relatively low rates of anxiety and depression in older patients (compared with the general population) indicate that adaptation processes took place, which should be taken into account in studies concerning the psychological status of patients. Young patients need special attention when dealing with mental distress.

Responsiveness or sensitivity to change of a questionnaire is an important criterion in the assessment of the effect of a medical intervention. In the literature there are several criteria for responsiveness, based on changes in the population mean. Here we present an alternative approach for the measurement of change (change reliability), applying the criteria of internal consistency to change scores. Using the Hospital Anxiety and Depression Scale HADS, these approaches are demonstrated and compared for 2 subject samples, comprising 901 oncologic patients and 2 695 cardiac patients. The effect size d is well suited to assess the effect of an intervention, based on changes of the sample mean. The analyses of the 2 samples yielded effect sizes of about 0.25. The newly created change reliability yielded coefficients of about .70 which indicate the reliability of the individual changes in anxiety and depression.

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