Screening for psychiatric illness in the palliative care inpatient setting: a comparison between the Hospital Anxiety and Depression Scale and the General Health Questionnaire-12

Abstract

The objective of this study was to compare the performance of the Hospital Anxiety and Depression Scale (HADS) with the 12-item General Health Questionnaire (GHQ-12) as a screening instrument for the detection of psychiatric disorders in a palliative care inpatient setting. The results from the HADS and GHQ were compared to diagnoses generated from a semistructured psychiatric interview (Revised Clinical Interview Schedule) using standard receiver operating characteristic analysis. The study was conducted at the Marie Curie Centre, Edinburgh, a 37-bedded palliative care inpatient facility. Out of a total of 282 admissions during the study period, 79 took part in the study. The remainder of patients either refused (69) or were too unwell to participate (134). The HADS was found to be an effective screening tool for identifying depression, with an area under the receiver operating characteristic curve of 0.92. A suggested cut-off of 20 would have a sensitivity of 0.77, a specificity of 0.85 and a positive predictive value (PPV) of 0.48. There was no significant difference between the two subscales in their ability to detect depressive illnesses, although there was a trend for the anxiety subscale to perform better (P < 0.15). The GHQ did not perform as well as the HADS in this type of population. In view of this, it can be concluded that the HADS is a valid screening tool for psychiatric disorders, particularly depression, in a palliative care setting.

Screening for Depression in Hospitalized Medical Patients

“…Five studies examined instruments that were self-administered by patients [10][11][12][13][14] ; 9 studies assessed instruments administered by nurses, physicians, or research staff members without formal psychiatric training [15][16][17][18][19][20][21][22][23] ; and 6 studies evaluated instruments administered by mental health professionals. [24][25][26][27][28][29] Four studies compared different instruments that were administered in the same manner (eg, both self-administered by patients).…”

Measurement of psychological distress in palliative care

“…The HADS provides separate depression and anxiety subscales, and the anxiety subscale has been used to monitor the course of anxiety symptoms over time, 68 although the full scale may be the most effective in screening for psychological disorders. 69 While the HADS may be superior to other general psychological symptom measures (such as the General Health Questionnaire) in palliative care patients, 70,71 concerns regarding its sensitivity and specificity as a screening tool in palliative care have been raised. 69 Other anxiety measures are available, but have not been developed specifically for use in physically ill populations.…”

Evaluación de la depresión en pacientes con cáncer terminal y su aplicación en el contexto mexicano: Una revisión

“…A finales de la dé-cada de los noventa y principios de este siglo, se realizaron trabajos que validaron el uso del HADS en población paliativa presentando una buena confiabilidad, sensibilidad y especificidad. [31][32][33][34] Posteriormente, se le ha utilizado en diversos estudios como gold standard para validar otro tipo de instrumentos. 15,16,18,25,35 Actualmente su uso es ampliamente difundido para la evaluación de la depresión en el contexto paliativo, sin embargo, una revisión sistemática advierte que dado el poco número de pacientes utilizados para las validaciones del HADS en este contexto, es necesario realizar más estudios para probar contundentemente su uso.…”