Background: Psychological distress is frequently observed, however, it is underestimated in cancerpatients. The aimof thisstudyisto develop a simple battery for screening for psychological distress, adjustment disorderand majordepressive disorder in Japanese cancer patients. Methods: One hundred and twenty-eight cancer patients were interviewed by psychiatrists and tested using the Hospital Anxiety and Depression Scale (HADS), a 14-item self-assessment questionnaire. Psychiatric diagnoses were performed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition-revised. Results: Cronbach ex values of the Japanese version of the scale were 0.77 for the subscale for anxiety and 0.79 for depression. By a receiver operating characteristic analysis, we determined that an optimal cut-off point for screening for adjustment disorder and major depressive disorder was 10/11, which gave high enough sensitivity and specificity (91.5 and 65.4%, respectively). To screen for major depressive disorder alone, 19/20 was an optimal cut-off point with 82.4% sensitivity and 96.3% specificity. The subscales of HADS(anxiety and depression) also had high screening performance. Conclusions: The Japanese version of HADS is a sensitive and specific tool for screening for psychological distress in Japanese cancer patients. This scalecan be usedfor an earlydetection of patients' psychological distress which may be followed by psychiatric interventions.Key words: screening -anxiety -depression -psycho-oncology
INTRODUCTIONCancer patients must face several stresses, and factors which cause their psychological distress, especially anxiety and depression. Previous reports indicated that the most frequent psychiatric diagnoses of cancer patients were adjustment disorder with anxiety and/or depression and they also suffered from major depressive disorder (1).Although patients with these psychiatric diagnoses need to take specific psychiatric therapies, including medication, they tend to be over-or underdiagnosed by medical staff (2,3). One reason for this tendency is that medical staff, even the family, take it for granted that cancer patients have some psychological distress so that it is not worthwhile taking psychiatric interventions (4), and Received November 6, 1997; accepted February 13, 1998 For reprints and all correspondence: Yosuke Uchitomi, Psycho-Oncology Division, National Cancer Center Research Institute East, 5-1, Kashiwanoha 6-chome, Kashiwa, 277-8577, Japan Abbreviations: HADS, Hospital Anxiety and Depression Scale; SCID, the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, third edition-revised; POMS, the Profile of Mood States; ROC, receiver operating characteristic; GFI, Goodness of Fit Index; PPV, positive predictive value the other is a difficulty in assessing their distress because of the physical symptoms (5,6). However, this psychological distress can disturb the patient's quality of life and affect their choice of treatments for cancer.Some screeni...