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The Hospital Anxiety and Depression Scale: low sensitivity for depression screening in demented and non-demented hospitalized elderly

Published online by Cambridge University Press:  13 September 2012

Nikolaos Samaras ,
François R. Herrmann ,
Dimitrios Samaras ,
Pierre-Olivier Lang ,
Alessandra Canuto ,
Alexandre Forster ,
Henriette Hilleret  and
Gabriel Gold
Nikolaos Samaras*
Affiliation:
Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
François R. Herrmann
Affiliation:
Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
Dimitrios Samaras
Affiliation:
Department of Medical Specialties, Clinical Nutrition, Geneva University Hospitals, Geneva, Switzerland
Pierre-Olivier Lang
Affiliation:
Nescens Center of Preventive Medicine, Clinic of Genolier, Genolier, Switzerland Translational Medicine Research Group, Cranfield Health, Cranfield University, Cranfield, UK
Alessandra Canuto
Affiliation:
Service of Psychiatry of Liaison and Crisis Intervention, Geneva University Hospitals and Faculty of Medicine of the University of Geneva, Geneva, Switzerland
Alexandre Forster
Affiliation:
Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
Henriette Hilleret
Affiliation:
Service of Psychiatry of Liaison and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
Gabriel Gold
Affiliation:
Department of Internal Medicine Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine of the University of Geneva, Geneva, Switzerland
*
Correspondence should be addressed to: Nikolaos Samaras, MD, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland. Chemin du Pont-Bochet 3, 1226 Thônex, Switzerland. Phone: +41795538309; Fax: +41223056115. Email: [email protected].
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Abstract

Background: We currently use the depression subscale (HADD) of the Hospital Anxiety and Depression Scale (HADS) for depression screening in elderly inpatients. Given recent concerns about the performance of the HADD in this age group, we performed a quality-control study retrospectively comparing HADD with the diagnosis of depression by a psychiatrist. We also studied the effect of dementia on the scale's performance.

Methods: HADS produces two 7-item subscales assessing depression or anxiety. The HADD was administered by a neuropsychologist. As “gold standard” we considered the psychiatrist's diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Patients older than 65 years, assessed by both the HADD and the psychiatrist, with a clinical dementia rating (CDR) score lower than 3, were included. The effect of dementia was assessed by forming three groups according to the CDR score (CDR0–0.5, CDR1, and CDR2). Simple and multiple logistic regression models were applied to predict the psychiatrist's depression diagnosis from HADD scores. Areas under the receiver operating characteristics curve (AUC) were plotted and compared by χ2 tests.

Results: On both univariate and multiple analyses, HADD predicted depression diagnosis but performed poorly (univariate: p = 0.009, AUC = 0.60 (95% confidence interval (CI) = 0.53–0.66); multiple: p = 0.007, AUC = 0.65 (95% CI = 0.58–0.71)), regardless of cognitive status. Because mood could have changed between the two assessments (they occurred at different points of the hospital stay), the multiple analyses were repeated after limiting time interval at 28, 21, and 14 days. No major improvements were noted.

Conclusion: The HADD performed poorly in elderly inpatients regardless of cognitive status. It cannot be recommended in this population for depression screening without further study.

Keywords

depressiondementiaelderlyhospitalizedscale
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 1 , January 2013 , pp. 82 - 87
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Aalten, P., de Vugt, M. E., Jaspers, N., Jolles, J. and Verhey, F. R. (2005). The course of neuropsychiatric symptoms in dementia. Part I: findings from the two-year longitudinal Maasbed study. International Journal of Geriatric Psychiatry, 20, 523–530. doi:10.1002/gps.1316.CrossRefGoogle ScholarPubMed
Aben, I., Verhey, F., Lousberg, R., Lodder, J. and Honig, A. (2002). Validity of the beck depression inventory, hospital anxiety and depression scale, SCL-90, and Hamilton depression rating scale as screening instruments for depression in stroke patients. Psychosomatics, 43, 386–393. doi:10.1176/appi.psy.43.5.386.CrossRefGoogle ScholarPubMed
Bambauer, K. Z., Locke, S. E., Aupont, O., Mullan, M. G. and McLaughlin, T. J. (2005). Using the Hospital Anxiety and Depression Scale to screen for depression in cardiac patients. General Hospital Psychiatry, 27, 275–284. doi:10.1016/j.genhosppsych.2005.03.002.CrossRefGoogle ScholarPubMed
Beekman, A. T., Copeland, J. R. and Prince, M. J. (1999). Review of community prevalence of depression in later life. British Journal of Psychiatry, 174, 307–311. doi:10.1192/bjp.174.4.307.CrossRefGoogle ScholarPubMed
Bjelland, I., Dahl, A. A., Haug, T. T. and Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research, 52, 69–77. doi:10.1016/S0022-3999(01)00296-3.CrossRefGoogle ScholarPubMed
Burgut, F. T., Benaur, M. and Hencliffe, C. (2006). Late-life depression: a neuropsychiatric approach. Expert Review of Neurotherapeutics, 6, 65–72. doi:10.1586/14737175.6.1.65.CrossRefGoogle ScholarPubMed
Caci, H., Bayle, F. J., Mattei, V., Dossios, C., Robert, P. and Boyer, P. (2003). How does the Hospital and Anxiety and Depression Scale measure anxiety and depression in healthy subjects Psychiatry Research, 118, 89–99. doi:10.1016/S0165-1781(03)00044-1.CrossRefGoogle ScholarPubMed
Dunbar, M., Ford, G., Hunt, K. and Der, G. (2000). A confirmatory factor analysis of the Hospital Anxiety and Depression scale: comparing empirically and theoretically derived structures. British Journal of Clinical Psychology, 39, 79–94. doi:10.1348/014466500163121.CrossRefGoogle ScholarPubMed
Helvik, A. S., Engedal, K., Skancke, R. H. and Selbæk, G. (2011). A psychometric evaluation of the Hospital Anxiety and Depression Scale for the medically hospitalized elderly. Nordic Journal of Psychiatry, 65, 338–344. doi:10.3109/08039488.2011.560684.CrossRefGoogle ScholarPubMed
Herrero, M. J., Blanch, J., Peri, J. M., De Pablo, J., Pintor, L. and Bulbena, A. (2003). A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. General Hospital Psychiatry, 25, 277–283. doi:10.1016/S0163-8343(03)00043-4.CrossRefGoogle Scholar
Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression scale – a review of validation data and clinical results. Journal of Psychosomatic Research, 42, 17–41. doi:10.1016/S0022-3999(96)00216-4.CrossRefGoogle Scholar
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572. doi:10.1192/bjp.140.6.566.CrossRefGoogle ScholarPubMed
Johnston, M., Pollard, B. and Hennessey, P. (2000). Construct validation of the hospital anxiety and depression scale with clinical populations. Journal of Psychosomatic Research, 48, 579–584. doi:10.1016/S0022-3999(00)00102-1.CrossRefGoogle ScholarPubMed
Lang, P. O.et al. (2010). Potentially inappropriate prescribing including under-use amongst older patients with cognitive or psychiatric co-morbidities. Age and Ageing, 39, 373–381. doi:10.1093/ageing/afq031.CrossRefGoogle ScholarPubMed
Leontjevas, R., van Hooren, S. and Mulders, A. (2009). The Montgomery–Asberg Depression Rating Scale and the Cornell Scale for Depression in Dementia: a validation study with patients exhibiting early-onset dementia. American Journal of Geriatric Psychiatry, 17, 56–64. doi:10.1097/JGP.0b013e31818b4111.CrossRefGoogle ScholarPubMed
Lowe, B.et al. (2004). Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. Journal of Affective Disorders, 78, 131–140. doi:10.1016/S0165-0327(02)00237-9.CrossRefGoogle ScholarPubMed
Lyketsos, C. G.et al. (2003). Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Archives of General Psychiatry, 60, 737–746. doi:10.1001/archpsyc.60.7.737.CrossRefGoogle ScholarPubMed
Moretti, R., Torre, P., Antonello, R. M. and Cazzato, G. (2006). Behavioral alterations and vascular dementia. Neurologist, 12, 43–47. doi:10.1097/01.nrl.0000186806.54314.e8.CrossRefGoogle ScholarPubMed
Poole, N. A. and Morgan, J. F. (2006). Validity and reliability of the Hospital Anxiety and Depression Scale in a hypertrophic cardiomyopathy clinic: the HADS in a cardiomyopathy population. General Hospital Psychiatry, 28, 55–58. doi:10.1016/j.genhosppsych.2005.08.004.CrossRefGoogle Scholar
Rodgers, J., Martin, C. R., Morse, R. C., Kendell, K. and Verrill, M. (2005). An investigation into the psychometric properties of the Hospital Anxiety and Depression scale in patients with breast cancer. Health and Quality of Life Outcomes, 3, 41. doi: 10.1186/1477-7525-3-41.CrossRefGoogle ScholarPubMed
Samaras, N., Rossi, G., Giannakopoulos, P. and Gold, G. (2010). Vascular depression. An age-related mood disorder. European Geriatric Medicine, 1, 220–225. doi:10.1016/j.eurger.2010.05.006.CrossRefGoogle Scholar
Starkstein, S. E. and Mizrahi, R. (2006). Depression in Alzheimer's disease. Expert Review of Neurotherapeutics, 6, 887–895. doi:10.1586/14737175.6.6.887.CrossRefGoogle ScholarPubMed
Thomas, B. C.et al. (2005). Reliability and validity of the Malayalam Hospital Anxiety and Depression Scale (HADS) in cancer patients. Indian Journal of Medical Research, 122, 395–399.Google ScholarPubMed
Wang, W., Lopez, V. and Martin, C. R. (2006). Structural ambiguity of the Chinese version of the Hospital Anxiety and Depression scale in patients with coronary heart disease. Health and Quality of Life Outcomes, 4, 6. doi:10.1186/1477-7525-4-6.CrossRefGoogle ScholarPubMed
Zigmond, A. S. and Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370. doi:10.1111/j.1600-0447.1983.tb09716.x.CrossRefGoogle ScholarPubMed
Zubenko, G. S.et al. (2003). A collaborative study of the emergence and clinical features of the major depressive syndrome of Alzheimer's disease. American Journal of Psychiatry, 160, 857–866. doi:10.1176/appi.ajp.160.5.857.CrossRefGoogle ScholarPubMed