Lesley Stafford1, Fiona Judd2, Penny Gibson3, Angela Komiti3, Michael Quinn4, G Bruce Mann5. 1. Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Australia. Electronic address: Lesley.stafford@thewomens.org.au. 2. Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia; Department of Psychiatry, University of Melbourne, Australia. 3. Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia. 4. Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Oncology and Dysplasia Unit, Royal Women's Hospital, Parkville, Australia. 5. The Breast Service, Royal Women's and Royal Melbourne Hospitals, Parkville, Australia; Department of Surgery, University of Melbourne, Australia.
Abstract
OBJECTIVE: Depression is common in cancer patients but frequently undetected. Consensus regarding validity and optimal thresholds of screening measures is lacking. We investigated the validity of the Hospital Anxiety and Depression Scale (HADS-D) and Center for Epidemiological Studies Depression Scale (CES-D) relative to a referent diagnostic standard in women with breast or gynecologic cancer. METHOD: Participants were 100 patients who completed the CES-D and HADS-D within a larger study. The Mini International Neuropsychiatric Interview was the criterion standard. Sensitivity, specificity, predictive values and likelihood ratios for various thresholds were calculated using receiver operating characteristics. Participants were assigned to two diagnostic groups: 'major depressive disorder' or 'any depressive disorder'. RESULTS: Separate analyses were conducted whereby participants found to be receiving depression/anxiety treatment at the time of validation (n=28) were excluded. Both measures had good internal consistency and criterion validity. There were no statistical differences in global accuracy between the measures for detecting either group. For optimal sensitivity and specificity in both groups, generally recommended thresholds were lowered for the HADS-D. For the CES-D, the threshold was lowered for 'any depressive disorder' and raised for 'major depressive disorder'. Negative predictive values associated with our recommended cutoffs were excellent, but positive predictive values were poor. CONCLUSIONS: The HADS-D and CES-D have acceptable properties and are equivalent for detecting depression in this population. Depending on the purpose of screening, the CES-D may be more suitable for identifying major depression. Threshold choice may have serious implications for screening program effectiveness, and the use of generally recommended thresholds should be cautious.
OBJECTIVE:Depression is common in cancerpatients but frequently undetected. Consensus regarding validity and optimal thresholds of screening measures is lacking. We investigated the validity of the Hospital Anxiety and Depression Scale (HADS-D) and Center for Epidemiological Studies Depression Scale (CES-D) relative to a referent diagnostic standard in women with breast or gynecologic cancer. METHOD:Participants were 100 patients who completed the CES-D and HADS-D within a larger study. The Mini International Neuropsychiatric Interview was the criterion standard. Sensitivity, specificity, predictive values and likelihood ratios for various thresholds were calculated using receiver operating characteristics. Participants were assigned to two diagnostic groups: 'major depressive disorder' or 'any depressive disorder'. RESULTS: Separate analyses were conducted whereby participants found to be receiving depression/anxiety treatment at the time of validation (n=28) were excluded. Both measures had good internal consistency and criterion validity. There were no statistical differences in global accuracy between the measures for detecting either group. For optimal sensitivity and specificity in both groups, generally recommended thresholds were lowered for the HADS-D. For the CES-D, the threshold was lowered for 'any depressive disorder' and raised for 'major depressive disorder'. Negative predictive values associated with our recommended cutoffs were excellent, but positive predictive values were poor. CONCLUSIONS: The HADS-D and CES-D have acceptable properties and are equivalent for detecting depression in this population. Depending on the purpose of screening, the CES-D may be more suitable for identifying major depression. Threshold choice may have serious implications for screening program effectiveness, and the use of generally recommended thresholds should be cautious.
Authors: Kunal C Kadakia; Kelley M Kidwell; Nicholas J Seewald; Claire F Snyder; Anna Maria Storniolo; Julie L Otte; David A Flockhart; Daniel F Hayes; Vered Stearns; N Lynn Henry Journal: Breast Cancer Res Treat Date: 2017-04-27 Impact factor: 4.872
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Authors: Kunal C Kadakia; Claire F Snyder; Kelley M Kidwell; Nicholas J Seewald; David A Flockhart; Todd C Skaar; Zereunesay Desta; James M Rae; Julie L Otte; Janet S Carpenter; Anna M Storniolo; Daniel F Hayes; Vered Stearns; N Lynn Henry Journal: Oncologist Date: 2016-03-23
Authors: Heidemarie Haller; Petra Voiß; Holger Cramer; Anna Paul; Mattea Reinisch; Sebastian Appelbaum; Gustav Dobos; Georg Sauer; Sherko Kümmel; Thomas Ostermann Journal: BMC Cancer Date: 2021-06-23 Impact factor: 4.430