Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: A meta-analysis
Abstract
Objective To examine the validity of the Hospital Anxiety and Depression Scale (HADS) in the identification of psychiatric complications of cancer, as defined by a robust criterion standard.Methods 50 analyses tested the depression subscale (HADS-D), anxiety subscale (HADS-A) or combined scales (HADS-T) against syndromal (clinical) depression (n=22), syndromal anxiety (n=4) or any mental ill health/distress (n=24), all defined by semi-structured psychiatric interview.Results The HADS and its subscales had both strengths and limitations. Overall it appeared to perform marginally better in non-palliative cancer settings. Specific findings for each subscale were as follows. In the identification of depression the HADS-T, HADS-D and HADS-A had a pooled sensitivity and specificity of 82.0%, 77.0%; 71.6%, 82.6% and 80.5%, 77.8%, respectively. All versions performed poorly in case-finding but well in a screening capacity. For anxiety there were no HADS-D studies. The HADS-T and HADS-A had a pooled sensitivity and specificity of 83.9%, 69.9% and 48.7%, 78.7%. They were poor at case-finding but good as screening instruments. For distress (any mental ill health) the HADS-T, HADS-D and HADS-A had a pooled sensitivity and specificity of 72.8%, 80.6%; 75.7%, 66.3% and 65.7%, 71.3%, respectively. When screening for distress and anxiety the HADS-T was the optimal subscale.Conclusion For the identification of depression, anxiety or distress in cancer settings, the HADS (including subscales) is not recommended as a case-finding instrument but it may, subject to concerns about its length, be a suitable addition to screening programme.
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The Hospital Anxiety and Depression Scale (HADS) is a widely used measure of psychological distress in cancer patients.
“The HADS is a 14-item self-report questionnaire that has been widely used to measure psychological distress in cancer patients [21].”
The HADS is validated and extensively used in the measurement of distress among cancer survivors.
“The HADS is validated and extensively used in the measurement of distress among cancer survivors (Vodermaier et al., 2009; Mitchell et al., 2010).”
Depressive symptoms were measured with the HADS-D, and presence of depression was defined as HADS-D ≥ 11, indicating probable moderate or severe depression.
“Depressive symptoms were measured with the Hospital Anxiety and Depression Scale's (HADS) subscale for depression (HADS-D). 23 Following well-established criteria, the presence of depression was defined as HADS-D ≥ 11, indicating probable moderate or severe depression. 24-26”
From Depressive symptoms predict clinical recurrence of inflammatory bowel disease (2022) · cites this paper as [23]
A HADS-D score of ≥ 11 represents a well-established cut off strongly indicating depression.
“a HADS-D score of ≥ 11 represents a well-established cut off strongly indicating depression, 23-26”
From Depressive symptoms predict clinical recurrence of inflammatory bowel disease (2022) · cites this paper as [23]
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- Authors
- Mitchell, A. J., Meader, N., & Symonds, P.
- Affiliations
- University of Leicester (GB)
- University College London (GB)
- Corresponding author
- Mitchell, Alex J.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2010-11
- Volume
- 126
- Issue
- 3
- Pages
- 335-348
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2108265793
- Cited by
- 394
- References
- 69
- Citations by year
- 2026: 25 · 2025: 17 · 2024: 31 · 2023: 23 · 2022: 33 · 2021: 31 · 2020: 26 · 2019: 26 · 2018: 22 · 2017: 29 · 2016: 28 · 2015: 22 · 2014: 23 · 2013: 12 · 2012: 21
- FWCI
- 1.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- Hospital Anxiety and Depression Scale, diagnostic validity, cancer-related depression, cancer-related anxiety, palliative care, psychiatric distress, screening tool, case finding, sensitivity and specificity, mental health screening
- MeSH terms
- Adjustment Disorders, Anxiety Disorders, Depressive Disorder, Hospitalization, Humans, Interview, Psychological, Mass Screening, Neoplasms, Palliative Care, Psychiatric Status Rating Scales, Psychometrics, Reproducibility of Results
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