Cited by 394Cancer survivorship and careAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

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Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: A meta-analysis

Mitchell, Alex J., Meader, Nick, Symonds, Paul·2010·Journal of Affective Disorders

DOI 10.1016/j.jad.2010.01.067

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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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Authors: Mitchell, A. J., Meader, N., & Symonds, P.
Affiliations: University of Leicester (GB)
University College London (GB)
Corresponding author: Mitchell, Alex J.
ORCID: Mitchell, Alex J.
Meader, Nick
Symonds, Paul
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2010-11
Volume: 126
Issue: 3
Pages: 335-348
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/j.jad.2010.01.067
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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
Health Sciences › Medicine › Psychiatry and Mental health › 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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Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: A meta-analysis

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