The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index.
Validation of the Hospital Anxiety and Depression Scale for use with multiple sclerosis patients
Abstract
Detecting clinically significant symptoms of depression and anxiety in medically ill patients using self-report rating scales presents a challenge because of somatic confounders. The Hospital Anxiety and Depression Scale (HADS) was developed with this in mind, but has never been validated for a multiple sclerosis population. Our objective was to validate the HADS for multiple sclerosis patients. Multiple sclerosis patients were interviewed for the presence of major depression (n = 180) and anxiety disorders (n = 140) with the Structured Clinical Interview for DSM-IV disorders. A receiver operating characteristic (ROC) analysis was undertaken to assess which HADS cut-off scores give the best yield with respect to diagnoses of major depression and all anxiety disorders defined by the Structured Clinical Interview for DSM-IV. A threshold score of 8 or greater on the HADS depression subscale provides a sensitivity of 90% and specificity of 87.3% (ROC area under the curve 0.938). The same cut-off score gives a sensitivity of 88.5% and a specificity of 80.7% on the anxiety subscale (ROC area under the curve 0.913), but for generalized anxiety disorder only. The study confirms the usefulness of the HADS as a marker of major depression and generalized anxiety disorder, but not other anxiety disorders, in multiple sclerosis patients.
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“A cut-off of >7 gives a high sensitivity and specificity for detecting clinically elevated depression and anxiety in pwMS (Honarmand & Feinstein, 2009).”
From Neuropsychology intervention for managing invisible symptoms of MS (NIMIS-MS) group: A pilot effectiveness and acceptability study (2024) · cites this paper as Honarmand & Feinstein, 2009
Citations
Cites
The Hospital Anxiety and Depression Scale
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Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS)
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New diagnostic criteria for multiple sclerosis: Guidelines for research protocols
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Measuring the Functional Impact of Fatigue: Initial Validation of the Fatigue Impact Scale
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Depression and multiple sclerosis
Sadovnick, A. D., Remick, R. A., Allen, J. B., Swartz, E. S., Yee, I. M. L., Eisen, K., Farquhar, R., Hashimoto, S. A., Hooge, J. P., Kastrukoff, L. F., et al. (1996) · Neurology · doi:10.1212/wnl.46.3.628 · Cited by 536
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Cited by
Sorted by citations
The link between multiple sclerosis and depression
Feinstein, A., Magalhaes, S., Richard, J., Audet, B., & Moore, C. S. (2014) · Nature Reviews Neurology · doi:10.1038/nrneurol.2014.139 · Cited by 550
Self-citationRecommendations for cognitive screening and management in multiple sclerosis care
Kalb, R. C., Beier, M. L., Benedict, R. H. B., Charvet, L. E., Costello, K., Feinstein, A., Gingold, J. N., Goverover, Y., Halper, J., Harris, C. J., et al. (2018) · Multiple Sclerosis Journal · doi:10.1177/1352458518803785 · Cited by 413
“therapy) or for relapse recovery; (3) evaluate progression of cognitive impairment; and/or (4)”
BackgroundSelf-citationMultiple sclerosis and depression
Feinstein, A. (2011) · Multiple Sclerosis Journal · doi:10.1177/1352458511417835 · Cited by 337
“Examples of these are the Hospital Anxiety andDepression Scale and the BeckFast Screen for depression in medically ill patients, both of which have been validated for patients with multiple sclerosis.(12,13) Useful as they are for screening purposes and clinical trials, self-report questionnaires cannot generate a dia…”
MethodSelf-citationPrevalence and concurrence of anxiety, depression and fatigue over time in multiple sclerosis
Wood, B., van der Mei, I., Ponsonby, A.-L., Pittas, F., Quinn, S., Dwyer, T., Lucas, R., & Taylor, B. (2013) · Multiple Sclerosis Journal · doi:10.1177/1352458512450351 · Cited by 294
Health-related quality of life in multiple sclerosis
Berrigan, L. I., Fisk, J. D., Patten, S. B., Tremlett, H. L., Wolfson, C. M., Warren, S., Fiest, K. M., McKay, K. A., Marrie, R. A., For the CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS), et al. (2016) · Neurology · doi:10.1212/wnl.0000000000002564 · Cited by 236
“7% for generalized anxiety disorder.(16) Fatigue was operationalized as the continuous total score on the Fatigue Impact Scale for Daily Use, a validated 8-item instrument.”
BackgroundMethodInfluential
Metadata
- Authors
- Honarmand, K., & Feinstein, A.
- Affiliations
- Sunnybrook Health Science Centre (CA)
- Venue
- Multiple Sclerosis Journal
- Publisher
- SAGE Publications
- Published
- 2009-11-13
- Volume
- 15
- Issue
- 12
- Pages
- 1518-1524
- ISSN
- 1352-4585 (ISSN-L)
- 1477-0970
- OpenAlex
- W2114728329
- Cited by
- 436
- References
- 43
- Citations by year
- 2026: 23 · 2025: 32 · 2024: 36 · 2023: 31 · 2022: 34 · 2021: 43 · 2020: 23 · 2019: 27 · 2018: 34 · 2017: 26 · 2016: 32 · 2015: 26 · 2014: 23 · 2013: 12 · 2012: 15
- FWCI
- 14.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Multiple Sclerosis Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Multiple Sclerosis Society
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- Hospital Anxiety and Depression Scale, multiple sclerosis, depression, anxiety disorders, generalized anxiety disorder, psychometric validation, cut-off values, sensitivity and specificity, self-report scale
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Multiple Sclerosis, Predictive Value of Tests, Psychiatric Status Rating Scales, Surveys and Questionnaires, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Reproducibility of Results, Logistic Models, Young Adult
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