ipos09 - how accurate is the hads as a screen for emotional complications of cancer (june09)
DESCRIPTION
This is a 15min talk as part of IPOS psycho-oncology conference 2009, Vienna Austria. Subject is a meta-analysis of the Hospital Anxiety and Depression scale in cancer settingsTRANSCRIPT
Alex Mitchell [email protected] Royal Infirmary UK
IPOS2009 – Talks 27:1
How Accurate is the HADS as a Screen for Emotional Complications of Cancer?A Meta-analysis against Robust Psychiatric Interviews
IPOS2009 – Talks 27:1
How Accurate is the HADS as a Screen for Emotional Complications of Cancer?A Meta-analysis against Robust Psychiatric Interviews
Individual Lecture 2; 24 June 2009: 3.30pm-4.30pm; Session 27 Lecture Nr.1
BackgroundBackground
1,2 or 3 Simple QQ15%
Clinical Skills Alone73%
ICD10/DSMIV0%
Short QQ3%
Other/Uncertain9%
Methods to Evaluate Depression
Unassisted Clinician Conventional Scales
Verbal Questions Visual-Analogue Test
PHQ2
WHO-5
Whooley/NICE
Distress Thermometer
Depression Thermometer
Ultra-Short (<5)Short (5-10) Long (10+)Untrained Trained
1,2 or 3 Simple QQ15%
Clinical Skills Alone73%
ICD10/DSMIV0%
Short QQ3%
Other/Uncertain9%
1,2 or 3 Simple QQ15%
Clinical Skills Alone73%
ICD10/DSMIV0%
Short QQ3%
Other/Uncertain9%
=> Table scales
=> accuracy
[handout 3]
HADs LimitationsHADs Limitations
HADS Validity vs Structured InterviewHADS Validity vs Structured Interview
METHODS Against depression
9x studies of the HADS-D5x of the HADS-T2x of the HADS-A were identified.
Studies reported results at almost all possible cut-points with little consistency of approach. Only 8 authors used an ROC curve to calculate an optimal cut-point.
Results vs Affective DisorderResults vs Affective DisorderAgainst affective disorders, there appeared to be
advantage for the HADS-D and a relatively poor performance for the HADS-A. The HADS-T occupied an intermediate position. The clinical utility index (UI+, UI-) was 0.364 and 0.724 for the HADS-D.
Sensitivity Specificity PPV NPV Fraction Correct
HADS-D 60.3% 85.1% 60.3% 85.1% 78.3%
HADS-A 51.2% 77.9% 65.4% 66.2% 65.9%
HADS-T 53.3% 81.6% 59.6% 77.5% 72.6%
HADS Validity vs DepressionHADS Validity vs DepressionRESULTSHADS-T = HADS-D = HADS-A
The clinical utility index (UI+, UI-) was 0.214 and 0.789 for the HADS-D
Sensitivity Specificity PPV NPV FCHADS-D 51.4% 86.9% 41.6% 90.8% 81.4% HADS-A 82.4% 81.7% 35.9% 97.4% 81.8%
HADS-T 77.7% 84.3% 44.5% 95.9% 83.4%
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
Pre-test Probability
Pos
t-tes
t Pro
babi
lity
HADS-T Positive (N=5)HADS-T Negative (N=5)Baseline ProbabilityHADS-A Positive (N=2)HADS-A Negative (N=2)HADS-D Positive (N=9)HADS-D Negative (N=9)
HADs ValidityHADs Validity
HADS vs ClinicianHADS vs Clinician
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
Pre-test Probability
Pos
t-tes
t Pro
babi
lity
Clinician Positive (Fallowfield et al, 2001)
Clinician Negative (Fallowfield et al, 2001)
Baseline Probability
HADS-D Positive (Mata-analysis)
HADS-D Negative (Meta-analysis)
HADS vs Other ScalesHADS vs Other Scales96 studies13 tools
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
Pre-test Probability
Post
-test
Pro
babi
lity
HADS+ HADS- Baseline ProbabilityGDS30+ GDS30- GDS15+GHQ28+ HDRS+ ZUNG+GDS15- GHQ28- HDRS-ZUNG- PHQ9+ PHQ9-WHOOLEY2Q+ WHOOLEY2Q- BDI+BDI- BDI-SF+ BDI-SF-CESD+ CESD- 1Q+1Q- GHQ12+ GHQ12-
Poster session 3 (25 June 2009) Poster category 7 (Methods and Measurements) Poster Nr. 20
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
DistressThermometer
AnxietyThermometer
DepressionThermometer
AngerThermometer
TenNineEightSevenSixFiveFourThreeTwoOneZero
ET vs DT (n=130)ET vs DT (n=130)Of 63% DT low scorers
51% recorded emotional difficulties on the new Emotion Thermometers (ET) tool
Out of those with any emotional complication
93.3% would be recognised using the AnxT alonevs 54.4% who would be recognised using the DT alone.
[handout 9]
DT DepTVsHADS-A
AnxT AngT
AUC:DT=0.82DepT=0.84AnxT=0.87AngT=0.685
DT DepTVsHADS-D
AnxT AngT
AUC:DT=0.67DepT=0.75AnxT=0.62AngT=0.69
Credits & Acknowledgments
Elena Baker-Glenn University of NottinghamPaul Symonds Leicester Royal InfirmaryChris Coggan Leicester General HospitalBurt Park University of NottinghamLorraine Granger Leicester Royal InfirmaryMark Zimmerman Brown University, Rhode IslandBrett Thombs McGill University CanadaJames Coyne University of PennsylvaniaNick Meader National Collaborative Centre MH
For more information www.psycho-oncology.info