The validity of the Hospital Anxiety and Depression Scale: An updated literature review
TL;DR: HADS was found to perform well in assessing the symptom severity and caseness of anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population.
About: This article is published in Journal of Psychosomatic Research.The article was published on 2002-02-01. It has received 8477 citations till now. The article focuses on the topics: Hospital Anxiety and Depression Scale & Anxiety.
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TL;DR: In this article, a 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity, and increasing scores on the scale were strongly associated with multiple domains of functional impairment.
Abstract: Background Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. Methods A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. Results A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. Conclusion The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
15,911 citations
Journal Article•
TL;DR: The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
Abstract: Background Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. Methods A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. Results A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. Conclusion The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
8,191 citations
Additional excerpts
...The high comorbidity of anxiety and depressive disorders and the high correlation between depressive and anxiety measures is well known.(17,29) Not surprisingly, our depression measure, the PHQ-8, strongly correlated with the GAD-7 and the Symptom Checklist-90 anxiety scales....
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TL;DR: The PHQ-4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders and has a substantial effect on functional status that was independent of depression.
2,343 citations
TL;DR: Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status.
Abstract: Context Maternal depressive symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR). Objective To estimate the risk of PTB, LBW, and IUGR associated with antenatal depression. Data Sources and Study Selection We searched for English-language and non–English-language articles via the MEDLINE, PsycINFO, CINAHL, Social Work Abstracts, Social Services Abstracts, and Dissertation Abstracts International databases (January 1980 through December 2009). We aimed to include prospective studies reporting data on antenatal depression and at least 1 adverse birth outcome: PTB ( Data Extraction Information was extracted on study characteristics, antenatal depression measurement, and other biopsychosocial risk factors and was reviewed twice to minimize error. Data Synthesis Pooled relative risks (RRs) for the effect of antenatal depression on each birth outcome were calculated using random-effects methods. In studies of PTB, LBW, and IUGR that used a categorical depression measure, pooled effect sizes were significantly larger (pooled RR [95% confidence interval] = 1.39 [1.19-1.61], 1.49 [1.25-1.77], and 1.45 [1.05-2.02], respectively) compared with studies that used a continuous depression measure (1.03 [1.00-1.06], 1.04 [0.99-1.09], and 1.02 [1.00-1.04], respectively). The estimates of risk for categorically defined antenatal depression and PTB and LBW remained significant when the trim-and-fill procedure was used to correct for publication bias. The risk of LBW associated with antenatal depression was significantly larger in developing countries (RR = 2.05; 95% confidence interval, 1.43-2.93) compared with the United States (RR = 1.10; 95% confidence interval, 1.01-1.21) or European social democracies (RR = 1.16; 95% confidence interval, 0.92-1.47). Categorically defined antenatal depression tended to be associated with an increased risk of PTB among women of lower socioeconomic status in the United States. Conclusions Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.
1,552 citations
TL;DR: Cluster analysis offers a novel multidimensional approach for identifying asthma phenotypes that exhibit differences in clinical response to treatment algorithms, and is specific to refractory asthma.
Abstract: Rationale: Heterogeneity in asthma expression is multidimensional, including variability in clinical, physiologic, and pathologic parameters. Classification requires consideration of these disparate domains in a unified model.Objectives: To explore the application of a multivariate mathematical technique, k-means cluster analysis, for identifying distinct phenotypic groups.Methods: We performed k-means cluster analysis in three independent asthma populations. Clusters of a population managed in primary care (n = 184) with predominantly mild to moderate disease, were compared with a refractory asthma population managed in secondary care (n = 187). We then compared differences in asthma outcomes (exacerbation frequency and change in corticosteroid dose at 12 mo) between clusters in a third population of 68 subjects with predominantly refractory asthma, clustered at entry into a randomized trial comparing a strategy of minimizing eosinophilic inflammation (inflammation-guided strategy) with standard care.Mea...
1,515 citations
References
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TL;DR: It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Abstract: A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
35,518 citations
TL;DR: A representation and interpretation of the area under a receiver operating characteristic (ROC) curve obtained by the "rating" method, or by mathematical predictions based on patient characteristics, is presented and it is shown that in such a setting the area represents the probability that a randomly chosen diseased subject is (correctly) rated or ranked with greater suspicion than a random chosen non-diseased subject.
Abstract: A representation and interpretation of the area under a receiver operating characteristic (ROC) curve obtained by the "rating" method, or by mathematical predictions based on patient characteristics, is presented. It is shown that in such a setting the area represents the probability that a randomly chosen diseased subject is (correctly) rated or ranked with greater suspicion than a randomly chosen non-diseased subject. Moreover, this probability of a correct ranking is the same quantity that is estimated by the already well-studied nonparametric Wilcoxon statistic. These two relationships are exploited to (a) provide rapid closed-form expressions for the approximate magnitude of the sampling variability, i.e., standard error that one uses to accompany the area under a smoothed ROC curve, (b) guide in determining the size of the sample required to provide a sufficiently reliable estimate of this area, and (c) determine how large sample sizes should be to ensure that one can statistically detect difference...
19,398 citations
"The validity of the Hospital Anxiet..." refers background in this paper
...The area under the ROC curve (AUC) is a measure of the information value inherent in a test to determine caseness over the whole range of possible threshold values [6]....
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Book•
15 Jun 2006
TL;DR: Practical Statistics for Medical Research is a problem-based text for medical researchers, medical students, and others in the medical arena who need to use statistics but have no specialized mathematics background.
Abstract: Most medical researchers, whether clinical or non-clinical, receive some background in statistics as undergraduates. However, it is most often brief, a long time ago, and largely forgotten by the time it is needed. Furthermore, many introductory texts fall short of adequately explaining the underlying concepts of statistics, and often are divorced from the reality of conducting and assessing medical research.
Practical Statistics for Medical Research is a problem-based text for medical researchers, medical students, and others in the medical arena who need to use statistics but have no specialized mathematics background.
The author draws on twenty years of experience as a consulting medical statistician to provide clear explanations to key statistical concepts, with a firm emphasis on practical aspects of designing and analyzing medical research. The text gives special attention to the presentation and interpretation of results and the many real problems that arise in medical research
17,322 citations
"The validity of the Hospital Anxiet..." refers methods in this paper
...In the studies where the ROC curves were plotted by us, approximations of AUC were calculated using the trapezium rule [7]....
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TL;DR: This transmutability of the validation matrix argues for the comparisons within the heteromethod block as the most generally relevant validation data, and illustrates the potential interchangeability of trait and method components.
Abstract: Content Memory (Learning Ability) As Comprehension 82 Vocabulary Cs .30 ( ) .23 .31 ( ) .31 .31 .35 ( ) .29 .48 .35 .38 ( ) .30 .40 .47 .58 .48 ( ) As judged against these latter values, comprehension (.48) and vocabulary (.47), but not memory (.31), show some specific validity. This transmutability of the validation matrix argues for the comparisons within the heteromethod block as the most generally relevant validation data, and illustrates the potential interchangeability of trait and method components. Some of the correlations in Chi's (1937) prodigious study of halo effect in ratings are appropriate to a multitrait-multimethod matrix in which each rater might be regarded as representing a different method. While the published report does not make these available in detail because it employs averaged values, it is apparent from a comparison of his Tables IV and VIII that the ratings generally failed to meet the requirement that ratings of the same trait by different raters should correlate higher than ratings of different traits by the same rater. Validity is shown to the extent that of the correlations in the heteromethod block, those in the validity diagonal are higher than the average heteromethod-heterotrait values. A conspicuously unsuccessful multitrait-multimethod matrix is provided by Campbell (1953, 1956) for rating of the leadership behavior of officers by themselves and by their subordinates. Only one of 11 variables (Recognition Behavior) met the requirement of providing a validity diagonal value higher than any of the heterotrait-heteromethod values, that validity being .29. For none of the variables were the validities higher than heterotrait-monomethod values. A study of attitudes toward authority and nonauthority figures by Burwen and Campbell (1957) contains a complex multitrait-multimethod matrix, one symmetrical excerpt from which is shown in Table 6. Method variance was strong for most of the procedures in this study. Where validity was found, it was primarily at the level of validity diagonal values higher than heterotrait-heteromethod values. As illustrated in Table 6, attitude toward father showed this kind of validity, as did attitude toward peers to a lesser degree. Attitude toward boss showed no validity. There was no evidence of a generalized attitude toward authority which would include father and boss, although such values as the VALIDATION BY THE MULTITRAIT-MULTIMETHOD MATRIX
15,795 citations
"The validity of the Hospital Anxiet..." refers background in this paper
...’’ Some authors have recommended not only the use of correlations between subscales to assess their divergent validity, but also a multitrait–multimethod approach [67]....
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TL;DR: The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described, and its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change.
Abstract: The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inner-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.
11,923 citations
"The validity of the Hospital Anxiet..." refers methods in this paper
...Finally, in four studies the correlations between the interviewbasedMontgomery Asberg Depression Rating Scale [57] and HADS-D were in the range .62 to .81, while the correlation with HADS-T was .77 [52,53,58,59]....
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...The same level of correlations was found when HADS-D was compared to Montgomery Asberg Depression Rating Scale....
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...Finally, in four studies the correlations between the interviewbasedMontgomery Asberg Depression Rating Scale [57] and HADS-D were in the range ....
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...Two studies examined the relationship between the BDI: Beck Depression Inventory; BDI-PC: Beck Depression Inventory for Primary Care; CAS: Clinical Anxiety Scale; HADS-A: Anxiety subscale of HADS; HADS-D: Depression subscale of HADS; HADS-T: Total score of HADS; HAMA-S: Hamilton Anxiety Scale— Somatic Items; HAMA-P: Hamilton Anxiety Scale— Psychic Items; HAMA-T: Hamilton Anxiety Scale—Total Scale; MADRS: Montgomery–Asberg Depression Rating Scale; SCL-90: Symptom Checklist 90 Scale; STAI-S: Spielberger State-Trait Anxiety Inventory—State Form; STAI-T: Spielberger State-Trait Anxiety Inventory—Trait Form; VAS: Visual Analogue Scale....
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