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The Hospital Anxiety and Depression Scale: low sensitivity for depression screening in demented and non-demented hospitalized elderly

Published online by Cambridge University Press:  13 September 2012

Nikolaos Samaras ,
François R. Herrmann ,
Dimitrios Samaras ,
Pierre-Olivier Lang ,
Alessandra Canuto ,
Alexandre Forster ,
Henriette Hilleret  and
Gabriel Gold
Nikolaos Samaras*
Affiliation:
Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
François R. Herrmann
Affiliation:
Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
Dimitrios Samaras
Affiliation:
Department of Medical Specialties, Clinical Nutrition, Geneva University Hospitals, Geneva, Switzerland
Pierre-Olivier Lang
Affiliation:
Nescens Center of Preventive Medicine, Clinic of Genolier, Genolier, Switzerland Translational Medicine Research Group, Cranfield Health, Cranfield University, Cranfield, UK
Alessandra Canuto
Affiliation:
Service of Psychiatry of Liaison and Crisis Intervention, Geneva University Hospitals and Faculty of Medicine of the University of Geneva, Geneva, Switzerland
Alexandre Forster
Affiliation:
Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
Henriette Hilleret
Affiliation:
Service of Psychiatry of Liaison and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
Gabriel Gold
Affiliation:
Department of Internal Medicine Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine of the University of Geneva, Geneva, Switzerland
*
Correspondence should be addressed to: Nikolaos Samaras, MD, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland. Chemin du Pont-Bochet 3, 1226 Thônex, Switzerland. Phone: +41795538309; Fax: +41223056115. Email: [email protected].
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Abstract

Background: We currently use the depression subscale (HADD) of the Hospital Anxiety and Depression Scale (HADS) for depression screening in elderly inpatients. Given recent concerns about the performance of the HADD in this age group, we performed a quality-control study retrospectively comparing HADD with the diagnosis of depression by a psychiatrist. We also studied the effect of dementia on the scale's performance.

Methods: HADS produces two 7-item subscales assessing depression or anxiety. The HADD was administered by a neuropsychologist. As “gold standard” we considered the psychiatrist's diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Patients older than 65 years, assessed by both the HADD and the psychiatrist, with a clinical dementia rating (CDR) score lower than 3, were included. The effect of dementia was assessed by forming three groups according to the CDR score (CDR0–0.5, CDR1, and CDR2). Simple and multiple logistic regression models were applied to predict the psychiatrist's depression diagnosis from HADD scores. Areas under the receiver operating characteristics curve (AUC) were plotted and compared by χ2 tests.

Results: On both univariate and multiple analyses, HADD predicted depression diagnosis but performed poorly (univariate: p = 0.009, AUC = 0.60 (95% confidence interval (CI) = 0.53–0.66); multiple: p = 0.007, AUC = 0.65 (95% CI = 0.58–0.71)), regardless of cognitive status. Because mood could have changed between the two assessments (they occurred at different points of the hospital stay), the multiple analyses were repeated after limiting time interval at 28, 21, and 14 days. No major improvements were noted.

Conclusion: The HADD performed poorly in elderly inpatients regardless of cognitive status. It cannot be recommended in this population for depression screening without further study.

Keywords

depressiondementiaelderlyhospitalizedscale
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 1 , January 2013 , pp. 82 - 87
Copyright
Copyright © International Psychogeriatric Association 2012

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