ipos09 - how accurate is the hads as a screen for emotional complications of cancer (june09)

Alex Mitchell alex.mitchell@leicspart.nhs.ukLeicester 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%

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Pre-test Probability

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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

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Pre-test Probability

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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

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Pre-test Probability

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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

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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