ipos10 t275 - large scale pragmatic validation of the hads for major depression in an ethnically...
DESCRIPTION
This is a talk (oral presentation) from IPOS 2010 held in Quebec City, Canada.TRANSCRIPT
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Alex Mitchell www.psycho-oncology.infoLorraine GraingerElena Baker-GlennKaren Lord
Department of Cancer & Molecular Medicine, Leicester Royal Infirmary
IPOS 2010, Quebec CityIPOS 2010, Quebec City
T275 - A Large Scale Pragmatic Validation of the HADS for Major Depression in an Ethnically Diverse Cancer PopulationT275 - A Large Scale Pragmatic Validation of the HADS for Major
Depression in an Ethnically Diverse Cancer Population
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1. Background1. Background
What methods are used to detect mood disorders?
How often do clinicians look for mood complications?
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Methods to Evaluate Depression
Conventional Scales
Short (5-10) Long (10+)
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1,2 or 3 Simple QQ15%
Clinical Skills Alone73%
ICD10/DSMIV0%
Short QQ3%
Other/Uncertain9% Other/Uncertain
2%
Use a QQ15%
ICD10/DSMIV13%
Clinical Skills Alone55%
1,2 or 3 Simple QQ15%
Cancer StaffCurrent Method (n=226)
Psychiatrists
Comment: Current preferred method of eliciting symptoms of distress/depression
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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
Baseline Probability
Depression+
Depression-
Comment: Slide illustrates Bayesian curve – pre-test post test probability for every possible prevalence
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2. HADS – Primary Analysis +Meta-Analysis2. HADS – Primary Analysis +Meta-Analysis
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We analysed data collected from Leicester Cancer Centre from 2007-2009 involving approximately 1000 people approached by a research nurse, research physician and two therapeutic radiographers.
The researcher applied DSMIV criteria of major depressive disorder (MDD).
We collated full data on 690 patient assessments of whom 12.9% had MDD, 121 were palliative and 115 (16.7%) were from ethnic minorities (largely British South Asian of India descent).
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Graphical – Screening principles
Non-Depressed
Depressed
# ofIndividuals
Cut-Off
# ofIndividuals
Severity of Depression
HighLow
High Sensitivity >>>>
<<<< low Specificity
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ResultsResults
In the parent sample of 690, the sensitivity and specificity were as follows
Sensitivity Specificity
HADS-A 87.6% 72.3%
HADS-D 86.5% 80.1%
HADS-T 95.5% 76.3%.
The AUC was highest for HADS-T > HADS-D > HADS-A.
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HADS-A = 0.865506 (cut9)HADS-D = 0.900949 (cut7)
HADS-T = 0.916096 (cut15)
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~Ethnic Minority~Ethnic Minority
30% in urban areas – largley british south asian(india)
20% in county
15% in hospital care
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Ethnic MinoritiesEthnic Minorities
Sensitivity and specificity were as follows
HADS-A 93.1% 66.3%
HADS-D 86.2% 65.1%
HADS-T 96.6% 66.3%.
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HADS-A = 0.846231 (cut9)HADS-D = 0.796512 (cut7)HADS-T = = 0.84603 (cut15)
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ConclusionsConclusions
In the mixed populations the HADS-D was preferred
In the ethnic minority population and HADS-A or HADS-T were preferred
There was no difference by cancer stage.
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