Usefulness of hospital anxiety and depression scale (HADS) as a screening tool at a geriatric day hospital setting

Abstract

Background.- Anxiety and depression are common conditions in older people affecting approximately 3% and 10% of elderly people living at home. Studies suggest that prevalence is higher in those with medical conditions. HADS is a commonly used screening tool for measuring the severity of anxiety and depression. It has been shown to be useful in hospital, outpatient and community settings. The aim of the study was to estimate the prevalence of anxiety using HADS and to measure the usefulness of HADS in screening depression using the Diagnostic and Statistical Manual (DSM IV) as a gold standard. Method.- Consecutive patients aged over 65 years attending the Medical Geriatric Day Hospital were recruited. HADS was administered by a trained nurse. An independent Old Age Psychiatrist, blinded to the screening tool result, performed the DSM IV assessment in a standardised manner. Results.- Hundred and one participants (58% women) were recruited. Mean age (S.D.; range) of the study population was 79.4 (6.7; 65-93) years. 31.6% screened positive for anxiety (score > 7) with 11.8% scoring borderline abnormal (8-10) and 19.8% scoring abnormal (11-21). The prevalence of depression using HADS was 32.7%. Prevalence of depression in the study population using DSM IV was 22.8%. Sensitivity and specificity of the HADS in diagnosing depression was 69.6% and 78.2%, respectively. Positive predictive value for HADS was 48.5% and the negative predictive value was 10.3%. Conclusion.- Studies have shown that the prevalence range of anxiety disorder in a general hospital is 1-34%. With caseness defined by a score of 8 or more, the Geriatric Day Hospital setting showed a high prevalence of anxiety. HADS had a relatively high negative predictive value suggesting it may have value in ruling out depression. However, the false positive rate mean that patients screened positive require a more comprehensive assessment as approximately half will not have depression.