CAN MOOD DISORDER IN WOMEN WITH BREAST-CANCER BE IDENTIFIED PREOPERATIVELY

The Hospital Anxiety and Depression (HAD) scale, a self-report questio nnaire, was tested as a method of identifying mood disorder among pati ents with operable breast cancer during the year after diagnosis. In a cohort of 91 patients anxiety and depression were assessed preoperati vely, and at 3 and 12 months post-operatively, using a standardised ps ychiatric interview and diagnostic rating criteria. The patients also completed the HAD scale at each assessment. Fifty out of 91 (55%) pati ents were full or borderline cases of depression and/or anxiety at one or more assessment points. Using a receiver operator characteristic c urve analysis, the optimum threshold for the preoperative HAD scale to tal score to identify psychiatric disorder either preoperatively or at 3 and 12 months post-operatively was 11. With this threshold 70% of b oth full and borderline cases occurring at any of the assessment point s were correctly identified. The false-positive rate was 12%. This app roach was particularly sensitive to full cases, correctly identifying 90% of them. The potential for the preoperative HAD scale total score to identify mood disorder in the year after diagnosis was influenced b y age. Among women aged less than 50 years, a preoperative HAD scale t otal score greater than or equal to 11 provided a highly sensitive ind icator of mood disorder (full and borderline cases) at any time in the year after diagnosis (sensitivity = 90%). The false-positive rate was 40%. Among women older than 50 who experienced a mood disorder, only 57% were correctly identified by a HAD scale total score of greater th an or equal to 11 (sensitivity = 57%). However, the false-positive rat e among older women was low (3%). This simple preoperative screening a pproach can be used to identify patients who have or are at high risk of developing severe mood disorder in the year after diagnosis. The HA D scale is also sensitive to the detection of borderline mood disorder in patients under the age of 50. It is a specific screening tool amon g patients over 50, but is not sensitive to the detection of borderlin e mood disorder in this age group.