Oa. Abiodun, A VALIDITY STUDY OF THE HOSPITAL ANXIETY AND DEPRESSION SCALE IN GENERAL-HOSPITAL UNITS AND A COMMUNITY SAMPLE IN NIGERIA, British Journal of Psychiatry, 165, 1994, pp. 669-672
Background. The utility of the Hospital Anxiety and Depression Scale (
HADS) as a screening instrument for anxiety and depressive disorders i
n non-psychiatric units (medical and surgical wards; gynaecology and a
ntenatal clinics of a teaching hospital) and a community sample in Nig
eria was investigated. Method. A two-stage screening procedure was emp
loyed. This involved the use of GHQ-12/GHQ-30 and HADS against the cri
teria of a standardised (PSE schedule) psychiatric interview, with psy
chiatric diagnosis assigned in accordance with ICD-9 criteria. Results
. Sensitivity for the anxiety sub-scale ranged from 85.0% in the medic
al and surgical wards to 92.9% in the ante-natal clinic, while sensiti
vity for the depression sub-scale ranged from 89.5% in the community s
ample to 92.1% in the gynaecology clinic. Specificity for the anxiety
sub-scale ranged from 86.5% in the gynaecology clinic to 90.6% in the
community sample, while specificity for the depression sub-scale range
d from 86.6% in the medical and surgical wards to 91.1% in the ante-na
tal clinic and community sample. Misclassification rates ranged from 9
.9% in the community sample to 13.2% in the medical and surgical wards
. Relative Operating Characteristic (ROC) analyses showed the HADS and
the GHQ-12 to be:quite similar in ability to discriminate between cas
es (anxiety and depression) and non-cases. Conclusions. The HADS is va
lid for use as a screening instrument in non-psychiatric units and alt
hough initially developed for use in hospital settings, it could be us
efully employed in community settings of developing countries to scree
n for mental morbidity.