A VALIDITY STUDY OF THE HOSPITAL ANXIETY AND DEPRESSION SCALE IN GENERAL-HOSPITAL UNITS AND A COMMUNITY SAMPLE IN NIGERIA

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.