Are we using appropriate self-report questionnaires for detecting anxiety and depression in women with early breast cancer?

The aim of this prospective study was to identify the psychiatric morbidity associated with the diagnosis and treatment of early breast cancer. At eac h of five time points, 269 women were interviewed using a shortened version of the Present State Examination (PSE) and 266 completed self-assessment q uestionnaires, the Hospital and Anxiety Depression Scale (HADS) and the Rot terdam Symptom Checklist (RSCL). This paper compares the ability of the que stionnaires to detect psychiatric morbidity with that of the PSE. The major ity of women who experienced anxiety and/or depression did so within 3 mont hs of their initial surgery. The clinical interview identified anxiety diso rder in 132 of 266 women (49.6%) and depressive illness in 99/266 (37.2%) d uring the first 3 months. Using the recommended threshold of greater than o r equal to 11 for caseness, the sensitivities for both tests were very low at 24.2% (HADS anxiety) and 14.1% (HADS depression) and 30.6% (RSCL psychol ogical distress scale). Lowering the threshold value to greater than or equ al to 7 on the HADS improved the sensitivity to 72% for the anxiety subscal e, but it remained low at 37.4% for the depression subscale. A threshold of greater than or equal to 7 for the RSCL scale raised sensitivity to 66.7%. Lowering the threshold values raised the sensitivity of both the instrumen ts but decreased their specificity: the lower the threshold, the greater th e number of women who were identified as false positives which would increa se the work load for clinic staff if used as a screening tool. Given that t he HADS was inadequate in discriminating for depressive illness, it was not surprising that its use as a unitary scale with a threshold value as low a s 12 resulted in a sensitivity of only 42.7%. In the light of these finding s, we question the use of both the HADS and the RSCL as suitable research o r screening instruments for detection of psychological morbidity in early b reast cancer. (C) 1999 Elsevier Science Ltd. All rights reserved.