Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale

The psychometric properties of the Italian version of the Hospital Anxiety and Depression Scale and its utility as a screening instrument for anxiety and depression in a non-psychiatric setting were evaluated. The questionnai re was administered twice to 197 breast cancer patients randomised in a pha se III adjuvant clinical trial: before the start of chemotherapy and at the first followup visit. The presence of psychiatric disorders was evaluated at the followup visit using the Structured Clinical Interview for DSM-III-R in 132 patients. Factor analyses identified two strictly correlated factor s. Crohnbach's alpha for the anxiety and depression scales ranged between 0 .80 and 0.85. At follow-up, 50 patients (38%) were assigned a current DSM-I II-R diagnosis, in most cases adjustment disorders (24%) or major depressiv e disorder (10%). Receiver operating characteristics (ROC) analysis was use d to test the discriminant validity for both anxiety and depressive disorde rs. The comparison of the areas under the curve (AUC) between the two scale s did not show any difference in identifying either anxiety (P=0.855) or de pressive disorders (P=0.357). The 14-item total scale showed a high interna l consistency (alpha=0.89 and 0.88) and a high discriminating power for all the psychiatric disorders (AUC=0.89; 95% CI=0.83-0.94). The cut-off point that maximised sensitivity (84%) and specificity (79%) was 10. These result s suggest that the total score is a valid measure of emotional distress, so that the Italian version of HADS can be used as a screening questionnaire for psychiatric disorders. The use of the two subscales as a 'case identifi er' or as an outcome measure should be considered with caution.