The use of the Hospital Anxiety and Depression Scale (HADS) in patients with chronic obstructive pulmonary disease: a pilot study

Aims. To investigate the use of the Hospital Anxiety and Depression Scale ( HADS) with recuperating chronic obstructive pulmonary disease (COPD) patien ts. To study prevalence rates and changes in clinically relevant anxiety an d depression during rehabilitation. Methods. Consecutive patients admitted to a non acute respiratory ward over a twelve week period were asked to complete a HADS questionnaire on three occasions. Nurses recorded basic demographic information on admission. Addi tional demographic, medical and psychiatric data were obtained by retrospec tive review of medical records. Results. Of 93 consecutive inpatients, 79 (85%) completed the admission HAD S. 72 patients were eligible to complete the day three HADS and 60 the disc harge HADS. Clinically relevant anxiety (HADS score of greater than or equa l to8) was indicated in 39 patients (50%) and depression in 22 (28%). HADS anxiety (p=0.05) and total scores (anxiety+depression) (p=0.03) decreased b etween admission and discharge. A larger proportion of patients scored with in the normal or mild psychopathology range by discharge. More severe COPD (FEV1% predicted) correlated with higher HADS anxiety scores (r=-0.39, p<0. 001) and HADS depression scores (r=-0.34, p<0.005). Patients with a recorde d history of anxiety (p<0.0001) and depression (p<0.02) had higher HADS sco res. Females (n=37) when compared to males (n=42), recorded significantly h igher HADS anxiety scores throughout (p<0.005). Conclusions. Clinically relevant anxiety, indicated by higher HADS scores, was more common in patients with severe COPD, a past history of anxiety or depression and females. Anxiety and total mood unproved during inpatient re habilitation. The use of this instrument with New Zealand COPD patients may improve identification and treatment of anxious and depressed patients.