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Validity of the Hospital Anxiety and Depression Scale to assess depression and anxiety following traumatic brain injury as compared with the Structured Clinical Interview for DSM-IV.
J Affect Disord. 2009 Apr; 114(1-3):94-102.JA

Abstract

BACKGROUND

Rating scales are often used in the assessment of depression and anxiety in traumatic brain injury (TBI), but few have been validated for use with this population. Overlap of symptoms between such disorders and TBI may lead to under- or over-diagnosis of depression or anxiety.

METHODS

100 participants with mild to severe TBI, and 87 informants, were interviewed using the SCID-IV (Axis I). The HADS was administered at the same time.

RESULTS

According to the SCID-IV, 34 participants were diagnosed with major depression and 36 with an anxiety disorder. Higher HADS scores were associated with a greater likelihood of depression and anxiety. However, the "clinical" categories of the HADS did not strongly correspond with the clinical diagnoses of depression and anxiety. Compared with SCID diagnoses, the depression subscale of the HADS had a sensitivity of 62% and a specificity of 92%. The anxiety subscale had a sensitivity of 75% and a specificity of 69%. Positive predictive and negative predictive values were calculated.

LIMITATIONS

This study included mostly moderate to severe TBI individuals, recruited from a rehabilitation hospital. Therefore, they may not necessarily be representative of the entire TBI population.

CONCLUSIONS

The HADS was a reliable measure of emotional distress in this TBI sample; however the cut-off scores and categories were not useful in predicting caseness of depression and anxiety. Clinicians should be mindful of the sequelae of TBI that may confound the scores yielded in rating scales and should follow up with a psychiatric interview when diagnosis is unclear.

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Authors+Show Affiliations

Whelan-Goodinson R
School of Psychology, Psychiatry and Psychological Medicine, Monash University, Melbourne, Australia. rochelle_w@hotmail.com
Ponsford J
No affiliation info available
Schönberger M
No affiliation info available

MeSH

AdultAgedAnxiety DisordersBrain InjuriesDepressive Disorder, MajorDiagnostic and Statistical Manual of Mental DisordersFemaleGlasgow Coma ScaleHospitalsHumansMaleMiddle AgedNeuropsychological TestsPredictive Value of TestsPsychiatric Status Rating ScalesROC CurveReproducibility of ResultsSeverity of Illness IndexSurveys and QuestionnairesYoung Adult

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

18656266

Clinical Trial Links

My Cardiac Recovery (MyCaRe): A Pilot RCT.

Citation

Whelan-Goodinson, Rochelle, et al. "Validity of the Hospital Anxiety and Depression Scale to Assess Depression and Anxiety Following Traumatic Brain Injury as Compared With the Structured Clinical Interview for DSM-IV." Journal of Affective Disorders, vol. 114, no. 1-3, 2009, pp. 94-102.
Whelan-Goodinson R, Ponsford J, Schönberger M. Validity of the Hospital Anxiety and Depression Scale to assess depression and anxiety following traumatic brain injury as compared with the Structured Clinical Interview for DSM-IV. J Affect Disord. 2009;114(1-3):94-102.
Whelan-Goodinson, R., Ponsford, J., & Schönberger, M. (2009). Validity of the Hospital Anxiety and Depression Scale to assess depression and anxiety following traumatic brain injury as compared with the Structured Clinical Interview for DSM-IV. Journal of Affective Disorders, 114(1-3), 94-102. https://doi.org/10.1016/j.jad.2008.06.007
Whelan-Goodinson R, Ponsford J, Schönberger M. Validity of the Hospital Anxiety and Depression Scale to Assess Depression and Anxiety Following Traumatic Brain Injury as Compared With the Structured Clinical Interview for DSM-IV. J Affect Disord. 2009;114(1-3):94-102. PubMed PMID: 18656266.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validity of the Hospital Anxiety and Depression Scale to assess depression and anxiety following traumatic brain injury as compared with the Structured Clinical Interview for DSM-IV. AU - Whelan-Goodinson,Rochelle, AU - Ponsford,Jennie, AU - Schönberger,Michael, Y1 - 2008/07/25/ PY - 2008/03/02/received PY - 2008/06/15/revised PY - 2008/06/15/accepted PY - 2008/7/29/pubmed PY - 2009/7/23/medline PY - 2008/7/29/entrez SP - 94 EP - 102 JF - Journal of affective disorders JO - J Affect Disord VL - 114 IS - 1-3 N2 - BACKGROUND: Rating scales are often used in the assessment of depression and anxiety in traumatic brain injury (TBI), but few have been validated for use with this population. Overlap of symptoms between such disorders and TBI may lead to under- or over-diagnosis of depression or anxiety. METHODS: 100 participants with mild to severe TBI, and 87 informants, were interviewed using the SCID-IV (Axis I). The HADS was administered at the same time. RESULTS: According to the SCID-IV, 34 participants were diagnosed with major depression and 36 with an anxiety disorder. Higher HADS scores were associated with a greater likelihood of depression and anxiety. However, the "clinical" categories of the HADS did not strongly correspond with the clinical diagnoses of depression and anxiety. Compared with SCID diagnoses, the depression subscale of the HADS had a sensitivity of 62% and a specificity of 92%. The anxiety subscale had a sensitivity of 75% and a specificity of 69%. Positive predictive and negative predictive values were calculated. LIMITATIONS: This study included mostly moderate to severe TBI individuals, recruited from a rehabilitation hospital. Therefore, they may not necessarily be representative of the entire TBI population. CONCLUSIONS: The HADS was a reliable measure of emotional distress in this TBI sample; however the cut-off scores and categories were not useful in predicting caseness of depression and anxiety. Clinicians should be mindful of the sequelae of TBI that may confound the scores yielded in rating scales and should follow up with a psychiatric interview when diagnosis is unclear. SN - 1573-2517 UR - https://www.unboundmedicine.com/medline/citation/18656266/Validity_of_the_Hospital_Anxiety_and_Depression_Scale_to_assess_depression_and_anxiety_following_traumatic_brain_injury_as_compared_with_the_Structured_Clinical_Interview_for_DSM_IV_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(08)00261-9 DB - PRIME DP - Unbound Medicine ER -