IPOS09 - How Accurate is the HADS as a Screen for Emotional Complications of Cancer (June09)

1,251 views

Published on

This is a 15min talk as part of IPOS psycho-oncology conference 2009, Vienna Austria. Subject is a meta-analysis of the Hospital Anxiety and Depression scale in cancer settings

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,251
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
20
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

IPOS09 - How Accurate is the HADS as a Screen for Emotional Complications of Cancer (June09)

  1. 1. IPOS2009 – Talks 27:1 IPOS2009 – Talks 27:1 How Accurate is the HADS as a Screen for How Accurate is the HADS as a Screen for Emotional Complications of Cancer? Emotional Complications of Cancer? A Meta-analysis against Robust Psychiatric Interviews A Meta-analysis against Robust Psychiatric Interviews Alex Mitchell alex.mitchell@leicspart.nhs.uk Leicester Royal Infirmary UK Individual Lecture 2; 24 June 2009: 3.30pm-4.30pm; Session 27 Lecture Nr.1
  2. 2. Background Background
  3. 3. Methods to Evaluate Depression Unassisted Clinician Conventional Scales Untrained Trained Short (5-10) Long (10+) Ultra-Short (<5) Other/Uncertain Other/Uncertain 9% 9% ICD10/DSMIV ICD10/DSMIV Other/Uncertain 0% 0% 9% ICD10/DSMIV Short QQ Short QQ 0% 3% 3% Short QQ 3% 1,2 or 3 Sim ple 1,2 or 3 Sim ple QQ QQ 15% 15% 1,2 or 3 Simple QQ 15% Clinical Skills Clinical Skills Alone Alone 73% 73% Clinical Skills Alone 73% Verbal Questions Visual-Analogue Test PHQ2 Distress Thermometer WHO-5 Depression Thermometer Whooley/NICE => Table scales
  4. 4. [handout 3] => accuracy
  5. 5. HADs Limitations HADs Limitations
  6. 6. HADS Validity vs Structured Interview METHODS Against depression 9x studies of the HADS-D 5x of the HADS-T 2x of the HADS-A were identified. Studies reported results at almost all possible cut-points with little consistency of approach. Only 8 authors used an ROC curve to calculate an optimal cut-point.
  7. 7. Results vs Affective Disorder Against affective disorders, there appeared to be advantage for the HADS-D and a relatively poor performance for the HADS-A. The HADS-T occupied an intermediate position. The clinical utility index (UI+, UI-) was 0.364 and 0.724 for the HADS-D. Sensitivity Specificity PPV NPV Fraction Correct HADS-D 60.3% 85.1% 60.3% 85.1% 78.3% HADS-A 51.2% 77.9% 65.4% 66.2% 65.9% HADS-T 53.3% 81.6% 59.6% 77.5% 72.6%
  8. 8. HADS Validity vs Depression RESULTS HADS-T = HADS-D = HADS-A The clinical utility index (UI+, UI-) was 0.214 and 0.789 for the HADS-D Sensitivity Specificity PPV NPV FC HADS-D 51.4% 86.9% 41.6% 90.8% 81.4% HADS-A 82.4% 81.7% 35.9% 97.4% 81.8% HADS-T 77.7% 84.3% 44.5% 95.9% 83.4%
  9. 9. 1.00 Post-test Probability 0.90 0.80 0.70 0.60 0.50 0.40 HADS-T Positive (N=5) HADS-T Negative (N=5) 0.30 Baseline Probability HADS-A Positive (N=2) HADS-A Negative (N=2) 0.20 HADS-D Positive (N=9) HADS-D Negative (N=9) 0.10 Pre-test Probability 0.00 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
  10. 10. HADs Validity HADs Validity
  11. 11. HADS vs Clinician
  12. 12. 1.00 0.90 Post-test Probability 0.80 0.70 0.60 0.50 0.40 Clinician Positive (Fallowfield et al, 2001) 0.30 Clinician Negative (Fallowfield et al, 2001) Baseline Probability 0.20 HADS-D Positive (Mata-analysis) HADS-D Negative (Meta-analysis) 0.10 Pre-test Probability 0.00 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
  13. 13. HADS vs Other Scales 96 studies 13 tools
  14. 14. 1.00 Post-test Probability 0.90 0.80 0.70 0.60 HADS+ HADS- Baseline Probability GDS30+ GDS30- GDS15+ GHQ28+ HDRS+ ZUNG+ GDS15- GHQ28- HDRS- 0.50 ZUNG- PHQ9+ PHQ9- WHOOLEY2Q+ WHOOLEY2Q- BDI+ BDI- BDI-SF+ BDI-SF- 0.40 CESD+ CESD- 1Q+ 1Q- GHQ12+ GHQ12- 0.30 0.20 0.10 Pre-test Probability 0.00 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
  15. 15. Poster session 3 (25 June 2009) Poster category 7 (Methods and Measurements) Poster Nr. 20
  16. 16. 1.00 0.90 0.80 Ten 0.70 Nine Eight 0.60 Seven Six 0.50 Five Four 0.40 Three Two 0.30 One 0.20 Zero 0.10 0.00 Distress Anxiety Depression Anger Thermometer Thermometer Thermometer Thermometer
  17. 17. [handout 9] ET vs DT (n=130) Of 63% DT low scorers 51% recorded emotional difficulties on the new Emotion Thermometers (ET) tool Out of those with any emotional complication 93.3% would be recognised using the AnxT alone vs 54.4% who would be recognised using the DT alone.
  18. 18. Vs DT DepT HADS-A AUC: DT=0.82 DepT=0.84 AnxT=0.87 AnxT AngT AngT=0.685
  19. 19. Vs DT DepT HADS-D AUC: DT=0.67 DepT=0.75 AnxT=0.62 AnxT AngT AngT=0.69
  20. 20. Credits & Acknowledgments Elena Baker-Glenn University of Nottingham Paul Symonds Leicester Royal Infirmary Chris Coggan Leicester General Hospital Burt Park University of Nottingham Lorraine Granger Leicester Royal Infirmary Mark Zimmerman Brown University, Rhode Island Brett Thombs McGill University Canada James Coyne University of Pennsylvania Nick Meader National Collaborative Centre MH For more information www.psycho-oncology.info

×