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T275 --A Large Scale Pragmatic Validation of the HADS for Major
  T275 A Large Scale Pragmatic Validation of the HADS for ...
1. Background

  What methods are used to detect mood disorders?


  How often do clinicians look for mood complications?
Methods to Evaluate Depression



                        Conventional Scales

                            Short (5-10) Lo...
Cancer Staff                                                                       Psychiatrists
           Current Method...
1




          Post-test Probability
0.9                                     Comment: Slide illustrates Bayesian
        ...
2. HADS – Primary Analysis +Meta-Analysis
We analysed data collected from Leicester Cancer Centre
 from 2007-2009 involving approximately 1000 people
 approached by...
Graphical – Screening principles

 #
 of                             Cut-Off
 Individuals
                                ...
Results
In the parent sample of 690, the sensitivity and specificity
  were as follows

                  Sensitivity     ...
HADS-A = 0.865506 (cut9)
HADS-D = 0.900949 (cut7)
HADS-T = 0.916096 (cut15)
~Ethnic Minority
30% in urban areas – largley british south asian
                       (india)

20% in county

15% in ho...
Ethnic Minorities
Sensitivity and specificity were as follows



HADS-A      93.1%             66.3%

HADS-D      86.2%   ...
HADS-A = 0.846231 (cut9)
HADS-D = 0.796512 (cut7)
HADS-T = = 0.84603 (cut15)
Conclusions
In the mixed populations the HADS-D was preferred




In the ethnic minority population and HADS-A or HADS-T
 ...
IPOS10 t275 - Large Scale Pragmatic Validation of the HADS for Major Depression in an Ethnically Diverse Cancer Population
IPOS10 t275 - Large Scale Pragmatic Validation of the HADS for Major Depression in an Ethnically Diverse Cancer Population
IPOS10 t275 - Large Scale Pragmatic Validation of the HADS for Major Depression in an Ethnically Diverse Cancer Population
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IPOS10 t275 - Large Scale Pragmatic Validation of the HADS for Major Depression in an Ethnically Diverse Cancer Population

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This is a talk (oral presentation) from IPOS 2010 held in Quebec City, Canada.

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IPOS10 t275 - Large Scale Pragmatic Validation of the HADS for Major Depression in an Ethnically Diverse Cancer Population

  1. 1. T275 --A Large Scale Pragmatic Validation of the HADS for Major T275 A Large Scale Pragmatic Validation of the HADS for Major Depression in an Ethnically Diverse Cancer Population Depression in an Ethnically Diverse Cancer Population Alex Mitchell www.psycho-oncology.info Lorraine Grainger Elena Baker-Glenn Karen Lord Department of Cancer & Molecular Medicine, Leicester Royal Infirmary IPOS 2010, Quebec City IPOS 2010, Quebec City
  2. 2. 1. Background What methods are used to detect mood disorders? How often do clinicians look for mood complications?
  3. 3. Methods to Evaluate Depression Conventional Scales Short (5-10) Long (10+)
  4. 4. Cancer Staff Psychiatrists Current Method (n=226) Other/Uncertain 9% Other/Uncertain ICD10/DSMIV 2% 0% ICD10/DSMIV 13% Short QQ 3% 1,2 or 3 Sim ple QQ 15% Clinical Skills Use a QQ Alone 15% 55% Clinical Skills Alone 73% 1,2 or 3 Sim ple QQ 15% Comment: Current preferred method of eliciting symptoms of distress/depression
  5. 5. 1 Post-test Probability 0.9 Comment: Slide illustrates Bayesian curve – pre-test post test probability for every possible prevalence 0.8 0.7 0.6 0.5 0.4 0.3 Baseline Probability Depression+ 0.2 Depression- 0.1 Pre-test Probability 0 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
  6. 6. 2. HADS – Primary Analysis +Meta-Analysis
  7. 7. We analysed data collected from Leicester Cancer Centre from 2007-2009 involving approximately 1000 people approached by a research nurse, research physician and two therapeutic radiographers. The researcher applied DSMIV criteria of major depressive disorder (MDD). We collated full data on 690 patient assessments of whom 12.9% had MDD, 121 were palliative and 115 (16.7%) were from ethnic minorities (largely British South Asian of India descent).
  8. 8. Graphical – Screening principles # of Cut-Off Individuals Low High Non-Depressed <<<< low Specificity Severity of Depression High Sensitivity >>>> Depressed # of Individuals
  9. 9. Results In the parent sample of 690, the sensitivity and specificity were as follows Sensitivity Specificity HADS-A 87.6% 72.3% HADS-D 86.5% 80.1% HADS-T 95.5% 76.3%. The AUC was highest for HADS-T > HADS-D > HADS-A.
  10. 10. HADS-A = 0.865506 (cut9) HADS-D = 0.900949 (cut7) HADS-T = 0.916096 (cut15)
  11. 11. ~Ethnic Minority 30% in urban areas – largley british south asian (india) 20% in county 15% in hospital care
  12. 12. Ethnic Minorities Sensitivity and specificity were as follows HADS-A 93.1% 66.3% HADS-D 86.2% 65.1% HADS-T 96.6% 66.3%.
  13. 13. HADS-A = 0.846231 (cut9) HADS-D = 0.796512 (cut7) HADS-T = = 0.84603 (cut15)
  14. 14. Conclusions In the mixed populations the HADS-D was preferred In the ethnic minority population and HADS-A or HADS-T were preferred There was no difference by cancer stage.

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