Screening for depression in women with metastatic breast cancer: a comparison of the Beck Depression Inventory Short Form and the Hospital Anxiety and Depression Scale

Aust N Z J Psychiatry. 2004 Jul;38(7):526-31. doi: 10.1080/j.1440-1614.2004.01385.x.


Objective: To compare two self-report questionnaires for identifying possible depression in women with metastatic breast cancer.

Method: We conducted structured psychiatric interviews and administered the Beck Depression Inventory Short Form (BDI-SF) and Hospital Anxiety and Depression Scale (HADS) to 227 women with stage IV breast cancer. The accuracy for identifying DSM-IV-defined major and minor depression was examined. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated and receiver operating characteristic curves plotted.

Results: Seventy-four (32.6%) patients satisfied DSM-IV criteria for a depressive disorder. With a cut-off of 4, the BDI-SF had a sensitivity of 0.84, specificity of 0.63, and PPV of 0.52. A cut-off of 11 on the HADS-Depression scale (HADS-D) resulted in sensitivity, specificity, and PPV of 0.16, 0.97, and 0.75, respectively. For major depression alone, the BDI-SF with a cut-off of 5 had excellent sensitivity but poor PPV; the HADS, with a cut-off of 7, had weak sensitivity and PPV.

Conclusions: Overall, the two scales perform similarly in identifying major depression, while the BDI-SF is the more useful in screening for DSM-IV major or minor depression categories in this clinical group.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breast Neoplasms / pathology
  • Breast Neoplasms / psychology*
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / etiology*
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Mass Screening
  • Middle Aged
  • Neoplasm Metastasis
  • Predictive Value of Tests
  • Psychological Tests*
  • Surveys and Questionnaires