Validity of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory for use in end-stage renal disease patients

Br J Clin Psychol. 2010 Nov;49(Pt 4):507-16. doi: 10.1348/014466509X477827. Epub 2009 Dec 14.


Objective: To validate the Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory (BDI) for use in patients with end-stage renal disease (ESRD) and to compare the outcome of both screening measures with each other.

Design: Cross-sectional and between-subjects design. The independent variable was the diagnosis depression by the Mini International Neuropsychiatric Interview (MINI). The dependent variables were the HADS and BDI total score.

Methods: All 130 patients with ESRD who were treated with haemodialysis (HD) or peritoneal dialyses in the Sint Lucas Andreas Hospital in Amsterdam were eligible for this study and were asked to fill out both HADS and BDI. The outcomes of both rating scales were compared with the diagnosis major depressive episode based on the MINI, which was seen as the gold standard. Receiver operating characteristic curves were used to choose optimal cut-off values.

Results: Of 62 enrolled subjects, 21 (34%) were diagnosed with a depressive disorder. Optimal cut-off values were ≥12 (HADS) and ≥13 (BDI). Sensitivity was 81.0% (HADS) and 75.0% (BDI). Specificity was 90.2% for both.

Conclusions: Both HADS and BDI are valid screening instruments for the diagnosis depression in ESRD patients but there is no statistical difference found between both rating scales.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Aged
  • Cross-Sectional Studies
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / psychology
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Kidney Failure, Chronic / psychology*
  • Kidney Failure, Chronic / therapy
  • Male
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Netherlands
  • Peritoneal Dialysis / psychology
  • Personality Inventory / statistics & numerical data*
  • Psychometrics / statistics & numerical data
  • ROC Curve
  • Renal Dialysis / psychology
  • Reproducibility of Results
  • Sick Role*