Discriminant validity of the Hospital Anxiety and Depression Scale, Beck Depression Inventory (II) and Beck Anxiety Inventory to confirmed clinical diagnosis of depression and anxiety in patients with chronic obstructive pulmonary disease

Tina Phan; Owen Carter; Claire Adams; Grant Waterer; Li Ping Chung; Maxine Hawkins; Cobie Rudd; Mel Ziman; Natalie Strobel

doi:10.1177/1479972316634604

Discriminant validity of the Hospital Anxiety and Depression Scale, Beck Depression Inventory (II) and Beck Anxiety Inventory to confirmed clinical diagnosis of depression and anxiety in patients with chronic obstructive pulmonary disease

Chron Respir Dis. 2016 Aug;13(3):220-8. doi: 10.1177/1479972316634604. Epub 2016 Mar 3.

Authors

Tina Phan¹, Owen Carter², Claire Adams³, Grant Waterer⁴, Li Ping Chung⁵, Maxine Hawkins⁶, Cobie Rudd², Mel Ziman⁷, Natalie Strobel⁸

Affiliations

¹ School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia t.phan@ecu.edu.au.
² Office of the Deputy Vice-Chancellor (Strategic Partnerships), Edith Cowan University, Joondalup, Western Australia, Australia.
³ School of Arts and Humanities, Edith Cowan University, Joondalup, Western Australia, Australia.
⁴ Royal Perth Hospital and School of Medicine and Pharmacology, The University of Western Australia, Royal Perth Hospital, Perth, Australia.
⁵ Respiratory Medicine, Fiona Stanley Hospital, Palmyra DC, Western Australia, Australia.
⁶ Clinical Psychology, Clear Health Partners, Perth, Australia.
⁷ School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia, Australia.
⁸ Office of the Deputy Vice-Chancellor (Strategic Partnerships), Edith Cowan University, Joondalup, Western Australia, Australia School of Paediatrics and Child Health, The University of Western Australia, Crawley, Western Australia, Australia.

Abstract

The objective of this study was to investigate the discriminant validity of commonly used depression and anxiety screening tools in order to determine the most suitable tool for patients with chronic obstructive pulmonary disease (COPD). COPD patients (n = 56) completed the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). These scores were compared to confirmed clinical diagnoses of depression and anxiety using the Mini Neuropsychiatric Interview. HADS depression subscale (HADS-D) sensitivity/specificity was 78/81%; BDI-II 89/77%; HADS anxiety subscale (HADS-A) 71/81%; and BAI 89/62%. HADS-D sensitivity/specificity was improved (100/83%) with the removal of Q4 'I feel as if I am slowed down' and adjusted cut-off (≥5). Removal of BDI-II Q21 'Loss of interest in sex' with adjusted cut-off ≥12 resulted in similar improvement (100/79%). No problematic items were identified for HADS-A or BAI. Previously reported low sensitivity/specificity of the HADS for COPD patients was not replicated. Furthermore, simple modifications of the HADS-D markedly improved sensitivity/specificity for depression.BDI-II, HADS-A and BAI produced acceptable sensitivity/specificity unmodified. Pending further research for COPD patients we recommend continued use of the HADS-A with standard cut-off (≥8) and removal of Q4 of the HADS-D with lower cut-off ≥5.

Keywords: Chronic obstructive pulmonary disease (COPD); anxiety; depression; screening tools; validity.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Anxiety Disorders / diagnosis*
Anxiety Disorders / etiology
Anxiety Disorders / psychology
Depression / diagnosis*
Depression / etiology
Depression / psychology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Psychiatric Status Rating Scales*
Pulmonary Disease, Chronic Obstructive / complications*
Pulmonary Disease, Chronic Obstructive / psychology
ROC Curve
Reproducibility of Results
Surveys and Questionnaires