Dear Steven,
We have some experience of using HADS in the recently concluded Health &
Lifestyle Survey in the UAE. We used a cut off point of 8 to define anxiety
and depression. UK literature also suggests a similar cut off. I have listed
below some of the papers we reviewed while deciding our cut off.
Dowell AC, Biran LA. Problems in using the hospital anxiety and depression
scale for screening patients in general practice. Br J Gen Pract 1990
Jan;40(330):27-8
"Using a threshold score of eight and over, 51% of patients screened by post
were probable 'cases' of psychiatric disorder and using a score of 11 and
over, 28% were 'cases'".
Barczak P, Kane N, Andrews S, Congdon AM, Clay JC, Betts T. Patterns of
psychiatric morbidity in a genito-urinary clinic. A validation of the
Hospital Anxiety Depression scale (HAD). Br J Psychiatry 1988
May;152:698-700
"Case definition by a score of 8 or more on either of the anxiety or
depressive subscales produced optimal results, giving sensitivities of 82%
and 70%, and specificities of 94% and 68%, for depressive and anxiety
disorders respectively".
Hamer D, Sanjeev D, Butterworth E, Barczak P. Using the Hospital Anxiety and
Depression Scale to screen for psychiatric disorders in people presenting
with deliberate self-harm. Br J Psychiatry 1991 Jun;158:782-4
"The HAD performed well as a screening instrument; a threshold score of
eight gave a sensitivity of 88% and a positive predictive value of 80%".
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital
Anxiety and Depression Scale. An updated literature review. J Psychosom Res
2002 Feb;52(2):69-77
In most studies an optimal balance between sensitivity and specificity was
achieved when caseness was defined by a score of 8 or above on both HADS-A
and HADS-D.
The last paper by Bjelland et al reviewed the published papers on HADS and
recommends a cut off of 8. We have to remember that HADS is used only as a
screening instrument in community surveys (at least that is what we
considered in our survey).
Hope you find the above information of some interest/?use.
Cheers & regards,
Badri
Dr.P.Badrinath M.D,M.Phil,(Epid)PhD(Cantab)DFPHM,MPH(Distinc)
Specialist Registrar in PHM & Honorary Clinical Lecturer,
Suffolk Public Health Network & University of Cambridge,
PO Box 170, St.Clement's Hospital,
Ipswich IP1 4LA, UK.
http://myprofile.cos.com/badrishanthi
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