Screening for psychiatric illness in the palliative care inpatient setting: a comparison between the Hospital Anxiety and Depression Scale and the General Health Questionnaire-12

Abstract

The objective of this study was to compare the performance of the Hospital Anxiety and Depression Scale (HADS) with the 12-item General Health Questionnaire (GHQ-12) as a screening instrument for the detection of psychiatric disorders in a palliative care inpatient setting. The results from the HADS and GHQ were compared to diagnoses generated from a semistructured psychiatric interview (Revised Clinical Interview Schedule) using standard receiver operating characteristic analysis. The study was conducted at the Marie Curie Centre, Edinburgh, a 37-bedded palliative care inpatient facility. Out of a total of 282 admissions during the study period, 79 took part in the study. The remainder of patients either refused (69) or were too unwell to participate (134). The HADS was found to be an effective screening tool for identifying depression, with an area under the receiver operating characteristic curve of 0.92. A suggested cut-off of 20 would have a sensitivity of 0.77, a specificity of 0.85 and a positive predictive value (PPV) of 0.48. There was no significant difference between the two subscales in their ability to detect depressive illnesses, although there was a trend for the anxiety subscale to perform better (P < 0.15). The GHQ did not perform as well as the HADS in this type of population. In view of this, it can be concluded that the HADS is a valid screening tool for psychiatric disorders, particularly depression, in a palliative care setting.