Using the Distress Thermometer and Hospital Anxiety and Depression Scale to screen for psychosocial morbidity in patients diagnosed with colorectal cancer

Abstract

Background: The Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS) are commonly used within oncology settings. However there is a paucity of research comparing these measures to gold standard structured clinical interviews assessing for clinical disorders. The aim of this study is to establish the sensitivity, specificity and optimal cut-off scores on these measures when compared to a clinical interview.

Method: Ninety-nine patients with colorectal cancer completed the DT and HADS and a psychologist-administered gold standard structured clinical interview (the Composite International Diagnostic Interview-CIDI). Receiver Operator Characteristic analyses (ROC) were conducted to establish the optimal cut-off score on the DT and HADS to identify clinical disorders based on the CIDI.

Results: Seventeen patients met criteria for a clinical disorder in the sample. A cut-off score of 4 on the DT indicated acceptable sensitivity (60%) and specificity (67%) to detect a current clinical disorder, while the optimal cut-off for the HADS was 10 (sensitivity=73%, specificity=72%). The area under the ROC values were 0.66 for the DT (95% CI: 0.51, 0.82) and 0.78 for the HADS (95% CI: 0.67, 0.90). The difference in AUC between the two measures was not statistically significant.

Limitations: The limitations to the design and methodology of the study are discussed.

Conclusion: The single item DT performed fairly, however not as well as the longer HADS in identifying clinical disorders amongst oncology patients, particularly anxiety disorders.