Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale
Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale
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DOI：
10.1007/s005200050241
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发表时间：
1999-05-01
影响因子：
3.1
通讯作者：
Morasso, G
中科院分区：
文献类型：
--
作者：
Costantini, M;Musso, M;Morasso, G
意大利版的医院焦虑和抑郁量表的心理测量学特性及其实用性作为一种筛选工具的焦虑和抑郁在非精神病设置进行了评估。在一项III期辅助临床试验中，197名乳腺癌患者随机接受了两次问卷调查：化疗开始前和首次随访时。在132例患者中，使用DSM-III-R的结构化临床访谈在随访时评估精神疾病的存在。因子分析确定了两个严格相关的因素。焦虑和抑郁量表的Crohnbach α介于0.80和0.85之间。在随访中，50名患者（38%）被分配到当前的DSM-III-R诊断，在大多数情况下，适应障碍（24%）或重度抑郁症（10%）。受试者工作特征（ROC）分析用于检验焦虑和抑郁障碍的判别效度。两种量表的曲线下面积（AUC）比较在识别焦虑（P=0.855）或抑郁障碍（P=0.357）方面没有显示任何差异。14项总量表显示出较高的内部一致性（α =0.89和0.88）和对所有精神疾病的较高区分力（AUC=0.89; 95%CI =0.83-0.94）。最大灵敏度（84%）和特异性（79%）的临界点为10。这些结果表明，总分是一个有效的措施，情绪困扰，使意大利版的HADS可以作为精神疾病的筛查问卷。应谨慎考虑使用这两个分量表作为“病例标识符”或作为结局指标。
The psychometric properties of the Italian version of the Hospital Anxiety and Depression Scale and its utility as a screening instrument for anxiety and depression in a non-psychiatric setting were evaluated. The questionnaire was administered twice to 197 breast cancer patients randomised in a phase III adjuvant clinical trial: before the start of chemotherapy and at the first followup visit. The presence of psychiatric disorders was evaluated at the followup visit using the Structured Clinical Interview for DSM-III-R in 132 patients. Factor analyses identified two strictly correlated factors. Crohnbach's alpha for the anxiety and depression scales ranged between 0.80 and 0.85. At follow-up, 50 patients (38%) were assigned a current DSM-III-R diagnosis, in most cases adjustment disorders (24%) or major depressive disorder (10%). Receiver operating characteristics (ROC) analysis was used to test the discriminant validity for both anxiety and depressive disorders. The comparison of the areas under the curve (AUC) between the two scales did not show any difference in identifying either anxiety (P=0.855) or depressive disorders (P=0.357). The 14-item total scale showed a high internal consistency (alpha=0.89 and 0.88) and a high discriminating power for all the psychiatric disorders (AUC=0.89; 95% CI=0.83-0.94). The cut-off point that maximised sensitivity (84%) and specificity (79%) was 10. These results suggest that the total score is a valid measure of emotional distress, so that the Italian version of HADS can be used as a screening questionnaire for psychiatric disorders. The use of the two subscales as a 'case identifier' or as an outcome measure should be considered with caution.