This is a talk (oral presentation) from IPOS 2010 held in Quebec City, Canada.

1. T275 --A Large Scale Pragmatic Validation of the HADS for Major
T275 A Large Scale Pragmatic Validation of the HADS for Major
Depression in an Ethnically Diverse Cancer Population
Depression in an Ethnically Diverse Cancer Population
Alex Mitchell www.psycho-oncology.info
Lorraine Grainger
Elena Baker-Glenn
Karen Lord
Department of Cancer & Molecular Medicine, Leicester Royal Infirmary
IPOS 2010, Quebec City
IPOS 2010, Quebec City

2. 1. Background
What methods are used to detect mood disorders?
How often do clinicians look for mood complications?

3. Methods to Evaluate Depression
Conventional Scales
Short (5-10) Long (10+)

6. Cancer Staff Psychiatrists
Current Method (n=226)
Other/Uncertain
9% Other/Uncertain
ICD10/DSMIV 2%
0% ICD10/DSMIV
13%
Short QQ
3%
1,2 or 3 Sim ple
QQ
15%
Clinical Skills
Use a QQ Alone
15% 55%
Clinical Skills
Alone
73% 1,2 or 3 Sim ple
QQ
15%
Comment: Current preferred method of eliciting
symptoms of distress/depression

7. 1
Post-test Probability
0.9 Comment: Slide illustrates Bayesian
curve – pre-test post test probability for
every possible prevalence
0.8
0.7
0.6
0.5
0.4
0.3 Baseline Probability
Depression+
0.2
Depression-
0.1
Pre-test Probability
0
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

8. 2. HADS – Primary Analysis +Meta-Analysis

9. We analysed data collected from Leicester Cancer Centre
from 2007-2009 involving approximately 1000 people
approached by a research nurse, research physician and
two therapeutic radiographers.
The researcher applied DSMIV criteria of major depressive
disorder (MDD).
We collated full data on 690 patient assessments of whom
12.9% had MDD, 121 were palliative and 115 (16.7%)
were from ethnic minorities (largely British South Asian
of India descent).

10. Graphical – Screening principles
#
of Cut-Off
Individuals
Low High
Non-Depressed
<<<< low Specificity
Severity of Depression
High Sensitivity >>>> Depressed
#
of
Individuals

11. Results
In the parent sample of 690, the sensitivity and specificity
were as follows
Sensitivity Specificity
HADS-A 87.6% 72.3%
HADS-D 86.5% 80.1%
HADS-T 95.5% 76.3%.
The AUC was highest for HADS-T > HADS-D > HADS-A.

12. HADS-A = 0.865506 (cut9)
HADS-D = 0.900949 (cut7)
HADS-T = 0.916096 (cut15)

13. ~Ethnic Minority
30% in urban areas – largley british south asian
(india)
20% in county
15% in hospital care

14. Ethnic Minorities
Sensitivity and specificity were as follows
HADS-A 93.1% 66.3%
HADS-D 86.2% 65.1%
HADS-T 96.6% 66.3%.

15. HADS-A = 0.846231 (cut9)
HADS-D = 0.796512 (cut7)
HADS-T = = 0.84603 (cut15)

16. Conclusions
In the mixed populations the HADS-D was preferred
In the ethnic minority population and HADS-A or HADS-T
were preferred
There was no difference by cancer stage.