It is composed of two 7-item subscales (HADS-D and HADS-A for depression and anxiety, resp.) both ranging from 0 to 21 with higher scores indicating more severe distress. The Hospital Anxiety and Depression Scale (HADS ) was originally designed by Zigmond and Snaith in 1983 as a short, easy-to-use, 14-item screening tool for depression and anxiety symptoms in the hospital outpatient setting. Mood and anxiety disorders in patients with COPD are likely underdiagnosed, emphasising the need for a reliable and accurate instrument in the recognition of depression. Impaired lung function is a risk factor for depression with up to 4 in 10 respiratory patients affected. Introductionĭepression is a common comorbidity in chronic obstructive pulmonary disease (COPD) patients. Younger men with comorbidities are at increased risk for depression. The HADS exhibits low diagnostic accuracy for depression in COPD patients. Age, comorbidities, sex, and lower airflow limitation predicted depression. Sensitivity and specificity were 62.1% and 62.6% for HADS-D compared to 75.9% and 55.2% for HADS-Total. Receiver-operating characteristic plots showed moderate accuracy for HADS-D, AUC 0.662 (95%CI 0.601–0.719), and HADS-Total, AUC 0.681 (95%CI 0.620–0.737), with optimal cut-off scores of >5 and >9, respectively. Patients diagnosed with depression (29/259 11.2%) had significantly higher HADS-D and HADS-Total scores than nondepressed patients (median (quartiles) HADS-D 6 versus 4, median HADS-Total 14 versus 8 ). Two hundred fifty-nine COPD patients (mean age 62.5 years 32% female mean FEV1 48% predicted) were included. Lung function, HADS score, 6-minute walking test (6-MWT), MRC dyspnoea score, and COPD Assessment Test (CAT) were evaluated. Diagnosis of depression was ascertained through clinical records. Consecutive COPD patients (GOLD stage I–IV, 40–75 years old) were enrolled in a multicentre, cross-sectional cohort study. The diagnostic accuracy of the Hospital Anxiety and Depression Scale (HADS) and risk factors for comorbid depression in chronic obstructive pulmonary disease (COPD) are addressed. Psychological morbidity is common in chronic respiratory diseases.
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