PT  - JOURNAL ARTICLE
AU  - Christoph Nowak
AU  - Noriane Sievi
AU  - Esther Schwarz
AU  - Christian Clarenbach
AU  - Malcolm Kohler
TI  - Depression in chronic obstructive pulmonary disease: Predictors and accuracy of the hospital anxiety and depression scale (HADS)
DP  - 2014 Sep 01
TA  - European Respiratory Journal
PG  - P4745
VI  - 44
IP  - Suppl 58
4099  - http://erj.ersjournals.com/content/44/Suppl_58/P4745.short
4100  - http://erj.ersjournals.com/content/44/Suppl_58/P4745.full
SO  - Eur Respir J2014 Sep 01; 44
AB  - Background: Depression is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD). The Hospital Anxiety and Depression Scale (HADS) has been extensively used to assess psychological distress in diverse clinical contexts although its validity is doubtful. We examined the diagnostic accuracy of the HADS for depression in COPD.Methods: This cross-sectional cohort included COPD patients between 40-75 years with mild to very severe disease who were enrolled in a multicenter longitudinal trial in Switzerland. Current diagnosis of depression was ascertained through clinical records. Lung function, 6-minute walking test (6-MWT), Medical Research Council (MRC) dyspnea score and COPD Assessment Test (CAT) were evaluated.Results: 259 COPD patients (mean age 62.5 years; 32% female; mean FEV1 48% predicted) were included. Patients diagnosed with depression (29/259; 11.2%) had significantly higher HADS-D and HADS-Total scores than non-depressed patients (median [quartiles] HADS-D 6 [4; 9] vs. 4 [2; 7], median HADS-Total 14 [10; 20] vs. 8 [5; 14]). 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. Corresponding sensitivity and specificity were 62.1% and 62.6% for HADS-D compared to 75.9% and 55.2% for HADS-Total. Younger age, more comorbidities, male sex, and lower airflow limitation predicted existing depression.Conclusion: The HADS exhibited low diagnostic accuracy in identifying current depression in COPD patients. It should not be used as a diagnostic tool in this population.