Alex Mitchell www.psycho-oncology.infoLorraine GraingerElena Baker-GlennKaren Lord

Department of Cancer & Molecular Medicine, Leicester Royal Infirmary

IPOS 2010, Quebec CityIPOS 2010, Quebec City

T275 - A Large Scale Pragmatic Validation of the HADS for Major Depression in an Ethnically Diverse Cancer PopulationT275 - A Large Scale Pragmatic Validation of the HADS for Major

Depression in an Ethnically Diverse Cancer Population

1. Background1. Background

What methods are used to detect mood disorders?

How often do clinicians look for mood complications?

Methods to Evaluate Depression

Conventional Scales

Short (5-10) Long (10+)

1,2 or 3 Simple QQ15%

Clinical Skills Alone73%

ICD10/DSMIV0%

Short QQ3%

Other/Uncertain9% Other/Uncertain

2%

Use a QQ15%

ICD10/DSMIV13%

Clinical Skills Alone55%

1,2 or 3 Simple QQ15%

Cancer StaffCurrent Method (n=226)

Psychiatrists

Comment: Current preferred method of eliciting symptoms of distress/depression

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

Pre-test Probability

Pos

t-tes

t Pro

babi

lity

Baseline Probability

Depression+

Depression-

Comment: Slide illustrates Bayesian curve – pre-test post test probability for every possible prevalence

2. HADS – Primary Analysis +Meta-Analysis2. HADS – Primary Analysis +Meta-Analysis

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).

Graphical – Screening principles

Non-Depressed

Depressed

# ofIndividuals

Cut-Off

# ofIndividuals

Severity of Depression

HighLow

High Sensitivity >>>>

<<<< low Specificity

ResultsResults

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.

HADS-A = 0.865506 (cut9)HADS-D = 0.900949 (cut7)

HADS-T = 0.916096 (cut15)

~Ethnic Minority~Ethnic Minority

30% in urban areas – largley british south asian(india)

20% in county

15% in hospital care

Ethnic MinoritiesEthnic 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%.

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

ConclusionsConclusions

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.