Silverstone P H
Department of Psychiatry, University of Alberta, Edmonton, Canada.
J Psychosom Res. 1994 Jul;38(5):441-50. doi: 10.1016/0022-3999(94)90105-8.
The Hospital Anxiety and Depression scale (HAD) is a brief questionnaire which was designed to indicate the likely presence of a depressive disorder in medically ill patients. However, more recently it has been used in several research studies to determine the presence of depression in both medical and psychiatric patients. The aim of the present study was to validate the usefulness of the HAD when used in this way. The HAD was compared to DSM-III-R diagnoses of major depressive disorder in 153 medical inpatients and 147 psychiatric out-patients. In both groups the sensitivity of the HAD was between 80 and 100% using the cut-off point of 8. However, the positive predictive value (PPV) of the HAD was only 17% in medical patients and 29% in psychiatric patients. Changing the cut-off point for depression or using the total HAD score did not significantly improve the PPV. These findings suggest that the HAD does not accurately determine the presence of DSM-III-R major depressive disorder in medical or psychiatric patients, and should not be used as a research instrument for this purpose. Nonetheless, the HAD should still be used for its original purpose, namely as a clinical indicator as to the possibility of a depressive disorder.
医院焦虑抑郁量表（HAD）是一份简短的问卷，旨在表明内科疾病患者中可能存在的抑郁障碍。然而，最近它已被用于多项研究，以确定内科和精神科患者中是否存在抑郁症。本研究的目的是验证以这种方式使用HAD的有效性。将HAD与153名内科住院患者和147名精神科门诊患者的DSM-III-R重度抑郁症诊断进行比较。在两组中，使用8分的临界值时，HAD的敏感性在80%至100%之间。然而，HAD在内科患者中的阳性预测值（PPV）仅为17%，在精神科患者中为29%。改变抑郁症的临界值或使用HAD总分并未显著提高PPV。这些发现表明，HAD不能准确确定内科或精神科患者中是否存在DSM-III-R重度抑郁症，不应将其用作此目的的研究工具。尽管如此，HAD仍应用于其最初目的，即作为抑郁障碍可能性的临床指标。
