Ramirez A J, Richards M A, Jarrett S R, Fentiman I S
ICRF Clinical Oncology Unit, Guy's Hospital, London, UK.
Br J Cancer. 1995 Dec;72(6):1509-12. doi: 10.1038/bjc.1995.538.
The Hospital Anxiety and Depression (HAD) scale, a self-report questionnaire, was tested as a method of identifying mood disorder among patients with operable breast cancer during the year after diagnosis. In a cohort of 91 patients anxiety and depression were assessed preoperatively, and at 3 and 12 months post-operatively, using a standardised psychiatric interview and diagnostic rating criteria. The patients also completed the HAD scale at each assessment. Fifty out of 91 (55%) patients were full or borderline cases of depression and/or anxiety at one or more assessment points. Using a receiver operator characteristic curve analysis, the optimum threshold for the preoperative HAD scale total score to identify psychiatric disorder either preoperatively or at 3 and 12 months post-operatively was 11. With this threshold 70% of both full and borderline cases occurring at any of the assessment points were correctly identified. The false-positive rate was 12%. This approach was particularly sensitive to full cases, correctly identifying 90% of them. The potential for the preoperative HAD scale total score to identify mood disorder in the year after diagnosis was influenced by age. Among women aged less than 50 years, a preoperative HAD scale total score > or = 11 provided a highly sensitive indicator of mood disorder (full and borderline cases) at any time in the year after diagnosis (sensitivity = 90%). The false-positive rate was 40%. Among women older than 50 who experienced a mood disorder, only 57% were correctly identified by a HAD scale total score of > or = 11 (sensitivity = 57%). However, the false-positive rate among older women was low (3%). This simple preoperative screening approach can be used to identify patients who have or are at high risk of developing severe mood disorder in the year after diagnosis. The HAD scale is also sensitive to the detection of borderline mood disorder in patients under the age of 50. It is a specific screening tool among patients over 50, but is not sensitive to the detection of borderline mood disorder in this age group.
医院焦虑抑郁（HAD）量表是一种自填式问卷，被作为一种在可手术乳腺癌患者确诊后一年内识别情绪障碍的方法进行了测试。在一组91名患者中，术前、术后3个月和12个月使用标准化的精神科访谈和诊断评级标准对焦虑和抑郁进行了评估。患者在每次评估时还完成了HAD量表。91名患者中有50名（55%）在一个或多个评估点为抑郁和/或焦虑的完全或临界病例。使用受试者工作特征曲线分析，术前HAD量表总分用于识别术前或术后3个月及12个月精神障碍的最佳阈值为11分。以此阈值，在任何评估点出现的完全和临界病例中有70%能被正确识别。假阳性率为12%。这种方法对完全病例特别敏感，能正确识别其中的90%。术前HAD量表总分在确诊后一年内识别情绪障碍的可能性受年龄影响。在年龄小于50岁的女性中，术前HAD量表总分≥11分是确诊后一年内任何时间情绪障碍（完全和临界病例）的高度敏感指标（敏感性=90%）。假阳性率为40%。在年龄大于50岁且患有情绪障碍的女性中，只有57%通过HAD量表总分≥11分被正确识别（敏感性=57%）。然而，老年女性的假阳性率较低（3%）。这种简单的术前筛查方法可用于识别确诊后一年内患有或有发展为严重情绪障碍高风险的患者。HAD量表对50岁以下患者临界情绪障碍的检测也很敏感。它在50岁以上患者中是一种特异性筛查工具，但对该年龄组临界情绪障碍的检测不敏感。
