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Some results from MedLine, searching for HADS, access provided by Community of Science in 1996

Citation:Leung CM, Ho S, Kan CS, Hung CH, Chen CN, Evaluation of the Chineseversion of the Hospital Anxiety and Depression Scale. A cross-culturalperspective., Int J Psychosom 40: 1-4, 29-34, , 1993.
The authenticity of the Chinese translation of the HospitalAnxiety and Depression Scale (HAD) was tested in a sample of medical students.The Chinese version demonstrated good agreement with the English original.There was a large difference between the mean anxiety and depression subscores.Factor analysis consistently yielded three factors, suggesting the existenceof a somatic factor. It is suggested that a common cut-off point for thesubscales of the HAD scale is not advisable and a multidimensional modelfor mood disorders is more appropriate in a cross-cultural context.

Citation:Lam CL, Pan PC, Chan AW, Chan SY, Munro C, Can the Hospital Anxietyand Depression (HAD) Scale be used on Chinese elderly in general practice?,Fam Pract 12: 2, 149-54, Jun, 1995.
A study was carried out in a general practice in Hong Kongto find out if the Hospital Anxiety and Depression (HAD) Scale could beused to detect psychological problems in Chinese elderly. The HAD Scalewas translated into Cantonese and administered by an interviewer to 298Chinese aged 60 or above before their doctor consultations. The acceptancerate of the Scale was 96% and each interview took only 5-10 min to complete.All 298 elderly understood and completed the HAD Scale. Validation of theresults of the HAD Scale by the Clinical Interview Schedule (CIS) was doneon a random sample of 100 elderly. Relative operating characteristic (ROC)analysis showed that the optimal cut-off points of the HAD Scale was adepression score of 6 and an anxiety score of 3. The sensitivity was "80%",specificity was 90%, OMR (overall misclassification rate) was 12%, positivepredictive value was 67% and negative predictive value was 95%. Thirty-sixper cent of the elderly had scores above these cut-off points. More femalesthan males had high anxiety scores. Nearly half of those with positiveHAD scores were not known to have any psychological illness. The HAD Scalehas great potential to be used as a screening instrument for psychologicalillnesses in Cantonese-speaking Chinese elderly all over the world.

Citation:Abiodun OA, A validity study of the Hospital Anxiety and DepressionScale in general hospital units and a community sample in Nigeria.,Br J Psychiatry 165: 5, 669-72, Nov, 1994.
BACKGROUND. The utility of the Hospital Anxiety and DepressionScale (HADS) as a screening instrument for anxiety and depressive disordersin non-psychiatric units (medical & surgical wards; gynaecology &antenatal clinics of a teaching hospital) and a community sample in Nigeriawas investigated. METHOD. A two-stage screening procedure was employed.This involved the use of GHQ-12/GHQ-30 and HADS against the criteria ofa standardised (PSE schedule) psychiatric interview, with psychiatric diagnosisassigned in accordance with ICD-9 criteria.

RESULTS. Sensitivity for the anxiety sub-scale ranged from 85.0% inthe medical and surgical wards to 92.9% in the ante-natal clinic, whilesensitivity for the depression sub-scale ranged from 89.5% in the communitysample to 92.1% in the gynaecology clinic. Specificity for the anxietysub-scale ranged from 86.5% in the gynaecology clinic to 90.6% in the communitysample, while specificity for the depression sub-scale ranged from 86.6%in the medical and surgical wards to 91.1% in the ante-natal clinic andcommunity sample. Misclassification rates ranged from 9.9% in the communitysample to 13.2% in the medical and surgical wards. Relative Operating Characteristic(ROC) analyses showed the HADS and the GHQ-12 to be quite similar in abilityto discriminate between cases (anxiety and depression) and non-cases.

CONCLUSIONS. The HADS is valid for use as a screening instrument innon-psychiatric units and although initially developed for use in hospitalsettings, it could be usefully employed in community settings of developingcountries to screen for mental morbidity.

Citation:el-Rufaie OE, Absood GH, Retesting the validity of the Arabic versionof the Hospital Anxiety and Depression (HAD) scale in primary health care.,Soc Psychiatry Psychiatr Epidemiol 30: 1, 26-31, Jan, 1995.
The Arabic version of the Hospital Anxiety and Depression(HAD) scale was retested and cut-off points determined in a sample of 217patients attending a primary health care centre in Al Ain, United ArabEmirates (U.A.E.). Subjects were screened using the HAD scale and all patientswere then interviewed by a single consultant psychiatrist. The scale scoreswere assessed against the psychiatrist's clinical evaluations. The studyfurnished evidence that the Arabic version of the HAD scale is a validinstrument for detecting anxiety and depressive disorders in primary healthcare settings. Spearman rank correlations of all items of the scale weresignificantly above zero. The butterflies item of the anxiety subscalehad the lowest correlation coefficients. The overall Cronbach alpha measuresof internal consistency were 0.7836 and 0.8760 for anxiety and depression,respectively. The cut-off points that produced a balanced combination ofsensitivity and specificity appropriate for referral to a psychiatric facilityby the general practitioner were 6/7 for anxiety and 3/4 for depression.Almost all other similar studies have determined a single cut-off pointfor both subscales of the HAD. This study also indicated that the HAD depressionsubscale is more consistent and more predictive than the HAD anxiety subscale.Moreover some of the problems arising from applying psychiatric researchinstruments across cultures are highlighted by this study.

Citation:Silverstone PH, Poor efficacy of the Hospital Anxiety and DepressionScale in the diagnosis of major depressive disorder in both medical andpsychiatric patients., J Psychosom Res 38: 5, 441-50, Jul, 1994.
The Hospital Anxiety and Depression scale (HAD) is a briefquestionnaire which was designed to indicate the likely presence of a depressivedisorder in medically ill patients. However, more recently it has beenused in several research studies to determine the presence of depressionin both medical and psychiatric patients. The aim of the present studywas to validate the usefulness of the HAD when used in this way. The HADwas compared to DSM-III-R diagnoses of major depressive disorder in 153medical inpatients and 147 psychiatric out-patients. In both groups thesensitivity of the HAD was between 80 and "100%" using the cut-off pointof 8. However, the positive predictive value (PPV) of the HAD was only17% in medical patients and 29% in psychiatric patients. Changing the cut-offpoint for depression or using the total HAD score did not significantlyimprove the PPV. These findings suggest that the HAD does not accuratelydetermine the presence of DSM-III-R major depressive disorder in medicalor psychiatric patients, and should not be used as a research instrumentfor this purpose. Nonetheless, the HAD should still be used for its originalpurpose, namely as a clinical indicator as to the possibility of a depressivedisorder.

Citation:Maher EJ, Mackenzie C, Young T, Marks D, The use of the HospitalAnxiety and Depression Scale (HADS) and the EORTC QLQ-C30 questionnairesto screen for treatable unmet needs in patients attending routinely forradiotherapy., Cancer Treat Rev 22 Suppl A: 123-9, Jan, 1996.

Citation:Javed MA, Psychiatric morbidity among male students., JPMA JPak Med Assoc 44: 4, 85-6, Apr, 1994.
An epidemiological study was conducted to assess the mentalhealth problems of first year male students studying in two educationalinstitutions. Based on the findings of general health questionnaire andhospital anxiety and depression scale, the estimated prevalence of psychologicaldisturbance was found to be 33% for the whole sample. Present findingsare discussed in terms of early identification and provision of betterhealth facilities for the students population.

Citation:Paterson AJ, Lamb AB, Clifford TJ, Lamey PJ, Burning mouth syndrome:the relationship between the HAD scale and parafunctional habits.,J Oral Pathol Med 24: 7, 289-92, Aug, 1995.
This study investigated 84 patients with burning mouth syndrome(BMS), who were asked to complete a hospital anxiety and depression (HAD)scale questionnaire. A control group of 69 patients was also included.All patients were interviewed regarding parafunctional habits and weresubjectively examined for signs of occlusal wear of the natural teeth ordentures. The results demonstrated that parafunctional habits were presentin 61% of patients with BMS. There was a statistically significantly relationshipbetween parafunctional habits and anxiety as indicated by the HAD scale,but not with depression.

Citation:Clark DA, Steer RA, Use of nonsomatic symptoms to differentiateclinically depressed and nondepressed hospitalized patients with chronicmedical illnesses., Psychol Rep 75: 3 Pt 1, 1089-90, Dec, 1994.
The differential sensitivity of the Depression subscale scoresof the Hospital Anxiety and Depression Scale and the Cognitive-Affectivesubscale scores of the revised Beck Depression Inventory were comparedfor 21 chronic medically ill hospitalized patients with DSM-III--R unipolardepressive disorders and 54 hospitalized medically ill patients withouta comorbid psychiatric disorder. Both subscales significantly differentiatedthese two types of patients beyond the .001 level and yielded comparableeffect sizes. The Cognitive-Affective subscale detected clinical depressionas well as a specialized self-report measure.

Citation:Psychological factors associated with oral lichen planus., JOral Pathol Med 273-5, Jul, 1995.
50 patients with oral lichen planus (LP) were investigatedfor current anxiety and depression and for related personality factors.Anxiety levels, as measured on the Hospital Anxiety and Depression (HAD)Scale, were elevated in 50% of cases while depression scores, measuredon the same scale, were low in all but a few. The sample profile showeda slight tendency towards anxiety, as measured by the Cattell 16 PF Questionnaire,but did not confirm previous reports of high intelligence and intellectualorientation. There were no statistically significant associations betweenerosive oral LP and either anxiety or depression, as measured on the HADScale, or anxiety as measured by the Cattell 16 PF Questionnaire.

Citation:Farooq S, Gahir MS, Okyere E, Sheikh AJ, Oyebode F, Somatization:a transcultural study., J Psychosom Res 39: 7, 883-8, Oct, 1995.
The primary aim of this study was to investigate the comparativerates of somatic complaints between Asian and Caucasian patients in a primarycare setting and to characterize the factors associated with increasedrates of somatization. One hundred and ninety-five individuals aged between16 and 65 yr were interviewed with the Bradford Somatic Inventory (BSI)and the Hospital Anxiety and Depression Scale (HAD) respectively. The mainfinding was that the Asian patients reported significantly more somaticand depressive symptoms than the Caucasian patients. Ethnicity was themost important variable determining this result.

Citation:Velikova G, Selby PJ, Snaith PR, Kirby PG, The relationship of cancerpain to anxiety., Psychother Psychosom 63: 3-4, 181-4, , 1995.
The interaction between pain and anxiety in the setting ofsomatic illness is a widely recognised association. More accurate knowledgeabout the association and also about the means of assessing anxiety ina clinical setting are of use to the clinician. The present study usedthe Hospital Anxiety and Depression Scale for assessment of anxiety, andthe set of linear analogue scales for detecting the presence and severityof anxiety and pain in an oncology clinic, where patients were undergoingactive treatment for cancer. The relationship between pain and anxietywas found to be significant, even when the possible mediating effect ofthe variables of illness severity and age were removed. The need for detectinganxiety in order to plan treatment strategy is emphasised.

Citation:Caplan RP, Stress, anxiety, and depression in hospital consultants,general practitioners, and senior health service managers [see comments],BMJ 309: 6964, 1261-3, Nov 12, 1994.
OBJECTIVE--To study stress, anxiety, and depression in agroup of senior health service staff.

DESIGN--Postal survey.

SUBJECTS--81 hospital consultants, 322 general practitioners, and 121senior hospital managers (total 524). MAIN OUTCOME MEASURES--Scores onthe general health questionnaire and the hospital anxiety and depressionscale.

RESULTS--Sixty five ("80%") consultants, 257 ("80%") general practitioners,and 67 (56%) managers replied. Of all 389 subjects, 183 (47%) scored positivelyon the general health questionnaire, indicating high levels of stress.From scores on the hospital anxiety and depression scale only 178 (46%)would be regarded as free from anxiety, with 100 (25%) scoring as borderlinecases and 111 (29%) likely to be experiencing clinically measurable symptoms.The findings for depression were also of some concern, especially for generalpractitioners, with 69 (27%) scoring as borderline or likely to be depressed.General practitioners were more likely to be depressed than managers (69(27%) v 4 (6%) scored > or = 8 on hospital anxiety and depression scale-D;P = 0.004) with no significant difference between general practitionersand consultants. General practitioners were significantly more likely toshow suicidal thinking than were consultants (36 (14%) v 3 (5%); P = 0.04)but not managers (9 (13%)). No significant difference could be found betweenthe three groups on any other measure.

CONCLUSIONS--The levels of stress, anxiety, and depression in seniordoctors and managers in the NHS seem to be high and perhaps higher thanexpected.

Citation:Pergami A, Catalan J, Hulme N, Burgess A, Gazzard B, How shoulda positive HIV result be given? The patients' view., AIDS Care 6:1, 21-7, , 1994.
The study aimed at obtaining information about the experienceof how the diagnosis of HIV infection was given. Thirty asymptomatic HIVseropositive subjects completed a self-report questionnaire enquiring abouttheir views of the process of communication of a positive test result.Subjects' current mood was assessed with the Hospital Anxiety and DepressionScale (HAD). Only about one-third of subjects were definitely satisfiedwith the way they were told the diagnosis. Satisfaction was associatedwith perceived reassurance and sympathy, and with the quality of the informationgiven. The views of patients, as reported in this study, should be takeninto account when training staff in the notification of HIV test results.

Citation:Bottomley A, The development of the Bottomley Cancer Social SupportScale., Eur J Cancer Care (Engl) 4: 3, 127-32, Sep, 1995.
At present, no social support scale exists that is cancer-specific.The objective of the study was to develop a cancer-specific scale thatnot only had validity in reflecting the experiences of cancer patients,but also one that was quick and easy to use in a busy clinical environment.Sixty patients with a primary diagnosis of cancer were selected from oncologywards and out-patient clinics, and they were administered the BottomleySocial Support Scale and the Hospital Anxiety and Depression Scale. Theresults indicate a valid and reliable social support scale that could beused in conjunction with other measures in a clinical setting. The clinicalimplications of the measure are that it will allow medical and supportstaff to assess the levels of social support and implement any appropriatesocial support interventions.

Citation:von Essen L, Burstrom L, Sjoden PO, Perceptions of caring behaviorsand patient anxiety and depression in cancer patient-staff dyads.,Scand J Caring Sci 8: 4, 205-12, , 1994.
Cancer patient and staff perceptions of the importance ofcaring behaviors (Caring Assessment Instrument, CARE-Q) and patient levelsof anxiety and depression (Hospital Anxiety and Depression Scale, HADS)were determined in 19 matched patient-staff dyads. Both groups perceivedcomforting and anticipating behaviors to be among the most important ones.Patients considered behaviors focused on staff explaining and facilitatingto be more important than did staff, whereas staff rated behaviors concerningaccessibility as more important than did patients. Patient and staff perceptionsof the importance of comforting behaviors were negatively associated. Nosignificant mean value difference or correlation was found on the HADSanxiety or depression subscales. Members of matched patient-staff dyadsdid not agree strongly on the importance of caring behaviors and patientlevels of anxiety and depression.

Citation:Kurer JR, Watts TL, Weinman J, Gower DB, Psychological mood of regulardental attenders in relation to oral hygiene behaviour and gingival health.,J Clin Periodontol 22: 1, 52-5, Jan, 1995.
This study examined the relationship between psychologicalmood, stress and oral hygiene behaviour in a group of 51 regular dentalattenders. Subjects brought a saliva sample for cortisol radioimmunoassay,completed the Hospital Anxiety and Depression (HAD) Scale, were assessedfor plaque and gingivitis, and were then instructed in toothbrushing. 5weeks later, 47 subjects were given a full repeat examination. There wasa slight reduction in plaque and gingivitis scores, but no change in moodas assessed by HAD Scale and salivary cortisol concentration. Mean anxietyscores were associated with gingivitis level, and mean depression scoreswith plaque. Neither mood nor cortisol were predictors of subsequent changein plaque or gingivitis.

Citation:Canney PA, Hatton MQ, The prevalence of menopausal symptoms in patientstreated for breast cancer., Clin Oncol (R Coll Radiol) 6: 5,297-9, , 1994.
A survey has been performed to discover the prevalence ofmenopausal symptoms in 108 patients successfully treated for breast cancer.Patients were assessed by them answering a custom designed questionnaire,and the use of the Hospital Anxiety and Depression (HAD) scale and theGreene Climacteric Scale. During the first year after treatment 70% ofwomen suffered such symptoms; overall 60% of women surveyed were affected.Adjuvant hormonal treatment was the largest contributing factor in thedevelopment of symptoms. There was a relationship with borderline casesof anxiety, but not with definite cases of anxiety, as measured by theHAD scale. The high proportion of women shown to be affected means thattreatment of menopausal symptoms should be incorporated into randomizedtrials of adjuvant therapy.

Citation:Millar K, Jelicic M, Bonke B, Asbury AJ, Assessment of preoperativeanxiety: comparison of measures in patients awaiting surgery for breastcancer., Br J Anaesth 74: 2, 180-3, Feb, 1995.
We have compared three measurements of anxiety to determinetheir equivalence in assessing anxiety before surgery. Forty-four patientsawaiting breast cancer surgery completed the state scale of the state-traitanxiety inventory (STAI), the hospital anxiety and depression scale (HAD)and a 100-mm visual analogue scale (VAS). Analysis restricted to correlationsbetween the scales gave the misleading impression that VAS scores wereinconsistent with those of the HAD and STAI. However, when scores wereconsidered in relation to normative cut-off values to categorize anxietylevels, the three scales showed good agreement. We conclude that the scaleswere equivalent in their assessment of anxiety before surgery, but thatreference to normative data was important in establishing such equivalenceand in determining the patient's state.

Citation:Pattison HM, Robertson CE, The effect of ward design on the well-beingof post-operative patients., J Adv Nurs 23: 4, 820-6, Apr, 1996.
Changes in the design of hospital wards have usually beendetermined by architects and members of the nursing and medical professions;the views and preferences of patients have seldom been sought directly.The Hospital Anxiety and Depression scale and the Disturbance Due to HospitalNoise questionnaire were administered to 64 female patients on bay andNightingale wards together with a questionnaire designed for this study.Perceptions of social and physical factors of ward design were examined,and their relationship to psychological well-being and sleep patterns.The results show that the bay ward seemed to offer a more favourable environmentfor patients but some of the disadvantages of bay wards are balanced bybetter staffing levels and better and more modern facilities. Visibilityto nurses was lower on the bay ward. The Nightingale ward was perceivedas significantly noisier than the bay ward and noise levels were significantlycorrelated to anxiety scores. Paradoxically the increase in noise levelsappeared to improve the perceived level of privacy on the Nightingale ward.Seventy-five per cent of patients were found to prefer the bay ward design,and since neither design appears to have major disadvantages their continuedintroduction should be encouraged. However, recommendations are made concerningthe optimizing of patients' well-being within the bay ward setting.

Citation:Pattison HM, Robertson CE, The effect of ward design on the well-beingof post-operative patients., J Adv Nurs 23: 4, 820-6, Apr, 1996.
Changes in the design of hospital wards have usually beendetermined by architects and members of the nursing and medical professions;the views and preferences of patients have seldom been sought directly.The Hospital Anxiety and Depression scale and the Disturbance Due to HospitalNoise questionnaire were administered to 64 female patients on bay andNightingale wards together with a questionnaire designed for this study.Perceptions of social and physical factors of ward design were examined,and their relationship to psychological well-being and sleep patterns.The results show that the bay ward seemed to offer a more favourable environmentfor patients but some of the disadvantages of bay wards are balanced bybetter staffing levels and better and more modern facilities. Visibilityto nurses was lower on the bay ward. The Nightingale ward was perceivedas significantly noisier than the bay ward and noise levels were significantlycorrelated to anxiety scores. Paradoxically the increase in noise levelsappeared to improve the perceived level of privacy on the Nightingale ward.Seventy-five per cent of patients were found to prefer the bay ward design,and since neither design appears to have major disadvantages their continuedintroduction should be encouraged. However, recommendations are made concerningthe optimizing of patients' well-being within the bay ward setting.

Citation:Jenkins PL, Lester H, Alexander J, Whittaker J, A prospective studyof psychosocial morbidity in adult bone marrow transplant recipients.,Psychosomatics 35: 4, 361-7, Jul-Aug, 1994.
Forty recipients of bone marrow transplantation were recruitedprospectively and assessed pretransplant, at 1 month postdischarge, andat 6 months postdischarge between 1989 and 1990. Assessments included apsychiatric interview, a variety of standardized questionnaires (HospitalAnxiety and Depression Scale, Mental Attitude to Cancer Scale, PsychosocialAdjustment to Illness Scale), and a standardized diagnostic interview.The influence of factors such as depression and anxiety upon length ofstay, survival, psychosocial adjustment, and negative prognostic attitudeswere examined. In contrast to other studies, little influence was foundfor psychiatric illness on physical outcome variables, but they did affectpsychosocial outcome. The implications of these findings are discussed.

Citation:Jadresic D, Riccio M, Hawkins DA, Wilson B, Shanson DC, Thompson C,Long-term impact of HIV diagnosis on mood and substance use--St Stephen'scohort study., Int J STD AIDS 5: 4, 248-52, Jul-Aug, 1994.
Twenty HIV positive and 68 HIV negative subjects were assessedby the Hospital Anxiety and Depression Scale and by the Alcohol and DrugsFrequency Schedule immediately prior to notification of their HIV serostatusand 6 months after serodiagnosis. The 2 groups did not differ significantlyin levels of anxiety or depression at baseline or follow-up. There wereborderline levels of pathological anxiety prior to notification of HIVserostatus in both groups. The drop to normal levels of anxiety which hadoccurred by follow-up was significant in the HIV positive group. Abouta third of subjects in both groups were regularly making use of alcoholand/or drugs, both at baseline and follow-up. Mean levels of weekly alcoholintake for both groups ranged from about 20 to 30 units per week. The drugsmost commonly used (in any frequency) were nitrates ('poppers') and cannabis.

Citation:Pritchard CW, Depression and smoking in pregnancy in Scotland.,J Epidemiol Community Health 48: 4, 377-82, Aug, 1994.
OBJECTIVE--The aim was to examine the association betweendepressive symptoms and smoking in pregnancy and to investigate the partplayed by social and psychosocial factors. SETTING--A single Glasgow hospital.

DESIGN--Prospective survey by postal questionnaires at 20 and 30 weeks'gestation. PARTICIPANTS--A total of 395 women (69% of the 572 eligible)parity 1 who booked for delivery between November 1988 and February 1990took part. MEASUREMENTS--Depressive symptoms were measured using the HospitalAnxiety and Depression Scale. Smoking was self reported. The Life EventsInventory and measures of role specific strain and stress in domestic roleswere used to assess psychosocial well being. MAIN

RESULTS--Smokers were more likely than non-smokers to experience depressivesymptoms at 20 and 30 weeks' gestation and on both occasions. The excessrisk remained substantial and significant after adjustment for social andpsychosocial factors.

CONCLUSIONS--Smoking is a significant risk factor for depression inpregnancy. The association of smoking with depression and psychosocialdifficulty represents a major problem for interventions intended to reducesmoking in pregnancy.

Citation:Johnson G, Burvill PW, Anderson CS, Jamrozik K, Stewart-Wynne EG, ChakeraTM, Screening instruments for depression and anxiety following stroke:experience in the Perth community stroke study., Acta Psychiatr Scand 91: 4, 252-7, Apr, 1995.
Evaluation of the relative efficacy of three screening instrumentsfor depression and anxiety in a group of stroke patients was undertakenas part of the Perth community stroke study. Data are presented on thesensitivity and specificity of the Hospital Anxiety and Depression Scale(HAPS), the Geriatric Depression Scale and the General Health Questionnaire(GHQ) (28-item version) in screening patients 4 months after stroke fordepressive and anxiety disorders diagnosed according to DSM-III criteria.The GHQ-28 and GDS but not the HADS depression, were shown to be satisfactoryscreening instruments for depression, with the GHQ-28 having an overallsuperiority. The performance of all 3 scales for screening post-strokeanxiety disorders was less satisfactory. The HADS anxiety had the bestlevel of sensitivity, but the specificity and positive predictive valueswere low and the misclassification rate high.

Citation:Malasi TH, Mirza IA, el-Islam MF, Validation of the Hospital Anxietyand Depression Scale in Arab patients., Acta Psychiatr Scand 84:4, 323-6, Oct, 1991.
The Hospital Anxiety and Depression Scale (HADS) was administeredto psychiatric out-patients with various diagnoses to assess its validity.The study was also designed to find out whether HADS can differentiatebetween diagnostic groups based on depression and anxiety symptoms. HADSwas able to discriminate patients from controls at a sensitivity of 79%and specificity of 87%. HADS was much less sensitive, specific and diagnosticallyaccurate in identifying anxiety and depressive disorders in the experimentalgroup at a cut-off point of 13 and 10 respectively for both conditions.Possible psychological, social and psychiatric reasons for the resultsare discussed.

Citation:Mumford DB, Tareen IA, Bajwa MA, Bhatti MR, Karim R, The translationand evaluation of an Urdu version of the Hospital Anxiety and DepressionScale., Acta Psychiatr Scand 83: 2, 81-5, Feb, 1991.
The translation of the Hospital Anxiety and Depression Scale(HADS) into Urdu was undertaken by the authors in committee. After examininginitial drafts by 6 independent translators, an agreed Urdu text was givento 6 back-translators, and subsequently modified further. The evaluationof the new translation was performed in 3 stages: evaluation of linguisticequivalence of items in a bilingual population; evaluation of conceptualequivalence by examining item-subscale correlations: and evaluation ofscale equivalence by 2-way classification of high and low scorers. Satisfactoryresults at each stage suggest that the Urdu version is a reliable and validtranslation of the HADS for use in Pakistan.

Citation:Upadhyaya AK, Stanley I, Hospital anxiety depression scale [letter],Br J Gen Pract 43: 373, 349-50, Aug, 1993.

Citation:Carroll BT, Kathol RG, Noyes R Jr, Wald TG, Clamon GH, Screeningfor depression and anxiety in cancer patients using the Hospital Anxietyand Depression Scale., Gen Hosp Psychiatry 15: 2, 69-74, Mar,1993.
Nine hundred and thirty inpatients and out-patients with cancerwere approached to complete the Hospital Anxiety and Depression Scale (HADS).Eight hundred and nine (86.9%) of those approached participated in thisscreening. Using the suggested cutoff score of 8 for the anxiety and depressionsubscales, we found that 47.6% of this population would warrant furtherpsychiatric evaluation. Twenty-three percent (23.1%) had scores 11 or greaterand would be the most likely to have had anxiety (17.7%) or depressive(9.9%) disorders based on DSM-III-R criteria. Patients with active malignantdisease and inpatient status were more likely to have higher depressionscores. The HADS was an easily administered tool that identified a largeproportion of cancer patients as having high levels of anxiety or depression.However, clinical psychiatric interviews were not performed, so it is notpossible to determine what proportion of patients would benefit from treatment.

Citation:Snaith RP, The hospital anxiety and depression scale [letter; comment],Br J Gen Pract 40: 336, 305, Jul, 1990.

Citation:Mumford DB, Hospital anxiety and depression scale [letter; comment],Br J Psychiatry 159: 729, Nov, 1991.

Citation:Thapar AK, Thapar A, Psychological sequelae of miscarriage: a controlledstudy using the general health questionnaire and the hospital anxiety anddepression scale., Br J Gen Pract 42: 356, 94-6, Mar, 1992.
This study was carried out to assess whether psychiatricmorbidity after a miscarriage is higher than that associated with earlypregnancy. A total of 60 consecutive women admitted to a Swansea hospitalwith a miscarriage were compared with 62 consecutive women who attendedan antenatal clinic at the same hospital, using the 28-item general healthquestionnaire and the hospital anxiety and depression scale. These werecompleted both at initial contact and six weeks later. Women who had hada miscarriage were found to be significantly more anxious and scored higheron the subscale for severe depression than the pregnant women, both atinitial assessment and six weeks later. At the six week assessment moresomatic symptoms were also experienced by the group who had had a miscarriage.This study highlights the psychological disturbance associated with miscarriage.The primary health care team and hospital staff need to take this intoconsideration when organizing follow up for women who have had a miscarriage.

Citation:Dowell AC, Biran LA, Problems in using the hospital anxiety anddepression scale for screening patients in general practice [see comments],Br J Gen Pract 40: 330, 27-8, Jan, 1990.
A study was made of the feasibility of screening generalpractice patients for anxiety and depression using the hospital anxietyand depression scale. A group of consecutive patients aged 18 years andover completed the questionnaire at the surgery and an age and sex matchedsample were sent questionnaires by post; 94 patients (84%) returned thepostal questionnaire. A further group of 170 consecutive patients comingfor consultation were recruited. Using a threshold score of eight and over,51% of patients screened by post were probable 'cases' of psychiatric disorderand using a score of 11 and over, 28% were 'cases'. These proportions weresimilar for patients screened when attending the surgery. The findingsare discussed in the context of well-person screening, and a strategy forfollow-up of probable cases is put forward.

Citation:Snaith RP, Availability of the hospital anxiety and depression (HAD)scale [letter; comment], Br J Psychiatry 161: 422, Sep, 1992.

Citation:Lewis G, Wessely S, Comparison of the General Health Questionnaireand the Hospital Anxiety and Depression Scale [see comments], Br JPsychiatry 157: 860-4, Dec, 1990.
The specificity and sensitivity of the HAD, 12-item GHQ andCIS were calculated by comparing the scores of dermatological patientson these tests with a criterion measure of disorder. Since psychiatry,along with many other branches of medicine, does not have an error-freecriterion, it was assumed that the criterion was an underlying latent constructwhich was measured by all of the tests and could be derived by factor analysisfrom the scores on them. No differences were found between the two questionnaires(HAD and GHQ) in their ability to detect cases of minor psychiatric disorderalthough they were somewhat less reliable than the CIS.

Citation:Nayani S, The evaluation of psychiatric illness in Asian patientsby the Hospital Anxiety Depression Scale [see comments], Br J Psychiatry 155: 545-7, Oct, 1989.
Twenty Asian psychiatric patients suffering from neuroticillness completed the Urdu version of the HAD Scale. The results were comparedwith the Clinical Interview Schedule. Somatic symptoms were significantlyrelated to various measures of anxiety but not to those of depression.This finding contradicts the previously held view of linking somatic symptomswith the presentation of depression.

Citation:Hamer D, Sanjeev D, Butterworth E, Barczak P, Using the HospitalAnxiety and Depression Scale to screen for psychiatric disorders in peoplepresenting with deliberate self-harm., Br J Psychiatry 158:782-4, Jun, 1991.
In-patients referred to a deliberate self-harm team wereasked to complete the HAD questionnaire and diagnoses were made using theSCID. The total prevalence of psychiatric disorder by DSM-III criteriawas 54%. The HAD performed well as a screening instrument; a thresholdscore of eight gave a sensitivity of 88% and a positive predictive valueof "80%"; its use by non-psychiatrists to detect depressive disorder in patientspresenting with deliberate self-harm is to be recommended.

Citation:Moorey S, Greer S, Watson M, Gorman C, Rowden L, Tunmore R, RobertsonB, Bliss J, The factor structure and factor stability of the hospitalanxiety and depression scale in patients with cancer [see comments],Br J Psychiatry 158: 255-9, Feb, 1991.
An exploratory factor analysis of the HAD was carried outin 568 cancer patients. Two distinct, but correlated, factors emerged whichcorresponded to the questionnaire's anxiety and depression subscales. Thefactor structure proved stable when subsamples of the total sample wereinvestigated. The internal consistency of the two subscales was also high.These results provide support for the use of the separate subscales ofthe HAD in studies of emotional disturbance in cancer patients.

Citation:Herrmann C, Scholz KH, Kreuzer H, [Psychologic screening of patientsof a cardiologic acute care clinic with the German version of the HospitalAnxiety and Depression Scale], Psychother Psychosom Med Psychol 41:2, 83-92, Feb, 1991.
A German version of the HAD-scale which had originally beendeveloped by Zigmond and Snaith for assessing psychological morbidity inmedical patients was tested in 136 medical students, 18 psychiatric and531 cardiologic patients. Its validity, reliability and acceptance werefound to be satisfactory, its integration into medical routine did notraise any problems. Among 203 patients with suspected coronary heart disease(137 men, 66 women; mean age 54 +/- 10 years) the sub-group with high (vs.normal) HAD anxiety scores showed a significantly higher number of negativeexercise tests (p less than .05) and coronary angiograms (p = .01; n =60). Hence, the German HAD version seems to be suitable for a psychologicalscreening of cardiologic patients. In patients with suspected coronaryheart disease it improves the non-invasive differentiation between organicand functional causes of chest pain.

Citation:Jelicic M, Bonke B, Millar K, Clinical note on the use of denialin patients undergoing surgery for breast cancer., Psychol Rep 72:3 Pt 1, 952-4, Jun, 1993.
44 patients awaiting surgery for breast cancer completedthe Hospital Anxiety and Depression Scale. Thirteen patients had anxietyscores within the normal range, and five of them even scored extremelylow in anxiety. These five and possibly all 13 patients were probably usingdenial as a defense against the stress of major surgery.

Citation:Ali B, Saud Anwar M, Mohammad SN, Lobo M, Midhet F, Ali SA, Saud M[corrected to Saud Anwar M], Psychiatric morbidity: prevalence, associatedfactors and significance [published erratum appears in JPMA J Pak Med Assoc1994 Apr;44(4):102], JPMA J Pak Med Assoc 43: 4, 69-70, Apr,1993.
A cross-sectional observational systematic study was carriedout on ambulatory patients at a tertiary care hospital to determine theprobable prevalence, associated factors and significance of psychiatricmorbidity by using an Urdu translation of the hospital anxiety and depression(HAD) scale over a period of 6 days in a week. Results showed a prevalenceof 38.4% which is slightly higher than what has been generally reported(30%). Two variables, i.e., female sex and being a housewife were significantlyrelated with the outcome. An attempt has been made to identify the probablereasons for this and some suggestions laid down for further work.

Citation:Zakrzewska JM, Feinmann C, A standard way to measure pain and psychologicalmorbidity in dental practice., Br Dent J 169: 10, 337-9, Nov24, 1990.
Dental surgeons are continually faced with patients in pain.In complicated cases, a measure of pain and its psychological consequencesare essential. The McGill Pain Questionnaire measures pain using 78 descriptorsand is useful not only in diagnosis but in monitoring treatment outcome.The Hospital Anxiety and Depression Scale is a simple way of assessinganxiety and depression in non psychiatric out-patient clinics. These twoscales are compared with other measures that can be used.

Citation:Hopwood P, Howell A, Maguire P, Screening for psychiatric morbidityin patients with advanced breast cancer: validation of two self-reportquestionnaires., Br J Cancer 64: 2, 353-6, Aug, 1991.
Eighty-one patients with advanced breast cancer completedthe Hospital Anxiety and Depression Scale (HADS) and Rotterdam SymptomChecklist (RSCL) to determine how well these questionnaires identifiedpatients suffering from an anxiety state or depressive illness, comparedwith an independent interview by a psychiatrist who used the Clinical InterviewSchedule. A threshold score was defined for each questionnaire which gavethe optimal sensitivity and specificity. Seventy-five per cent of patientswere correctly identified as suffering from an affective disorder by boththe Rotterdam Symptom Checklist and by the Hospital Anxiety and DepressionScale. Twenty-one per cent of 'normal' patients were misclassified by theRotterdam Checklist and 26% by the Hospital Anxiety and Depression Scale.When the HADs anxiety and depression subscales were analysed separately,the performance of the anxiety items was superior to that of the depressionitems. Both questionnaires were found to have good predictive value andcould be used in patients with advanced cancer to help screen out thosewith an affective disorder.

Citation:Silverstone PH, Low self-esteem in eating disordered patients inthe absence of depression., Psychol Rep 67: 1, 276-8, Aug, 1990.
Both low self-esteem and depression are well recognised asoccurring in patients with eating disorders. 43 patients with eating disorderswere studied to assess whether this low self-esteem occurred as part ofan affective disorder or was independent of this. The patients, 23 withanorexia nervosa and 20 with bulimia nervosa, were assessed for low self-esteem,using the Rosenberg Self-esteem Questionnaire, and for depression, usingthe Hospital Anxiety and Depression Scale. The patients had low self-esteem,despite only a minority (33%) being depressed. This study demonstratesthat low self-esteem occurs in patients with eating disorders in the absenceof depression.

Citation:Thompson DR, Meddis R, A prospective evaluation of in-hospital counsellingfor first time myocardial infarction men., J Psychosom Res 34:3, 237-48, , 1990.
Self-ratings of anxiety and depression were studied oversix months in 60 male patients, under 66 yr of age, who were admitted toa coronary care unit with a first time acute myocardial infarction. Patientswere randomly assigned to either a treatment group, where they receiveda simple programme of in-hospital counselling in addition to routine care,or to a control group, where they received routine care only. All patientscompleted the Hospital Anxiety and Depression scale and a battery of visualanalogue scales measuring anxiety on a range of topics related to recoveryfrom a myocardial infarction. Patients who received in-hospital counsellingreported statistically significantly less anxiety and depression than thosewho received routine care alone. This effect was sustained for six monthsafter leaving hospital. It is concluded that a simple programme of in-hospitalcounselling, provided by a coronary care nurse, is efficacious and shouldbe routinely offered to first myocardial infarction patients in hospital.

Citation:Thompson DR, Meddis R, Wives' responses to counselling early aftermyocardial infarction., J Psychosom Res 34: 3, 249-58, , 1990.
Self-ratings of anxiety and depression were studied oversix months in 60 wives of first time myocardial infarction patients. Coupleswere randomly assigned to either a treatment group, where they receiveda simple programme of education and psychological support in addition toroutine care, or to a control group, where they received routine care only.All wives completed the Hospital Anxiety and Depression scale and a batteryof visual analogue scales measuring anxiety on a range of topics relatedto recovery from a heart attack. Wives in the treatment group reportedstatistically significantly less anxiety than controls. This effect wassustained for six months after the counselling. It is concluded that asimple programme of in hospital counselling is efficacious and should beroutinely offered to the wives of coronary patients.

Citation:Wands K, Merskey H, Hachinski VC, Fisman M, Fox H, Boniferro M, Aquestionnaire investigation of anxiety and depression in early dementia.,J Am Geriatr Soc 38: 5, 535-8, May, 1990.
We report findings on a study of anxiety and depression byquestionnaire in 50 patients with mild dementia and 134 control subjectsusing the Hospital Anxiety and Depression Scale. Thirty-eight percent ofpatients and 9% of controls had a possible or probable diagnosis of ananxiety disorder. Possible or probable depression was found in 28% of thepatients and 3% of the controls. These rates for the patients were abovethose in normal populations. All patients and control subjects were testedwith the Extended Scale for Dementia (ESD). Neither group showed a significantrelationship between depression and ESD scores. In the control subjectsthere was a negative correlation (P less than .006) between anxiety andcognitive scores, one that was not found in the patients.

Citation:Lewin B, Robertson IH, Cay EL, Irving JB, Campbell M, Effects ofself-help post-myocardial-infarction rehabilitation on psychological adjustmentand use of health services., Lancet 339: 8800, 1036-40, Apr25, 1992.
A home-based exercise programme has been found to be as usefulas a hospital-based one in improving cardiovascular fitness after an acutemyocardial infarction. To find out whether a comprehensive home-based programmewould reduce psychological distress, 176 patients with an acute myocardialinfarction were randomly allocated to a self-help rehabilitation programmebased on a heart manual or to receive standard care plus a placebo packageof information and informal counselling. Psychological adjustment, as assessedby the Hospital Anxiety and Depression Scale, was better in the rehabilitationgroup at 1 year. They also had significantly less contact with their generalpractitioners during the following year and significantly fewer were readmittedto hospital in the first 6 months. The improvement was greatest among patientswho were clinically anxious or depressed at discharge from hospital. Thecost-effectiveness of the home-based programme has yet to be compared withthat of a hospital-based programme, but the findings of this study indicatethat it might be worth offering such a package to all patients with acutemyocardial infarction.

Citation:Rosenqvist S, Berglund G, Bolund C, Fornander T, Rutqvist LE, SkoogL, Wilking N, Lack of correlation between anxiety parameters and oestrogenreceptor status in early breast cancer., Eur J Cancer 29A: 9,1325-6, , 1993.
Correlation between anxiety parameters and oestrogen receptorlevels (ER) were investigated in 89 patients with primary breast cancer.Patients were divided into two groups, ER poor (< 0.05 fmol/microgramDNA) and ER rich (> 0.05 fmol/microgram DNA). No differences were foundbetween anxiety levels, determined by a modified Hospital Anxiety and Depression(HAD) scale, in the two groups. This report does not support the findingsfrom other studies, claiming an association between psychological parametersand oestrogen receptor status, which is believed to be a prognostic predictor.

Citation:Greenough CG, Fraser RD, Comparison of eight psychometric instrumentsin unselected patients with back pain., Spine 16: 9, 1068-74,Sep, 1991.
A comparative evaluation of eight psychometric instrumentswas made in 274 patients who were currently suffering or previously hadsuffered from low-back pain. The specificity and sensitivity values fordetection of psychological disturbance were calculated and optimum cutoffscores determined for each test. The influence of current pain, socialgroup, compensation, migrant status, and unemployment on the accuracy ofeach test were evaluated. The Pain Drawing, the Inappropriate Symptoms,the Inappropriate Signs, and the Illness Behavior Questionnaire were foundto be least discriminating. The Modified Somatic Perception Questionnaire,the Hospital Anxiety Scale, the Hospital Depression Scale, and the ZungDepression Scale were the most accurate and least affected by the factorsexamined. The combination of the Modified Somatic Perception Questionnaireand the Zung Depression Scale yielded specificities and sensitivities of91% and 84% for men and 96% and 85% for women, respectively. This combinationis recommended for the assessment of psychological disturbance in patientswith low-back pain.

Citation:Barczak P, Kane N, Andrews S, Congdon AM, Clay JC, Betts T, Patternsof psychiatric morbidity in a genito-urinary clinic. A validation of theHospital Anxiety Depression scale (HAD)., Br J Psychiatry 152:698-700, May, 1988.
The prevalence of psychiatric disorder (by DSM-III criteria)in a population attending a genito-urinary clinic was found to be 31%.The performance of the Hospital Anxiety Depression (HAD) scale as a screeningquestionnaire for psychiatric disorder was assessed. Case definition bya score of 8 or more on either of the anxiety or depressive subscales producedoptimal results, giving sensitivities of 82% and 70%, and specificitiesof 94% and 68%, for depressive and anxiety disorders respectively.

Citation:Huston GJ, The Hospital Anxiety and Depression Scale [letter],J Rheumatol 14: 3, 644, Jun, 1987.

Citation:Snaith RP, Zigmond AS, The hospital anxiety and depression scale[letter], Br Med J (Clin Res Ed) 292: 6516, 344, Feb 1, 1986.

Citation:el-Rufaie OE, Absood G, Validity study of the Hospital Anxiety andDepression Scale among a group of Saudi patients., Br J Psychiatry 151: 687-8, Nov, 1987.
The Arabic version of the HAD scale was validated in a sampleof 50 Saudi patients. The scale scores were assessed against the principalauthor's clinical evaluations. Spearman correlations of all items of thescale, except for one, were statistically significant. The non-significanceof one item was probably related to the way it was translated into Arabic.The study furnished evidence that the Arabic version was a reliable instrumentfor detecting states of anxiety and depression in Saudi patients in a primaryhealth care setting.

Citation:Wilkinson MJ, Barczak P, Psychiatric screening in general practice:comparison of the general health questionnaire and the hospital anxietydepression scale., J R Coll Gen Pract 38: 312, 311-3, Jul, 1988.

Citation:Lamey PJ, Lamb AB, The usefulness of the HAD scale in assessinganxiety and depression in patients with burning mouth syndrome., OralSurg Oral Med Oral Pathol 67: 4, 390-2, Apr, 1989.
A recent index of anxiety and depression (Hospital Anxietyand Depression Scale) was applied to 74 patients with burning mouth syndrome.The scale pointed to anxiety, more than depression, being a feature ofburning mouth syndrome. The validity and clinical application of this scaleto assess anxiety and depression in such patients are discussed.

Citation:Aylard PR, Gooding JH, McKenna PJ, Snaith RP, A validation studyof three anxiety and depression self-assessment scales., J PsychosomRes 31: 2, 261-8, , 1987.
All measuring instruments require further validation bothin the setting for which they were designed and in other fields. The HospitalAnxiety and Depression Scale was designed for detection and assessmentof those mood disorders in the setting of hospital medical and surgicalclinics. Reasons are given for supposing it has advantages over other similarscales. The present study undertakes a further validation of the scalein a general hospital setting. The opportunity is taken to assess the usefulness,in this setting of the Irritability Depression and Anxiety Scale and alsoof two subscales of the General Health Questionnaire, the one relatingto the concept of depression and the other to the concept of anxiety. Scoreranges of the latter two subscales are suggested and will require replicationfor confirmation of their usefulness.

Citation:Snaith RP, Taylor CM, Rating scales for depression and anxiety:a current perspective., Br J Clin Pharmacol 19 Suppl 1: 17S-20S,, 1985.
Research now requires instruments capable of a better distinctionbetween depressive and anxiety disorders. The study is concerned with tworelatively recent clinician-rated scales, the Montgomery-Asberg DepressionRating Scale and the Clinical Anxiety Scale together with two recent self-assessmentscales, the Irritability-Depression-Anxiety Scale and the Hospital Anxietyand Depression Scale. The concurrent validity of these scales as measuresof the separate concepts of anxiety and depression is examined.

Citation:Thompson DR, A randomized controlled trial of in-hospital nursingsupport for first time myocardial infarction patients and their partners:effects on anxiety and depression., J Adv Nurs 14: 4, 291-7,Apr, 1989.
This study monitored and compared levels of anxiety and depressionreported by first myocardial infarction (MI) male patients and their partners,throughout the patients' hospital stay. An independent variable of a programmeof supportive-educative counselling provided by a coronary care nurse wasintroduced to determine whether it significantly affected reactions. Sixtycouples were randomly assigned to one of two groups: (a) the treatmentgroup (in which they received the systematic programme of nursing supportin addition to routine care), or (b) the control group (in which they receivedroutine care but no other intervention). Anxiety and depression were measuredby the Hospital Anxiety and Depression (HAD) scale at 24 hours and 5 daysafter the patient's admission to hospital. At 5 days there were statisticallysignificant differences between both groups with respect to the HAD scalemean scores. These findings strongly suggest that a simple programme ofin-hospital couple counselling, provided by a coronary care nurse, statisticallysignificantly reduces anxiety and depression in first MI male patientsand anxiety in their partners.

Citation:Identifying anxiety and depressive disorders among primary carepatients: a pilot study., Acta Psychiatr Scand 280-2, Mar, 1988.
One stage case-identification method, using the Arabic Versionof the Hospital Anxiety and Depression Scale (HAD) was applied in a pilotstudy for estimating the prevalence of depressive and anxiety disordersamong a group of Saudi primary care attenders. The validity of the ArabicVersion of the HAD scale was previously tested and found valid with highsensitivity and specificity. The total prevalence rate of depression was17% and that of anxiety was 16%. Seven percent of the sample suffered bothdepression and anxiety i.e. the total percentage of patients with depression,anxiety or both was 26%. Higher morbidity of depression was recorded amongfemales and a higher morbidity of anxiety among male patients.

Citation:el-Rufaie OE, Albar AA, Al-Dabal BK, 77: 3,

Citation:The Scottish First Episode Schizophrenia Study. III. Cognitive performance.The Scottish Schizophrenia Research Group., Br J Psychiatry 150:338-40, Mar, 1987.
Cognitive performance in 46 first episode schizophrenicswas assessed within 1 week of admission to hospital by Progressive Matrices,Mill Hill Vocabulary Scale, Block Design and Similarities subtests of theWechsler Adult Intelligence Scale, and Digit Copying Test. Patients' intellectualperformance was at a dull normal level, just within one standard deviationfrom the mean. There was an association between the presence of anxietyand depression and lower scores on psychological tests. Patients assessedby the Present State Examination as belonging to the 'uncertain psychosis'category performed more poorly.

Citation:Hicks JA, Jenkins JG, The measurement of preoperative anxiety.,J R Soc Med 81: 9, 517-9, Sep, 1988.
Preoperative anxiety was assessed using the hospital anxietyand depression (HAD) scale, multiple affect adjective check list (MAACL)and linear analogue anxiety scale (LAAS) in 100 consecutive day case patientsundergoing termination of pregnancy. The HAD scale, a recently introducedself assessment scale comprising 7 multiple choice questions, was readilyaccepted and easily understood by patients. There was a high degree ofcorrelation between the HAD scale and both the MAACL (correlation coefficient0.74) and the LAAS (correlation coefficient 0.67). There was only a moderatedegree of correlation between the HAD scale and the anaesthetist's assessmentof anxiety (correlation coefficient 0.46). The HAD scale is a useful methodof subjective measurement of preoperative anxiety.

Citation:Hashimoto F, Kellner R, Kapsner CO, Upper respiratory tract infectionsincrease self-rated hostility and distress., Int J Psychiatry Med 17:1, 41-7, , 1987.
The authors administered a personality inventory, the EysenckPersonality Inventory and a distress scale, the Symptom Questionnaire,to all patients in a walk-in clinic of a general hospital during an influenzaepidemic. Hostility, depression, anxiety and somatic symptoms were significantlyhigher in patients with upper respiratory tract infections (p less than.005); the majority scored in the range of psychiatric patients, regardlessof whether patients had clinically classical influenza or merely symptomsand signs of another respiratory tract infection. There were no differencesin the personality traits of extraversion or neuroticism between any ofthe groups, suggesting that hostility and distress were consequences ofthe viral infections and were largely unaffected by preexisting personalitytraits.

Citation:Cundall DB, Children and mothers at clinics: who is disturbed?,Arch Dis Child 62: 8, 820-4, Aug, 1987.
One hundred and eighty one white children aged 6 to 11 yearswho were attending medical out-patient clinics with their mothers were studiedto assess the prevalence of psychological disturbance in the children,and anxiety and depression in the mothers. Teachers were also asked toassess the children independently using the Rutter scales. Mothers assessed70 (39%) of the children as being disturbed, 20 of whom were also assessedas being disturbed by their teachers. A further 15 children were assessedas being disturbed by their teachers but not by their mothers. Thirty five(19%) of the mothers assessed themselves as anxious and two as depressedusing the hospital anxiety and depression scale. Anxious and depressedmothers were significantly more likely to assess their child as being disturbed.In contrast, the teachers' assessments of the children were not affectedby the mental state of the mothers. These findings confirm that mothers'perceptions of their children are modified by their own moods.

Citation:Robertson DA, Ray J, Diamond I, Edwards JG, Personality profileand affective state of patients with inflammatory bowel disease., Gut 30: 5, 623-6, May, 1989.
The Eysenck Personality Inventory and Hospital Anxiety andDepression scale were administered to 80 patients undergoing medical treatmentfor long standing inflammatory bowel disease: 22 patients were studiedbefore the diagnosis was established and 40 patients with diabetes mellitusserved as controls. High neuroticism and introversion scores were moreprevalent in the patients with inflammatory bowel disease than controls(p less than 0.05) and these characteristics were as prominent in patientsbefore diagnosis as in established cases. Introversion scores increasedwith the duration of disease (r = 0.51). Depression was uncommon, occurringonly in patients with active chronic disease. Patients believed there wasa close link between personality, stress and disease activity. Fifty sixof the patients recognised factors that initiated the disease and in 42this was thought to be a stressful life event or a 'nervous personality'.

Citation:Marsh DT, Stile SA, Stoughton NL, Trout-Landen BL, Psychopathologyof opiate addiction: comparative data from the MMPI and MCMI., Am JDrug Alcohol Abuse 14: 1, 17-27, , 1988.
The MMPI and MCMI were administered to 163 former opiateaddicts who were being maintained in a methadone program affiliated withan urban hospital. Highest group mean MMPI scores were found for PsychopathicDeviate, Depression, Hypomania, and Hysteria. For the MCMI, highest groupmean clinical syndrome scores were found for Drug Abuse, Alcohol Abuse,Anxiety, and Dysthymia; highest personality disorder scores were foundfor Antisocial, Narcissistic, Histrionic, and Paranoid. The MCMI Drug AbuseScale identified only 49% of subjects as having a recurrent or recent historyof drug abuse. Frequency and factor analyses documented the heterogeneityof the population with respect to clinical syndromes, as well as the prevalenceof personality disorders (86% had elevations on MCMI Personality Scales).Factor and correlational analyses did not provide strong evidence of similarfactor structure or convergent validity of the MMPI and MCMI with thispopulation.

Citation:Ryde-Brandt B, Mothers of primary school children with Down's syndrome.How do they experience their situation?, Acta Psychiatr Scand 78:1, 102-8, Jul, 1988.
The occurrence of anxiety or depression, experience of socialsupport and feelings about the family situation were evaluated in 13 mothersof children of primary school age with Down's syndrome (DS). The resultswere compared with those obtained in a group of 13 females engaged in takingcare of these children and assisting their families. Questionnaires wereused to assess feelings of depression or anxiety (Hospital Anxiety andDepression Scale), to evaluate social support (Interview Schedule for SocialInteraction) and the family situation (Family Adaptability and CohesionEvaluation Scale). A semi-structured interview with the mothers was alsoconducted. The results indicated that negative feelings at the birth ofa child with DS had almost invariably changed in a positive direction.Experience of depression or anxiety was uncommon. Social and emotionalcontacts were quantitatively normal, although more empathy was often desired.The families were relatively often described as enmeshed and controlled,but the experience of the family situation was generally positive.

Citation:Smith J, Carr V, Morris H, Gilliland J, The dexamethasone suppressiontest in relation to symptomatology: preliminary findings controlling forserum dexamethasone concentrations., Psychiatry Res 25: 2, 123-33,Aug, 1988.
A diagnostically heterogeneous sample of psychiatric inpatients(n = 52) was administered the 1 mg dexamethasone suppression test (DST)shortly after hospital admission. Each was also assessed using the HamiltonRating Scale for Depression (HRSD) and selected items of the Present StateExamination (PSE) representing psychomotor retardation and anxiety. A potentdeterminant of postdexamethasone serum cortisol concentrations was foundto be the level of serum dexamethasone concentration achieved followingthe oral dose. No relationship was found between postdexamethasone cortisolconcentration and the scores on either the HRSD or an anxiety scale derivedfrom selected PSE items. However, symptoms of psychomotor retardation weresignificantly related to postdexamethasone serum cortisol concentration,particularly when the serum dexamethasone concentrations were taken intoaccount. It may be that DST nonsuppression in psychiatric patients is inpart a reflection of the presence of psychomotor retardation, a phenomenonthat cuts across diagnostic categories.

Citation:Malt U, The long-term psychiatric consequences of accidental injury.A longitudinal study of 107 adults., Br J Psychiatry 153: 810-8,Dec, 1988.
One hundred and seven accidentally injured adults were studiedwhile in hospital and assessed prospectively twice more in a mean periodof 28 months. The patients were studied by means of taped clinical interviews,including the Comprehensive Psychopathological Rating Scale (which includesthe Montgomery-Asberg Depression Rating Scale), and several self-reportmeasures of distress (Schedule of Recent Life Events, General Health Questionnaire,Impact of Event Scale and State Anxiety Inventory) at the three assessments.The total incidence of psychiatric disorders considered to be caused bythe accident during the follow-up period was 22.4%. The incidence of non-organicpsychiatric disorders caused by the accident was 16.8% at the first follow-upand 9.3% at the final follow-up. Depressive disorders of different severitywere most often seen. Only one patient suffered from a post-traumatic stressdisorder during the follow-up, and none at the final follow-up (DSM-III).Organic mental disorders were diagnosed in 9.3% of the patients. In 5.6%of the patients this was the only disorder.

Citation:Chandarana PC, Eals M, Steingart AB, Bellamy N, Allen S, The detectionof psychiatric morbidity and associated factors in patients with rheumatoidarthritis., Can J Psychiatry 32: 5, 356-61, Jun, 1987.
Eighty-six patients with a confirmed diagnosis of rheumatoidarthritis were surveyed to assess the extent of psychiatric morbidity asindicated by two screening questionnaires, the General Health Questionnaireand the Hospital Anxiety and Depression Scale. In addition to an investigationof the concordance of the screening questionnaires, a description of demographiccharacteristics and measures of disability were taken. Disability due toarthritis was indicated by measures of years of chronicity, pain, durationof morning stiffness, functional level, active treatment involvement, andpresence of coexisting medical problems. The relationship of physical symptomsto level of psychiatric distress was investigated. Psychiatric cases wereidentified using recommended cut off scores on results of the screeningquestionnaires. GHQ cut off scores of 6/7 identified as "cases"31.8% of the sample. HADS subscale cut off scores of 8/9 identified 21.4%of subjects with "anxiety" and 19.0% with "depression"scores in the morbid range. Nineteen percent of patients were found tohave scores on both tests concurrently in the pathological range.

Citation:Overall JE, Rhoades HM, Moreschi E, The Nurses Evaluation RatingScale (NERS)., J Clin Psychol 42: 3, 454-66, May, 1986.
The Nurses Evaluation Rating Scale (NERS) consists of 16items designed to capture salient dimensions of psychopathology and nursingcare requirements for psychiatric patients. Reliability and validity ofthe NERS were evaluated by using a total of 3,052 sets of ratings accomplishedby 19 staff nurses on a total of 235 adult psychiatric inpatients. Allitems of the NERS were utilized in describing psychopathology in this sampleof patients, although no patient was positive on all items. Factor analysisrevealed four distinct clusters of items, which represented higher-orderconstructs of thinking disturbance, depression, anxiety, and psychomotorretardation. Test-retest reliability was found to be comparable to thereliability of most other clinical assessments of psychopathology. Scoringfor the four factors was defined, and analysis of change during first 10days of hospital stay revealed statistically significant improvement. TheNERS appears to be a promising instrument for longitudinal, daily evaluationsof inpatient psychopathology as seen in the routine clinical practice ofpsychiatric nurses.

Citation:Berrios GE, Ryley JP, Garvey TP, Moffat DA, Psychiatric morbidityin subjects with inner ear disease., Clin Otolaryngol 13: 4,259-66, Aug, 1988.
A prospective assessment of psychiatric morbidity in a sampleof 207 patients with inner ear disorders, attending an ENT clinic, wascarried out. As a group, they were found to have higher psychiatric morbidityon the general health questionnaire (GHQ) than either normal samples orsamples affected by other forms of physical disease. Within the sampletinnitus patients scored the highest, and presbyacusis patients the lowest.High GHQ scores predicted an exaggerated self-rating of symptom severityin a visual analogue scale. Past psychiatric history did not play a rolein the development of psychiatric morbidity. Elderly subjects complainedmore often of fear of collapsing in the street but this was not related,as has been suggested, to the subsequent development of agoraphobic symptoms.Factor analysis of GHQ items for the 'cases' yielded 'depression', 'anxiety'and 'personality' factors. No correlation was found between these factorsand the rest of the clinical variables. It is concluded that tinnitus showsthe clearest association with psychiatric morbidity and hence merits detailedpsychological analysis. Such a study has been started at Addenbrooke'sHospital.

Citation:Neuling SJ, Winefield HR, Social support and recovery after surgeryfor breast cancer: frequency and correlates of supportive behaviours byfamily, friends and surgeon., Soc Sci Med 27: 4, 385-92, , 1988.
In a longitudinal study of recovery after surgery for breastcancer, subjects reported the frequency of, and their satisfaction with,various supportive behaviours on the part of family members, close friendsand medical professionals. The reliability of the Multi-Dimensional SupportScale (MDSS) devised for this purpose is described. Measures of psychological,social and physical adjustment approached normality by 3 months post-operation.Frequency of support from all sources decreased as time from surgery passed,whilst satisfaction with support varied with the type of support givenand the source from which it was received. Quite different patterns emergedin support needs from professional and non-professional sources, with empathicsupport being required from all sources, whilst informational support wasdesired from surgeons, rather than from family and friends. Further, subjectswere more discriminating in the amounts of support required from familyand friends, such that it was more likely for these sources to give unwantedsupport than it was for professional sources, from whom many subjects reportedinadequate support. Satisfaction with social support was matched with measuresof adjustment, and it was found that those satisfied with support fromfamily members were significantly less anxious and depressed in hospitalthan were those who were not satisfied with support from this source. However,at 1 month post-operation, anxiety and depression levels were significantlyrelated to satisfaction with support from surgeons; and at 3 months post-operation,anxiety and depression measures were significantly related to satisfactionwith support from both family members and surgeons.(ABSTRACT TRUNCATEDAT 250 WORDS)

Citation:Buckelew SP, DeGood DE, Schwartz DP, Kerler RM, Cognitive and somaticitem response pattern of pain patients, psychiatric patients, and hospitalemployees., J Clin Psychol 42: 6, 852-60, Nov, 1986.
Standard psychological tests generally provide a single globalscore that reflects multidimensional constructs, such as depression andanxiety. This single score, however, integrates a range of item contents,including cognitive/affective, somatic, and behavioral characteristicsof these multidimensional constructs. The present study was designed tocompare the pattern of item endorsement among chronic pain patients (N= 50), psychiatric inpatients (N = 50), and hospital employees (N = 50)on the SCL-90-R (Derogatis, Rickels, & Rock, 1976). Pain patients reportedthe highest SCL-90 scale level of Somatization, while the psychiatric inpatientsreported the highest level of Anxiety and Depression. Additionally, thewithin-scale pattern of item responses on the Anxiety and Depression scalesdiffered among groups. Although psychiatric inpatients endorsed equivalentlevels of somatic and cognitive items, the pain patients' reports of psychologicaldistress were limited primarily to somatic signs of anxiety and depression.Thus, the interpretation of pain patients' psychological profiles and subsequenttreatment recommendations may be inappropriate if based on normative dataobtained from psychiatric and/or normal populations.

Citation:Miles MS, Emotional symptoms and physical health in bereaved parents.,Nurs Res 34: 2, 76-81, Mar-Apr, 1985.
The purpose of this study was to compare the emotional symptomsand physical health of parents whose children had died suddenly in an accident,parents whose children had died following a chronic disease, and nonbereavedparents. Data for this retrospective survey were collected by mailed questionnaires:the Hopkins Symptom Checklist (HSCL), Bereavement Health Assessment Scale,Review of Life Experiences Scale, and a personal-situation questionnaire.Subjects were 30 bereaved parents who had experienced the death of a childfollowing a chronic disease; 31 bereaved parents whose children died inan accident; and 81 nonbereaved parents. Findings indicated significantdifferences between the bereaved groups and the control group on the totalscale score of the HSCL and on the subscales measuring Depression, Anxiety,Somatization, Obsession-Compulsion, and Interpersonal Sensitivity. However,there were no differences on these variables between the two bereaved groups.Bereaved parents with higher concurrent life stresses and parents froma lower socioeconomic background were at higher risk for emotional symptomatology.There were no significant differences among the three groups on the numberof physician/nurse visits, number of hospital admissions, number of newor recurrent illnesses, or drug usage. Bereaved parents, however, morefrequently reported appetite and sleep problems.

Citation:Zigmond AS, Snaith RP, The hospital anxiety and depression scale.,Acta Psychiatr Scand 67: 6, 361-70, Jun, 1983.
A self-assessment scale has been developed and found to bea reliable instrument for detecting states of depression and anxiety inthe setting of an hospital medical out-patient clinic. The anxiety and depressivesubscales are also valid measures of severity of the emotional disorder.It is suggested that the introduction of the scales into general hospitalpractice would facilitate the large task of detection and management ofemotional disorder in patients under investigation and treatment in medicaland surgical departments.

Citation:Magni G, Messina C, De Leo D, Mosconi A, Carli M, Psychologicaldistress in parents of children with acute lymphatic leukemia., ActaPsychiatr Scand 68: 4, 297-300, Oct, 1983.
Psychological distress in parents of children with acutelymphatic leukemia was evaluated by means of the Symptom Distress Checklist.This scale was administered twice: within a few days after the child'sadmission to hospital and 8 months later. Twenty-five consecutive, unselectedsubjects were compared with controls matched for age, sex, marital statusand social class. At the first evaluation the sample presented higher meanscores than the controls for anxiety (P less than 0.005), depression (Pless than 0.005), sleep disturbances (P less than 0.005) and obsessions(P less than 0.05). An 8 months' follow-up confirmed the persistence ofanxiety (P less than 0.05), sleep disturbances (P less than 0.05) and aboveall depression (P less than 0.005).

Citation:Matson JL, Kazdin AE, Senatore V, Psychometric properties of thepsychopathology instrument for mentally retarded adults., Appl ResMent Retard 5: 1, 81-9, , 1984.
One hundred and ten adults, from borderline to severe levelsof mental retardation, were assessed through the out-patient clinic of auniversity-affiliated mental health center and a large state psychiatrichospital. These patients were included only after they had demonstratedthe ability to respond to questions of similar difficulty to those presentedin the Psychopathology Instrument for Mentally Retarded Adults. This measurewas designed by the authors based on DSM III criteria, and covered seventypes of psychopathology including schizophrenia, depression, psychosexualdisorders, adjustment disorder, anxiety, somatoform disorders, and personalityproblems. In the present study the psychometric properties of the scalewere reviewed and/or evaluated including internal consistency of itemsand test-retest reliability, and factor analysis.

Citation:Moore NC, Medazepam and the driving ability of anxious patients.,Psychopharmacology (Berl) 52: 1, 103-6, Mar 23, 1977.
A double-blind crossover trial of Medazepam was carried outin 14 anxious hospital patients. The mean self-adjusted dosage was 16.5mg daily. The active drug was no more effective than placebo in relievinganxiety, which was rated both clinically and by the Middlesex Health Questionnaire(M.H.Q.) (Crown and Crisp, 1970). This may have been because the dose wasrelatively low for chronically anxious hospital patients. Even this dosagecaused significantly higher scores on the M.H.Q. scale for depression.Braking and driving simulator tests were not adversely affected by Medazepam.In real driving conditions those taking the drug made significantly moretechnical, but not dangerous, errors. Pulse and blood pressure also werenot affected.

Citation:Schiller E, Baker J, Return to work after a myocardial infarction:evaluation of planned rehabilitation and of a predictive rating scale.,Med J Aust 1: 23, 859-62, Jun 5, 1976.
This paper reports the first recorded controlled trial ofcardiac rehabilitation after myocardial infarction in men of working age,viewed as a team intervention effort to facilitate the patient's returnto normal work. Our results show that this intervention is helpful in returningto jobs which they can handle successfully men who would otherwise be atrisk of remaining unemployed. A previously developed rating scale for predictingreturn to work after myocardial infarction was used and reevaluated. Employmentand occupational level at admission to hospital, work history, availabilityof the previous job, educational level, family and social stability, ageat which regular cigarette smoking commenced, and level of anxiety anddepression on a personality scale proved highly predictive.

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