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[Occurrence of anxiety and depression disorders after acute cardiac events during hospital rehabilitation. Application of the Hospital Anxiety and Depression Scale as a screening instrument].

UNLABELLED
Hospital Anxiety and Depression Scale (HADS) is one of the most frequently used screening instruments for comorbid psychiatric disorders in patients with somatic diseases. Depression and anxiety disorders occurring after acute coronary events predict a worse prognosis and rehabilitation outcome and impair the patient's quality of life. Therefore, diagnosis and treatment of depression and anxiety are important clinical issues.


METHODS
Item characteristics, different aspects of reliability and validity of the HADS test parameters have been analysed on the basis of a follow-up study of 747 patients after acute coronary events participating in a hospital rehabilitation program. Short form of the Beck Depression Inventory, Spielberger State Anxiety Inventory, Hamilton Anxiety and Hamilton Depression Questionnaires were used as references. Criterion validity and cut-off points of HADS subscales were determined according to MINI+, a standardised diagnostic interview.


RESULTS
The Depression (D) and Anxiety (A) subscales of the Hungarian version of HADS demonstrated high internal consistency (HADS-D: Cronbach =0,81, HADS-A: =0,85). Explorative factor analysis yielded a two-factor (1st: anxiety and 2nd: depression) structure. HADS subscales have shown high correlations with scales measuring similar constructs and validated in Hungarian. Empirical cut-off points of both subscales were determined with ROC analysis (HADS-D: 9 points, HADS-A 8 points). Sensitivity and specificity at these cut-off points fell into the acceptable 0.7 - 0.9 range.


CONCLUSION
On the basis of these results, HADS can be used as a reliable and valid instrument for the measurement and identification of anxiety and depression symptoms and disorders in cardiac patients.