Fast screening of depression in cancer patients: the effectiveness of the HADS L. CASTELLI, phd, Psycho-oncology Unit, Department of Neuroscience and Oncology, University of Turin, Turin, L. BINASCHI, psychd, Psycho-oncology Unit, Department of Neuroscience and Oncology, University of Turin, Turin, P. CALDERA, md, Psycho-oncology Unit, Department of Neuroscience and Oncology, University of Turin, Turin, A. MUSSA, md, Surgical Oncology Unit, Department of Oncology, University of Turin, Turin, & R. TORTA, md, Psycho-oncology Unit, Department of Neuroscience and Oncology, University of Turin, Turin, Italy CASTELLI L., BINASCHI L., CALDERA P., MUSSA A. & TORTA R. (2011) European Journal of Cancer Care 20, 528–533 Fast screening of depression in cancer patients: the effectiveness of the HADS In oncology clinics, there is an increasing need for fast and accurate screening scales and procedures in order to evaluate cancer patients for depression. The present study investigated the comparative effectiveness in recognising depressed patients of the Hospital Anxiety and Depression Scale (HADS), a self-report screening scale, and the Montgomery-Asberg Depression Rating Scale (MADRS), a semi-structured clinician-rated scale, in 151 patients affected by mixed cancer pathologies. With the MADRS, 73.5% of the patients were identified as depressed, whereas the HADS identified 36.4% and 58.3% as depressed, using the cut-offs of 11 and 8 respectively. The results suggest moderate agreement between the MADRS and the HADS when a cut-off of 8 is used (K-test: 0.44), while using a HADS cut-off of 11 gave a significantly higher underestimation of depressed patients (K-test: 0.29). In conclusion, the results suggest that the HADS can be useful as a sufficiently accurate first-step screening tool for depression in mixed oncology settings. Keywords: depression, cancer, HADS, MADRS. INTRODUCTION Depression is one of the most frequent emotional disor- ders affecting cancer patients. It has an unfavourable impact on their quality of life, their decision making regarding cancer treatment, caregiver distress, and increases their risk of suicide (Chochinov et al. 1995; Grassi et al. 1996; Colleoni et al. 2000; Fang et al. 2001; Massie 2004). The prevalence of depression and more gen- erally of psychological distress in cancer patients is extremely variable – from 0% to 58% – depending on the time and stage of the disease, age and sex of the patient and diagnostic instruments (Massie 2004). In addition, depression which is associated with the diagnosis of cancer and requires therapeutic intervention is often under-recognised and under-diagnosed (Hopwood & Stephens 2000; Néron et al. 2007; Thomas et al. 2010). For both patients and clinicians, the medical visit focuses mainly on somatic aspects and depression is often consid- ered a ‘normal’ reaction to cancer. So there is an increasing need for a fast and accurate screening scale and procedure in order to screen cancer patients for depression (Pignone et al. 2000; Néron et al. 2007). As far as depression and psychological distress are con- cerned, many self-assessment tools are used for cancer patients in clinical practice. Among these tools, some of Correspondence address: Riccardo Torta, Psycho-oncology Unit, Depart- ment of Neuroscience, University of Turin, Corso Bramante 88, 10126 Turin, Italy (e-mail: riccardo.torta@unito.it). Accepted 28 March 2010 DOI: 10.1111/j.1365-2354.2010.01217.x European Journal of Cancer Care, 2011, 20, 528–533 Original article © 2010 Blackwell Publishing Ltd