Screening for psychological distress in Japanese cancer patients

BACKGROUND: Psychological distress is frequently observed, however, it isunderestimated in cancer patients. The aim of this study is to develop asimple battery for screening for psychological distress, adjustmentdisorder and major depressive disorder in Japanese cancer patients.METHODS: One hundred and twenty-eight cancer patients were interviewed bypsychiatrists and tested using the Hospital Anxiety and Depression Scale(HADS), a 14-item self-assessment questionnaire. Psychiatric diagnoses wereperformed according to the Diagnostic and Statistical Manual of MentalDisorders, third edition-revised. RESULTS: Cronbach alpha values of theJapanese version of the scale were 0.77 for the subscale for anxiety and0.79 for depression. By a receiver operating characteristic analysis, wedetermined that an optimal cut-off point for screening for adjustmentdisorder and major depressive disorder was 10/11, which gave high enoughsensitivity and specificity (91.5 and 65.4%, respectively). To screen formajor depressive disorder alone, 19/20 was an optimal cut-off point with82.4% sensitivity and 96.3% specificity. The subscales of HADS (anxiety anddepression) also had high screening performance. CONCLUSIONS: The Japaneseversion of HADS is a sensitive and specific tool for screening forpsychological distress in Japanese cancer patients. This scale can be usedfor an early detection of patients' psychological distress which may befollowed by psychiatric interventions.