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Pulmonary Medicine
Volume 2014, Article ID 973858, 7 pages
Research Article

Accuracy of the Hospital Anxiety and Depression Scale for Identifying Depression in Chronic Obstructive Pulmonary Disease Patients

1Division of Pulmonology, University Hospital of Zurich, 8091 Zurich, Switzerland
2Medical Sciences Department, Uppsala University, 75237 Uppsala, Sweden
3Division of Pulmonology, Cantonal Hospital of Glarus, 8750 Glarus, Switzerland
4Division of Pulmonology, Cantonal Hospital of St. Gallen, 9007 St. Gallen, Switzerland
5Division of Pulmonology, Clinical Barmelweid, 5017 Barmelweid, Switzerland
6Division of Pulmonology, Cantonal Hospital of Aarau, 5000 Aarau, Switzerland
7University Clinic of Internal Medicine, Cantonal Hospital Baselland and University of Basel, 4031 Basel, Switzerland
8Division of Pulmonology, Cantonal Hospital of Münsterlingen, 8596 Münsterlingen, Switzerland

Received 21 June 2014; Revised 12 November 2014; Accepted 20 November 2014; Published 4 December 2014

Academic Editor: Denis Caillaud

Copyright © 2014 Christoph Nowak et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Psychological morbidity is common in chronic respiratory diseases. The diagnostic accuracy of the Hospital Anxiety and Depression Scale (HADS) and risk factors for comorbid depression in chronic obstructive pulmonary disease (COPD) are addressed. Consecutive COPD patients (GOLD stage I–IV, 40–75 years old) were enrolled in a multicentre, cross-sectional cohort study. Diagnosis of depression was ascertained through clinical records. Lung function, HADS score, 6-minute walking test (6-MWT), MRC dyspnoea score, and COPD Assessment Test (CAT) were evaluated. Two hundred fifty-nine COPD patients (mean age 62.5 years; 32% female; mean FEV1 48% predicted) were included. Patients diagnosed with depression (29/259; 11.2%) had significantly higher HADS-D and HADS-Total scores than nondepressed patients (median (quartiles) HADS-D 6 [4; 9] versus 4 [2; 7], median HADS-Total 14 [10; 20] versus 8 [5; 14]). Receiver-operating characteristic plots showed moderate accuracy for HADS-D, AUC 0.662 (95%CI 0.601–0.719), and HADS-Total, AUC 0.681 (95%CI 0.620–0.737), with optimal cut-off scores of >5 and >9, respectively. Sensitivity and specificity were 62.1% and 62.6% for HADS-D compared to 75.9% and 55.2% for HADS-Total. Age, comorbidities, sex, and lower airflow limitation predicted depression. The HADS exhibits low diagnostic accuracy for depression in COPD patients. Younger men with comorbidities are at increased risk for depression.