Agreement between HADS classifications and single-item screening questions for anxiety and depression: a cross-sectional survey of cancer patients

Background: We assessed agreement between reported anxiety and depression levels of cancer patients using a) single self-report items and b) the Hospital Anxiety and Depression Scale (HADS). We also explored whether anxiety and depression assessment by a) single self-report items or b) the HADS was most strongly associated with a preference to be offered professional assistance. The proportion of patients indicating that they would accept (or were currently using) professional support if they were experiencing anxiety or depression was also examined. Patients and methods: A consecutive sample of cancer patients undergoing radiotherapy at four metropolitan public hospitals in Australia completed a touchscreen computer survey. A consecutive subsample of patients attending three of these treatment centres answered additional questions about psychological support preferences. Results: Of 304 respondents, 54% (95% CI: 48%, 60%) perceived that they were currently experiencing mild to severe anxiety and depression. 22% (95% CI: 18%, 27%) indicated a preference to be offered professional help. There was moderate agreement between the HADS and single-item responses for categorisation of anxiety and depression. Patient-perceived mild to severe anxiety and depression levels appeared to be the best measure for identifying those with a preference to be offered professional assistance. Of a subsample of 193 respondents, 89% (95% CI: 84, 93%) indicated that if they were experiencing anxiety or depression, they would accept (or were currently using) professional support. Conclusions: Single item screening in a cancer care setting may not adequately capture clinical anxiety and depression. However, single items assessing patients’ perceived levels of anxiety and depression are useful indicators of whether patients want to be offered, and are likely to accept, psychosocial care.