Screening for affective and anxiety disorders in medical patients - comparison of HADS, GHQ-12 and Brief-PHQ

Objectives: The detection of patients with comorbid mental disorders is of high clinical importance. Screening instruments can be recommended for early recognition. This study investigates the discriminant validity of the Hospital Anxiety and Depression Scale (HADS), General Health Questionnaire (GHQ-12) and Patient Health Questionnaire (Brief-PHQ-D) in chronically ill patients. Methods: Two hundred and four patients with chronic illness participated in a two-stage survey. First patients were screened with HADS, Brief-PHQ and GHQ-12 and then examined for mental disorders by clinical standardized interview (M-CIDI). Validity of the three instruments was compared using ROC(receiver operating characteristics)-analysis and CIDI-diagnoses as criteria. Results: The Brief-PHQ and the HADS performed better than GHQ-12 concerning affective and anxiety disorders without reaching significance. Even though the Brief-PHQ performs significantly better in the category of “any mental disorder”, the differences between the Brief-PHQ and the HADS remain not significant considering anxiety and affective disorders. The Brief-PHQ performed slightly better considering depressive disorders with an area under the curve (AUC) of 0.844, a sensitivity of 80% and a specifity of 75.7%. Conclusions: Screener can be used for the detection of mental disorders in patients with chronical illness. Especially the Brief-PHQ and the HADS can be recommended considering sensitivity and specifity. An advantage of the Brief-PHQ is the ability of categorial and dimensional analysis.