The Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital and Depression Scale (HADS-A) as screening tools for generalized anxiety disorder among cancer patients

Abstract

Objective

Anxiety in cancer patients may represent a normal psychological reaction. To detect patients with pathological levels, appropriate screeners with established cut-offs are needed. Given that previous research is sparse, we investigated the diagnostic accuracy of two frequently used screening tools in detecting generalized anxiety disorder (GAD).

Methods

We used data of a multi-center study including 2141 cancer patients. Diagnostic accuracy was investigated for the Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital Anxiety and Depression Scale (HADS-A). GAD, assessed with the Composite International Diagnostic Interview for Oncology, served as a reference standard. Overall accuracy was measured with the area under the receiver operating characteristics curve (AUC). The AUC of the two screeners were statistically compared. We also calculated accuracy measures for selected cut-offs.

Results

Diagnostic accuracy could be interpreted as adequate for both screeners, with an identical AUC of .81 (95 % CI: .79 – .82). Consequently, the two screeners did not differ in their performance (p = .86). The best balance between sensitivity and specificity was found for cut-offs ≥ 7 (GAD-7) and ≥ 8 (HADS-A). The officially recommended thresholds for the GAD-7 (≥ 10) and the HADS-A (≥11) showed low sensitivities of 55 % and 48 %, respectively.

Conclusions

The GAD-7 and HADS-A showed AUC of adequate diagnostic accuracy and hence are applicable for GAD screening in cancer patients. Nevertheless, the choice of optimal cut-offs should be carefully evaluated.

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