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'A no means no'--measuring depression using a single-item question versus Hospital Anxiety and Depression Scale (HADS-D).

Journal article
Authors Johanna Skoogh
Nathalie Ylitalo
P Larsson Omeróv
A Hauksdóttir
U Nyberg
Ulrica Wilderäng
Boo Johansson
M Gatz
Gunnar Steineck
Published in Annals of oncology
Volume 21
Issue 9
Pages 1905-1909
ISSN 1569-8041
Publication year 2010
Published at Institute of Clinical Sciences, Department of Oncology
Department of Psychology
Pages 1905-1909
Language en
Keywords depression, HADS-D, population-based, questionnaire, single-item question
Subject categories Cancer and Oncology


Background: Depression often develops undetected; to make treatment possible, a single-item screening question may be useful. Patients and methods: We attempted to compare the accuracy of the single-item question ‘Are you depressed?’ with the seven-item Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) among 1192 Swedish testicular cancer survivors. Results: We obtained information from 974 men (82%). Fifty-nine men (6%) answered ‘Yes’ to the question ‘Are you depressed?’ while 118 (12%) answered ‘I don't know’ and 794 (82%) answered ‘No’. Among the 794 men who answered ‘No’ to the question ‘Are you depressed?’, 790 (99.5%) were not considered as depressed according to HADS-D 11+. Of those answering ‘Yes’, 34% (20/59) were identified as depressed according to the same cut-off. Sensitivity of ‘Yes’ compared with HADS-D ≥11 was 61%, rising to 88% when ‘Yes’ and ‘I don't know’ were combined. Conclusion: In a population of men with a prevalence of depression similar to that of the normal population, almost none of those responding ‘No’ to the written question ‘Are you depressed?’ were depressed according to HADS-D ≥11. Adding the category ‘I don't know’ increases sensitivity in detecting depression.

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