Download 547. Jane_Dahm_2009_RPIGPoster

Utility of the Depression Anxiety Stress Scales in assessing
depression and anxiety following traumatic brain injury
J. Dahm1, J. Ponsford1,2, D. Wong1,3, M.Schönberger1,2
1Monash
University, 2Monash-Epworth Rehabilitation Research Centre, 3Epworth Hospital
Introduction
Prevalence of anxiety and depression following traumatic brain injury (TBI) is higher than
population rates and is associated with poorer outcomes. A quick self-report measure of
depression and anxiety symptoms would assist in identifying those at risk and provide input to
rehabilitation planning. However, utility of such measures is complicated by confounding somatic
symptoms of the injury, patients’ overall level of distress and lack of self-awareness.
The Hospital Anxiety Depression Scale (HADS) measures self-reported symptoms of anxiety
(HADS-A) and depression (HADS-D) and includes few somatic symptoms. It is frequently used
following TBI, but the extent to which symptoms of anxiety and depression reflect general
distress over injury-related changes remains unclear.
The Depression Anxiety Stress Scales (DASS) is a self-report measure comprising three scales:
depression (DASS-D), anxiety (DASS-A) and stress (DASS-S). A short version, DASS-21, is
available. DASS-D excludes somatic symptoms but DASS-A includes somatic items associated
with physiological hyperarousal. By measuring general distress on a separate scale the DASS
may show greater sensitivity and specificity than the HADS following TBI.
Aims
• To examine and compare the sensitivity and specificity of the DASS and HADS in predicting
clinical diagnosis of anxiety and depression in individuals with TBI.
• To examine the sensitivity and specificity of the DASS-21 and a version excluding somatic items
from DASS-A.
Method
Sixty-two participants with TBI (77% male; 75% injured in road accidents) recruited from Epworth
Hospital; mean age 35.55 years (SD = 16.00, range = 19 - 78 years); mean education 12.79
years (SD = 2.31, range = 8 - 20 years); mean time since injury 565.68 days (SD = 294.58, range
= 181-1460 days); mean lowest GCS score 8.81 (SD = 4.34, range = 3 -15).
Table 1
Utility of the DASS and HADS in predicting mood disorders
Sensitivity
%
Specificity
%
AUC
Scale
DASS-D
81
80
.86**
HADS-D
69
87
.76**
DASS-S
80
79
.83**
DASS21-D
81
80
.84**
DASS21-S
75
76
.82**
** p < .01
Table 2
Utility of the DASS and HADS in predicting anxiety disorders
Sensitivity
%
Specificity
%
AUC
DASS-A
60
81
.76**
HADS-A
75
83
.86**
DASS-S
80
79
.82**
DASS21-A
60
81
.80**
DASS21-S
75
81
.82**
DASS-A
no somatic
65
74
.76**
DASS-A no
musculoskeletal
65
83
.77**
DASS-A no
autonomic
60
74
.75**
Scale
** p < .01
Anxiety and depression were measured using the Structured Clinical Interview for the DSM-IVTR (SCID-I), with the HADS and DASS being completed in a separate session.
Results
Twenty-three participants (37%) were diagnosed with one or more anxiety or mood disorders
using the SCID-I. Twenty participants were diagnosed with an anxiety disorder, and 16
participants were diagnosed with a mood disorder.
For prediction of diagnosis of a mood or anxiety disorder, all DASS and HADS scales
demonstrated a significant area under the curve (AUC). DASS scales correlated highly with their
HADS equivalents, with r = .85 for the depression scales and r = .69 for the anxiety scales.
Tables 1 and 2 show the sensitivity and specificity of each of the scales at the cutoff
recommended in the relevant manual, as well as the AUCs. Figures 1 and 2 show the ROC
curves for predicting anxiety and mood disorders. Logistic regression analyses revealed that
DASS-D, but not HADS-D, made an individual contribution in predicting diagnosis of a mood
disorder. Conversely, HADS-A, but not DASS-A, made an individual contribution in predicting
diagnosis of an anxiety disorder.
Figure 1. ROC curve for DASS and HADS
predicting mood disorders
Sensitivity of DASS-A at the recommended cut-off increased with removal of musculoskeletal
items such as shakiness and trembling, suggesting they reflect symptoms of injury rather than
anxiety. Specificity of DASS-A decreased with removal of autonomic arousal items such as heart
racing and perspiration, suggesting they reflect the physiological hyperarousal of anxiety.
However, the AUCs remained similar.
Conclusions
Figure 2. ROC curve for DASS and HADS
predicting anxiety disorders
DASS-D demonstrated a better trade-off between sensitivity and specificity than HADS-D in predicting depression, but HADS-A
demonstrated a better trade-off than DASS-A in predicting anxiety. A larger sample is required to confirm this.
DASS-S demonstrated good sensitivity and specificity for both anxiety and depression, indicating that anxiety and depression in individuals
with TBI are related to levels of general distress.
Performance of the DASS-21 was similar to the DASS. The short form is easier to use in those with TBI. DASS21-S shows promise as a 7item screening measure of general distress that is in the public domain.
The impact of somatic symptoms on DASS ratings should be examined further.
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