Psychological morbidity is common in chronic respiratory diseases. The diagnostic accuracy of the Hospital Anxiety and Depression Scale (HADS) and risk factors for comorbid depression in chronic obstructive pulmonary disease (COPD) are addressed. Consecutive COPD patients (GOLD stage I–IV, 40–75 years old) were enrolled in a multicentre, cross-sectional cohort study. Diagnosis of depression was ascertained through clinical records. Lung function, HADS score, 6-minute walking test (6-MWT), MRC dyspnoea score, and COPD Assessment Test (CAT) were evaluated. Two hundred fifty-nine COPD patients (mean age 62.5 years; 32% female; mean FEV1 48% predicted) were included. Patients diagnosed with depression (29/259; 11.2%) had significantly higher HADS-D and HADS-Total scores than nondepressed patients (median (quartiles) HADS-D 6 [4; 9] versus 4 [2; 7], median HADS-Total 14 [10; 20] versus 8 [5; 14]). Receiver-operating characteristic plots showed moderate accuracy for HADS-D, AUC 0.662 (95%CI 0.601–0.719), and HADS-Total, AUC 0.681 (95%CI 0.620–0.737), with optimal cut-off scores of >5 and >9, respectively. Sensitivity and specificity were 62.1% and 62.6% for HADS-D compared to 75.9% and 55.2% for HADS-Total. Age, comorbidities, sex, and lower airflow limitation predicted depression. The HADS exhibits low diagnostic accuracy for depression in COPD patients. Younger men with comorbidities are at increased risk for depression. 1. Introduction Depression is a common comorbidity in chronic obstructive pulmonary disease (COPD) patients [1]. Impaired lung function is a risk factor for depression with up to 4 in 10 respiratory patients affected [2]. Mood and anxiety disorders in patients with COPD are likely underdiagnosed [3], emphasising the need for a reliable and accurate instrument in the recognition of depression. The Hospital Anxiety and Depression Scale (HADS [4]) was originally designed by Zigmond and Snaith in 1983 as a short, easy-to-use, 14-item screening tool for depression and anxiety symptoms in the hospital outpatient setting [5]. It is composed of two 7-item subscales (HADS-D and HADS-A for depression and anxiety, resp.) both ranging from 0 to 21 with higher scores indicating more severe distress. Items enquire about symptoms over the preceding week and are self- or clinician-rated on a 4-point Likert scale. The developers suggested categorising subjects according to subscale score into noncases (0 to 7), possible cases (8 to 10), and probable cases (>10) of clinical depression [4]. A 1997 review found both subscales to be reliable and valid measures
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