Evidence Table – Non-Physical (Depression and Anxiety)Clinical validation of an anxiety and depression screening test for intensive in-hospital rehabilitation

Study typeNo. of patientsPrevalence/incidencePatient characteristicsType of testReference standardSensitivity & specificity, PPV & NPV
Validity & Reliability
ID:

Author:
Vedana et al (2001)

Study type:
Cross- sectional

Level of evidence: (+)
Total no. of patients = 102

Based on 102 patients:
Male = 66.7%
Female = 33.3%
Mean age (range) = 61.4 (19–76)
Cardiac rehabilitation = 61
Respiratory rehabilitation = 25
Neuro-orthopaedic rehabilitation = 16

Study period:
Not stated.

Setting:
An Intensive Rehabilitation Centre in Italy
Not provided.Voluntary, self-sufficient and literate patients admitted to the Division of Cardiac, Respiratory and Neuro-motor Rehabilitation in the Intensive Rehabilitation Centre.

Exclusion:
Not stated.
Hospital Anxiety & Depression Scales (HADS)
*14 items – score rated 0–3
*subscale: depression 7 items
*subscale: anxiety 7 items (scores ranging from 0–21)
Cut-off point = 9

Schedule A–D:
State-Trait Anxiety Inventory (STAI-X1)

*20 items – score rated 1–4 (scores ranging from 20–80)
Male cut-off point = 49
Female cut-off point = 55

Depression Questionnaire (DQ)
*24 items – rated Yes or No (scores ranging from 0 to 24)
Male cut-off point = 8
Female cut-off point = 12

Cut-off point equal to the 90th percentile.

All self-report questionnaires.

Note: All tests administered first, followed by the clinical interview by the psychologist (same day).
Clinical interview by clinical psychologist using an anxiety- depression assessment form based on previous experiences and the DSM-IV (DSM code 300.4)(psychologist as reference standard)
STAI-X1Sensitivity = 52%, Specificity = 99% PPV = 93%, NPV = 86%
HADS-ASensitivity = 72%, Specificity = 84% PPV = 60%, NPV = 90%
QDSensitivity = 75%, Specificity = 88% PPV = 60%, NPV = 93%
HADS-DSensitivity = 80%, Specificity = 84% PPV = 55%, NPV = 95%
Analysis of ROC
STAI-X1 with 80th percentile cut-off point instead of 90th (psychologist as reference standard)
Sensitivity = 76%, Specificity = 84% PPV = 61%, NPV = 91%
AUC = 0.88 (95% CI: 0.80–0.95)
STAI-X1 with 80th percentile cut-off point instead of 90th (HADS- A as reference standard)Female cut-off point = 48
Sensitivity = 75%
Specificity = 91%
AUC = 0.85 (95% CI: 0.71–0.99)

Male cut-off point = 43
Sensitivity = 78%
Specificity = 96%
AUC = 0.95 (95% CI: 0.90–1.00)
Additional comments:
No information on time point and periods of follow-up; study population were already in rehabilitation programme; did not provide information on critical care/ICU stay.
No clear exclusion criteria.
Italian rehabilitation setting – issue on generalisability.

From: 6.4 Appendix 4, Review protocols and evidence tables

Cover of Rehabilitation After Critical Illness
Rehabilitation After Critical Illness [Internet].
NICE Clinical Guidelines, No. 83.
Centre for Clinical Practice at NICE (UK).
Copyright © 2009, National Institute for Health and Clinical Excellence.

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