Validation of the emotion thermometers and hospital anxiety and depression scales in Singapore: Screening cancer patients for distress, anxiety and depression

Aim: To validate the emotion thermometer (ET) and hospital anxiety and depression scales (HADS) in Singapore, screening cancer patients for distress, anxiety and depression. Methods: Three hundred fifteen cancer patients from National Cancer Centre and Singapore General Hospital participated in the study. Interviews and assessments were conducted in English, assessing patients' sociodemographic data and screening for emotional symptoms using the ET, HADS and Mini-International Neuropsychiatric Interview (MINI) tools. Results: Fifty-three patients (16.83%) fulfilled the MINI criteria for major depressive disorder and 30 patients (12.77%) for generalized anxiety disorder. The ET depression thermometer correlated positively with HADS depression subscale, r = 0.645 (P < 0.01), with area under curve (AUC) value being 0.76, when cutoff score is 3. The ET anxiety thermometer correlated positively with HADS anxiety subscale, r = 0.632 (P < 0.01), with an AUC value of 0.76, when cutoff score is 4. The ET distress thermometer correlated positively with HADS depression subscale, r = 0.506 (P < 0.01), with AUC value being 0.72, when cutoff score is 2, the ET distress thermometer also correlated positively with HADS anxiety subscale, r = 0.652 (P < 0.01), with the AUC value being 0.77, when cutoff score is 4. Using MINI diagnoses for anxiety and depression as the gold standard, cutoff score for HADS depression scale is 7, which yielded an AUC of 0.826. The cutoff score for HADS anxiety scale is 5, yielding an AUC of 0.779. Conclusion: Results from the study support the use of both ET and HADS as valid and reliable instruments assessing for distress, anxiety and depression in cancer patients.