The Hospital Anxiety and Depression Scale (HAD) as a screening instrument in tinnitus evaluation

The identification of anxiety and depressive disorders in tinnitus patients is important from a therapeutic point of view. We have addressed this question by investigating the screening performance of the Hospital Anxiety and Depression Scale (HAD) in a consecutive series of tinnitus patients (n=82) without severe socially disabling hearing loss referred to an audiological clinic. The structured clinical interview for DSM-III criteria was used as the gold standard. Receiver operating characteristic (ROC) curves were used to compare the screening abilities of the HAD subscales for anxiety and depression and the total HAD Scale. The ROC analysis showed that the HAD Scale was better at detecting depression than anxiety disorders in tinnitus patients. The optimal cut-off score for the subscales was greater than or equal to5 when we were screening for any anxiety or depressive disorder as well as for major depression. The performance of the HAD depression subscale was superior, especially when we were screening for major depression only (sensitivity 1.00; specificity 0.75). The findings of the study suggest that the HAD Scale is more useful for screening for depression than for anxiety disorders in tinnitus patients.