***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Abstract The psychometric properties of the Italian version of the Hospital Anxiety and Depression Scale  and its utility as a screening instrument for  anxiety and depression  in a non-psychiatric setting were evaluated . The question naire was administered twice to 197 breast cancer patients r and omised in a phase III adjuvant clinical trial : before the start of  chemotherapy  and at the first follow-up visit . The presence of psychiatric disorders was evaluated at the follow-up visit using the Structured Clinical Interview for DSM-III-R in 132 patients . Factor analyses identified two strictly correlated factors . Crohnbach 's alpha for the anxiety and depression scales ranged between 0.80 and 0.85 . At follow-up , 50 patients ( 38 % ) were assigned a current DSM-III-R diagnosis , in most cases adjustment disorders ( 24 % ) or major depressive disorder ( 10 % ) . Receiver operating characteristics ( ROC ) analysis was used to test the discriminant validity for both anxiety and depressive disorders . The comparison of the areas under the curve ( AUC ) between the two scales did not show any difference in identifying either anxiety ( P=0.855 ) or depressive disorders ( P=0.357 ) . The 14-item total scale showed a high internal consistency ( alpha=0.89 and 0.88 ) and a high discriminating power for all the psychiatric disorders ( AUC=0.89 ; 95 % CI=0.83–0.94 ) . The cut-off point that maximised sensitivity ( 84 % ) and specificity ( 79 % ) was 10 . These results suggest that the total score is a valid measure of emotional distress , so that the Italian version of HADS can be used as a screening question naire for psychiatric disorders . The use of the two subscales as a ' case identifier ' or as an outcome measure should be considered with caution OBJECTIVE To determine the validity of a two- question case-finding instrument for depression as compared with six previously vali date d instruments . DESIGN The test characteristics of a two- question case-finding instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments , using the Quick Diagnostic Interview Schedule as a criterion st and ard for the diagnosis of major depression . SETTING Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center . PARTICIPANTS Five hundred thirty-six consecutive adult patients without mania or schizophrenia . MEASUREMENTS AND MAIN RESULTS Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient question naire , both the long and short forms of the Center for Epidemiologic Studies Depression Scale , both the long and short forms of the  Book Depression Inventory , the Symptom-Driven Diagnostic System for Primary Care , the Medical Outcomes Study depression measure , and the Quick Diagnostic Interview Schedule . The prevalence of depression , as determined by the st and ardized interview , was 18 % ( 97 of 536 ) . Overall , the case-finding instruments had sensitivities of 89 % to 96 % and specificities of 51 % to 72 % for diagnosing major depression . A positive response to the two-item instrument had a sensitivity of 96 % ( 95 % confidence interval [ CI ] , 90 - 99 % ) and a specificity of 57 % ( 95 % CI 53 - 62 % ) . Areas under the receiver operating characteristic curves were similar for all of the instruments , with a range of 0.82 to 0.89 . CONCLUSIONS The two- question case-finding instrument is a useful measure for detecting depression in primary care . It has similar test characteristics to other case-finding instruments and is less time-consuming The  Hospital Anxiety and Depression ( HAD ) scale , a self-report question naire , was tested as a method of identifying mood disorder among patients with operable breast cancer during the year after diagnosis . In a cohort of 91 patients anxiety and depression were assessed preoperatively , and at 3 and 12 months post-operatively , using a st and ardised psychiatric interview and diagnostic rating criteria . The patients also completed the HAD scale at each assessment . Fifty out of 91 ( 55 % ) patients were full or borderline cases of depression and /or anxiety at one or more assessment points . Using a receiver operator characteristic curve analysis , the optimum threshold for the preoperative  HAD scale total score to identify psychiatric disorder either preoperatively or at 3 and 12 months post-operatively was 11 . With this threshold 70 % of both full and borderline cases occurring at any of the assessment points were correctly identified . The false-positive rate was 12 % . This approach was particularly sensitive to full cases , correctly identifying 90 % of them . The potential for the preoperative  HAD scale total score to identify mood disorder in the year after diagnosis was influenced by age . Among women aged less than 50 years , a preoperative  HAD scale total score > or = 11 provided a highly sensitive indicator of mood disorder ( full and borderline cases ) at any time in the year after diagnosis ( sensitivity = 90 % ) . The false-positive rate was 40 % . Among women older than 50 who experienced a mood disorder , only 57 % were correctly identified by a HAD scale total score of > or = 11 ( sensitivity = 57 % ) . However , the false-positive rate among older women was low ( 3 % ) . This simple preoperative screening approach can be used to identify patients who have or are at high risk of developing severe mood disorder in the year after diagnosis . The HAD scale  is also sensitive to the detection of borderline mood disorder in patients under the age of 50 . It is a specific screening tool among patients over 50 , but is not sensitive to the detection of borderline mood disorder in this age group BACKGROUND This study aim ed to determine the prevalence of  psychiatric morbidity and distress among 189 consecutively recruited cancer patients upon admission to surgical oncology wards , and to investigate the recognition of distressed patients by medical staff . PATIENTS AND METHODS Assessment consisted of a  diagnostic psychiatric interview  ( SCID , DSM-IV ) ,  patient-reported distress using a st and ardised question naire  ( Hospital Anxiety and Depression Scale )  , and  physicians ' and nurses ' estimates of patients ' distress .  Twenty-eight per cent of patients were assigned a psychiatric diagnosis , with adjustment disorder predominating . RESULTS Surgeons accurately recognised marked distress in 77 % of patients with a psychiatric disorder and nurses did so in 75 % . Because of low specificity , the positive predictive value was only 39 % in surgeons and 40 % in nurses . However , recognition of distress translated into referral to the psychosocial liaison service for only a minor proportion of distressed patients . CONCLUSIONS Since a remarkable proportion of distressed patients remained unrecognised by the medical staff , only systematic screening of patients upon admission allows timely support to those who are most in need The authors performed a principal components factor analysis on the 18-item Brief Symptom Inventory ( BSI-18 ) , a new brief screening inventory . The factor analysis , in which four factors were specified , is consistent with findings in a previous community sample . The study sample consisted of 1,543 cancer patients who completed the full BSI as part of their entry into care at a regional cancer center . The reliability of the BSI-18 was determined based on the calculation of the internal consistency , mean item scores , and correlations with the total score of the BSI . In addition , sensitivity and specificity was calculated to determine the ability of the BSI-18 to discriminate positive and negative cases . The BSI-18 is a shortened version of the BSI that can serve as a brief psychological screening instrument . The BSI-18 can be incorporated into outpatient clinics to prospect ively and rapidly identify cancer patients with elevated levels of distress who are in need of clinical interventions . Early identification of distress with appropriate interventions can reduce distress , enhance quality of life , and decrease health care costs Effective evaluation and treatment of cancer pain require valid and independent measurement of pain intensity , pain relief , and psychological distress . The Memorial Pain Assessment Card ( MPAC ) is a simple instrument design ed to provide rapid evaluation of these subjective experiences . On the 8.5 by 11 inch card are printed the eight pain intensity descriptors , and three visual analog scales which measure pain intensity , pain relief , and mood . Experienced patients can complete it in less than 20 seconds . The authors administered the MPAC to 50 hospitalized cancer patients within 48 hours of referral to the Pain Service for inadequate pain control , together with st and ard measures : The McGill Pain Question naire , Profile of Mood States , Hamilton Depression Scale , and Zung Anxiety Scale . Correlational and multiple regression analyses revealed that the MPAC can distinguish pain intensity from pain relief and from general psychological distress , and it can provide multidimensional assessment that is practically equivalent to the full assessment battery . We conclude that the MPAC is valid and effective for clinical use , and recommend it for the assessment of individual patients , and as an outcome measure in clinical trials PURPOSE This study was performed as part of a large depression screening project in cancer patients to determine the degree of physician recognition of levels of depressive symptoms in cancer patients and to describe patient characteristics that influence the accuracy of physician perception of depressive symptoms . METHODS Twenty-five ambulatory oncology clinics affiliated with Community Cancer Care , Inc of Indiana enrolled and surveyed 1,109 subjects treated by 12 oncologists . Subjects completed the Zung Self-Rating Depression Scale ( ZSDS ) and physicians were asked to rate their patients ' level of depressive symptoms , anxiety , and pain using numerical rating scales . Subjects ' sex , age , primary tumor type , medications , primary caregiver , and disease stage at diagnosis were also recorded . RESULTS Physician ratings of depression were significantly associated with their patients ' levels of endorsement of depressive symptoms on the ZSDS . However , agreement between physicians and patients is most frequently clustered when patients report little or no depressive symptoms . While physician ratings are concordant with patient endorsement of no significant depressive symptomatology 79 % of the time , they are only concordant 33 % and 13 % of the time in the mild-to-moderate/severe ranges , respectively . Physician ratings were most influenced by patient endorsement of frequent and obvious mood symptoms , ie , sadness , crying , and irritability . Physician ratings also appeared to be influenced by medical correlates of patients ' level of depressive symptoms ( functional status , stage of disease , and site of tumor ) . Additionally , patients whose depression was inaccurately classified reported significantly higher levels of pain and had higher levels of disability . Physicians ' ratings of depression were most highly correlated with physicians ' ratings of patients ' anxiety and pain . CONCLUSION Physicians ' perceptions of depressive symptoms in their patients are correlated with patient 's ratings , but there is a marked tendency to underestimate the level of depressive symptoms in patients who are more depressed . They are most influenced by symptoms such as crying and depressed mood , and medical factors that are useful , but not the most reliable , indicators of depression in this population . Physicians ' ratings of their patients ' distress symptoms seem to be global in nature -- they are highly correlated with anxiety , pain , and global dysfunction . Physician assessment might be improved if they were instructed to assess and probe for the more reliable cognitive symptoms such as anhedonia , guilt , suicidal thinking , and hopelessness . Screening instruments and the use of brief follow-up interviews would help to identify patients who are depressed A prospect i ve validation study was conducted in 171 consenting patients from oncology and palliative care outpatient clinics to vali date the Distress Thermometer ( DT ) against the  Hospital Anxiety and Depression Scale ( HADS ) ,  General Health Question naire-12 ( GHQ-12 )  and  Brief Symptom Inventory-18 ( BSI-18 ) at baseline , four weeks and eight weeks . Receiver Operating Characteristic analysis was used to examine the sensitivity and specificity of the DT scores against the clinical ly significant cut-off scores of the criterion measures reporting 95 % confidence intervals . St and ardised response means were used to compare DT scores with criterion measures over time . For a cut-off of 4 vs 5 , sensitivity against HADS was 79 % , specificity 81 % ; against GHQ-12 , sensitivity was 63 % , specificity 83 % ; and against BSI-18 , sensitivity was 88 % , specificity 74 % . At both four and eight weeks , DT scores tended to change significantly in the same direction as the criterion measures . Ninety-five percent of patients found completing the DT acceptable . The DT is valid and acceptable for use as a rapid screening instrument for patients in the UK with cancer . Our results indicate that it can be used to monitor change in psychological distress over time , but further work is needed to confirm this Background : Depression is an important predictor of post therapy quality of life ( QOL ) in head and neck ( H&N ) cancer patients . In addition , depression rates may vary among cultures . Objective : As part of a larger cross cultural study on post therapy QOL differences in H&N cancer patients , the goal of this project was to translate a well-vali date d English language depression scale into Swahili , and then vali date this scale in Kenyan H&N cancer patients . Methods , Setting s and Subjects : In Part 1 of the study , we translated the Patient Health Question naire-9 ( PHQ-9 ) into Swahili , adhering to established International Quality of Life Association ( IQOLA ) guidelines . In Part 2 , we psychometrically vali date d the newly translated scale using a prospect i ve study of 48 patients at the Kenyatta National Hospital EN 
    Output:
    
Among the ultrashort measures ( ie , those containing one to four items ) , the Combined  Depression Questions performed best in patients receiving palliative care .
Among the short measures ( ie , those containing five to 20 items ) , the Center for Epidemiologic Studies -Depression Scale and the Hospital Anxiety and Depression Scale demonstrated adequate psychometric properties .