***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    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 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 Prediction of delayed psychiatric disorders  in breast cancer patients by using a screening procedure was investigated . Two question naires , the Psychological Distress Inventory and the Hospital Anxiety and Depression Scale  , were administered before and during chemotherapy , and at the first follow-up visit . A psychiatric diagnosis was assigned to 50 of the 132 patients ( 38 % ) evaluated at follow-up . Including a set of clinical and demographic variables in a logistic regression , increasing age ( P=0.001 ) and psychiatric history ( P<0.001 ) were associated with psychiatric morbidity at follow-up . The accuracy of the two question naires in predicting delayed psychiatric disorders increased from the evaluation before chemotherapy to the evaluation during chemotherapy . The most accurate prediction was observed for the concurrent evaluation at follow-up . The accuracy of three predictive models developed for each evaluation point by including age , psychiatric history and psychological distress measured with each of the two question naires was not significantly better than that observed using only the question naires ' scores as predictors PURPOSE Distress has been recognized as the sixth vital sign in cancer care and several guidelines recommend routine screening . Despite this , screening for distress is rarely conducted and infrequently evaluated . METHODS A program of routine online screening for distress was implemented for new patients with breast and lung cancer . Patients were r and omly assigned to one of three conditions : ( 1 ) minimal screening : the distress thermometer ( DT ) only plus usual care ; ( 2 ) full screening : DT , problem checklist , Psychological Screen for Cancer part C measuring anxiety and depression , a personalized report summarizing concerns and the report on the medical file ; or ( 3 ) triage : full screening plus optional personalized phone triage with referral to re sources . Patients in all conditions received an information packet and were reassessed 3 months later with the full screening battery . RESULTS Five hundred eighty-five patients with breast cancer and 549 patients with lung cancer were assessed at baseline ( 89 % of all patients ) , and 75.5 % retained for follow-up . High prevalence of baseline distress was found across patients . Twenty percent fewer patients with lung cancer in triage continued to have high distress at follow-up compared to those in the other two groups , and patients with breast cancer in the full screening and triage conditions showed lower distress at follow-up than those in minimal screening . The best predictor of decreased anxiety and depression in full screening and triage conditions was receiving a referral to psychosocial services . CONCLUSION Routine online screening is feasible in a large cancer center and may help to reduce future distress levels , particularly when coupled with uptake of appropriate re sources The aim of this prospect i ve study was to identify the psychiatric morbidity associated with the diagnosis and treatment of early breast cancer . At each of five time points , 269 women were interviewed using a shortened version of the Present State Examination ( PSE ) and 266 completed self- assessment question naires , the Hospital and Anxiety Depression Scale ( HADS ) and the Rotterdam Symptom Checklist ( RSCL ) . This paper compares the ability of the question naires to detect psychiatric morbidity with that of the PSE . The majority of women who experienced anxiety and /or depression did so within 3 months of their initial surgery . The clinical interview identified anxiety disorder in 132 of 266 women ( 49.6 % ) and depressive illness in 99/266 ( 37.2 % ) during the first 3 months . Using the recommended threshold of > or = 11 for caseness , the sensitivities for both tests were very low at 24.2 % ( HADS anxiety ) and 14.1 % ( HADS depression ) and 30.6 % ( RSCL psychological distress scale ) . Lowering the threshold value to > or = 7 on the HADS improved the sensitivity to 72 % for the anxiety subscale , but it remained low at 37.4 % for the depression subscale . A threshold of > or = 7 for the RSCL scale raised sensitivity to 66.7 % . Lowering the threshold values raised the sensitivity of both the instruments but decreased their specificity : the lower the threshold , the greater the number of women who were identified as false positives which would increase the work load for clinic staff if used as a screening tool . Given that the HADS was inadequate in discriminating for depressive illness , it was not surprising that its use as a unitary scale with a threshold value as low as 12 result ed in a sensitivity of only 42.7 % . In the light of these findings , we question the use of both the HADS and the RSCL as suitable research or screening instruments for detection of psychological morbidity in early breast cancer Two hundred fifteen r and omly accessed cancer patients who were new admissions to three collaborating cancer centers were examined for the presence of formal psychiatric disorder . Each patient was assessed in a common protocol via a psychiatric interview and st and ardized psychological tests . The American Psychiatric Association 's DSM-III diagnostic system was used in making the diagnoses . Results indicated that 47 % of the patients received a DSM-III diagnosis , with 44 % being diagnosed as manifesting a clinical syndrome and 3 % with personality disorders . Approximately 68 % of the psychiatric diagnoses consisted of adjustment disorders , with 13 % representing major affective disorders ( depression ) . The remaining diagnoses were split among organic mental disorders ( 8 % ) , personality disorders ( 7 % ) , and anxiety disorders ( 4 % ) . Approximately 85 % of those patients with a positive psychiatric condition were experiencing a disorder with depression or anxiety as the central symptom . The large majority of conditions were judged to represent highly treatable disorders 
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Conclusions The HADS anxiety subscale performed worse than the total and the depression subscales for both indicators .
Diagnostic accuracy varied widely by threshold but was consistently superior for depression screening than for screening of any mental disorder