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J. Dahm 1, J. Ponsford 1,2, D. Wong 1,3, M.Schönberger 1,2 1 Monash University, 2 Monash-Epworth Rehabilitation Research Centre, 3 Epworth Hospital Introduction.

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Presentation on theme: "J. Dahm 1, J. Ponsford 1,2, D. Wong 1,3, M.Schönberger 1,2 1 Monash University, 2 Monash-Epworth Rehabilitation Research Centre, 3 Epworth Hospital Introduction."— Presentation transcript:

1 J. Dahm 1, J. Ponsford 1,2, D. Wong 1,3, M.Schönberger 1,2 1 Monash University, 2 Monash-Epworth Rehabilitation Research Centre, 3 Epworth Hospital Introduction Prevalence of anxiety and depression following traumatic brain injury (TBI) is higher than population rates and is associated with poorer outcomes. A quick self-report measure of depression and anxiety symptoms would assist in identifying those at risk and provide input to rehabilitation planning. However, utility of such measures is complicated by confounding somatic symptoms of the injury, patients’ overall level of distress and lack of self-awareness. The Hospital Anxiety Depression Scale (HADS) measures self-reported symptoms of anxiety (HADS-A) and depression (HADS-D) and includes few somatic symptoms. It is frequently used following TBI, but the extent to which symptoms of anxiety and depression reflect general distress over injury-related changes remains unclear. The Depression Anxiety Stress Scales (DASS) is a self-report measure comprising three scales: depression (DASS-D), anxiety (DASS-A) and stress (DASS-S). A short version, DASS-21, is available. DASS-D excludes somatic symptoms but DASS-A includes somatic items associated with physiological hyperarousal. By measuring general distress on a separate scale the DASS may show greater sensitivity and specificity than the HADS following TBI. Method Sixty-two participants with TBI (77% male; 75% injured in road accidents) recruited from Epworth Hospital; mean age years (SD = 16.00, range = years); mean education years (SD = 2.31, range = years); mean time since injury days (SD = , range = days); mean lowest GCS score 8.81 (SD = 4.34, range = 3 -15). Anxiety and depression were measured using the Structured Clinical Interview for the DSM-IV- TR (SCID-I), with the HADS and DASS being completed in a separate session. Results Twenty-three participants (37%) were diagnosed with one or more anxiety or mood disorders using the SCID-I. Twenty participants were diagnosed with an anxiety disorder, and 16 participants were diagnosed with a mood disorder. For prediction of diagnosis of a mood or anxiety disorder, all DASS and HADS scales demonstrated a significant area under the curve (AUC). DASS scales correlated highly with their HADS equivalents, with r =.85 for the depression scales and r =.69 for the anxiety scales. Tables 1 and 2 show the sensitivity and specificity of each of the scales at the cutoff recommended in the relevant manual, as well as the AUCs. Figures 1 and 2 show the ROC curves for predicting anxiety and mood disorders. Logistic regression analyses revealed that DASS-D, but not HADS-D, made an individual contribution in predicting diagnosis of a mood disorder. Conversely, HADS-A, but not DASS-A, made an individual contribution in predicting diagnosis of an anxiety disorder. Sensitivity of DASS-A at the recommended cut-off increased with removal of musculoskeletal items such as shakiness and trembling, suggesting they reflect symptoms of injury rather than anxiety. Specificity of DASS-A decreased with removal of autonomic arousal items such as heart racing and perspiration, suggesting they reflect the physiological hyperarousal of anxiety. However, the AUCs remained similar. Conclusions DASS-D demonstrated a better trade-off between sensitivity and specificity than HADS-D in predicting depression, but HADS-A demonstrated a better trade-off than DASS-A in predicting anxiety. A larger sample is required to confirm this. DASS-S demonstrated good sensitivity and specificity for both anxiety and depression, indicating that anxiety and depression in individuals with TBI are related to levels of general distress. Performance of the DASS-21 was similar to the DASS. The short form is easier to use in those with TBI. DASS21-S shows promise as a 7- item screening measure of general distress that is in the public domain. The impact of somatic symptoms on DASS ratings should be examined further. Table 1 Utility of the DASS and HADS in predicting mood disorders Scale Sensitivity % Specificity % AUC DASS-D ** HADS-D ** DASS-S ** DASS21-D ** DASS21-S ** Table 2 Utility of the DASS and HADS in predicting anxiety disorders Scale Sensitivity % Specificity % AUC DASS-A ** HADS-A ** DASS-S ** DASS21-A ** DASS21-S ** DASS-A no somatic ** DASS-A no musculoskeletal ** DASS-A no autonomic ** Aims To examine and compare the sensitivity and specificity of the DASS and HADS in predicting clinical diagnosis of anxiety and depression in individuals with TBI. To examine the sensitivity and specificity of the DASS-21 and a version excluding somatic items from DASS-A. Utility of the Depression Anxiety Stress Scales in assessing depression and anxiety following traumatic brain injury Figure 1. ROC curve for DASS and HADS predicting mood disorders Figure 2. ROC curve for DASS and HADS predicting anxiety disorders ** p <.01


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