**11. Depression assessment in cancer patients**

Through this chapter, the great importance of timely detection of depression in cancer patients has been established. Achieving the correct diagnosis helps us carry out better management, not only of the symptoms caused by the oncological disease but also an adequate intervention regarding the symptoms of depression, allowing us even to achieve an intervention of some family members in the process [38].

Even though the diagnosis is clinical and the ICD 10 or DSM5 criteria can be used, it is also possible to use some evaluation questionnaires that also allow the case to be documented properly.

For more accurate detection of depression, an evaluation in which some exploratory questions are used at the beginning is recommended; if significant symptoms are detected, it is desirable to apply some specialized test that has been previously standardized [39].

The hospital anxiety and depression scale (HAD-Hospital Anxiety and Depression Scale-HADS, Zigmond and Snaith, 1983; see **Table 1**), has been the most used self-assessment instrument to detect emotional distress (anxiety and depression) in populations with physical illness. It is a short instrument (with 14 items) that has shown reliability and validity, being used both for diagnosis and for assessing the severity of the disorder and that has been adapted and validated in various populations and cultures, always showing adequate sensitivity and specificity to discriminate anxiety and depression [39].

It consists of two subscales, HADA for anxiety and HADD for depression, of seven items each with scores from 0 to 3. It includes cognitive and affective dimensions and omits somatic aspects such as loss of appetite, fatigue, insomnia, and others to avoid attributing them to depression and not to the disease itself.

**Hospital Anxiety and Depression Scale questionnaire. To evaluate anxiety and depressive state of patients with physical symptoms, they were asked to attempt a questionnaire comprising 14 items. Note: Copyright © 1983. John Wiley & Sons, Inc. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370.14**


**Hospital Anxiety and Depression Scale questionnaire. To evaluate anxiety and depressive state of patients with physical symptoms, they were asked to attempt a questionnaire comprising 14 items. Note: Copyright © 1983. John Wiley & Sons, Inc. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370.14**


#### **Table 1.**

*HAD-hospital anxiety and depression scale-HADS, Zigmond y Snaith, 1983.*

The authors themselves recommend the original cut-off points: eight for possible cases and > 10 for probable cases in both subscales [40].

*"The advantage of the HADS over other instruments that assess anxious and depressive symptomatology is that it does not include somatic symptoms that can be explained by cancer or its treatment. Being a brief, easy-to-apply and reliable instrument for clinical practice and research in the cancer population, it is relevant to determine the magnitude of the problem, prevention and implementation of actions for treatment" [41].*

On the other hand, the Beck Depression Inventory-II (structured by Beck, Steer and Brown, 1996; see **Appendix A**), a self-report instrument composed of 21 items developed to evaluate the symptoms corresponding to the diagnostic criteria of depressive disorders of the Manual Diagnosis and Statistics of Mental Disorders (DSM5) has also demonstrated to have good psychometric properties, being able to detect the presence of depressive symptoms with significant clinical levels, allowing to timely intervene in the comprehensive care of cancer patients to achieve a better prognosis and better quality of care [42].
