COSMIN database

A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses

Luckett, T., Butow, P. N., King, M. T., Oguchi, M., Heading, G., Hackl, N. A., Rankin, N., and Price, M. A.
OBJECTIVE: The objective of this paper is to inform choice of optimal patient-reported outcome measures (PROMs) of anxiety, depression and general distress for studies evaluating psychosocial interventions for English-speaking adults with heterogenous cancer diagnoses.

METHODS: A systematic review was conducted to identify all PROMs used to assess anxiety, depression and general distress in randomised controlled trials (RCTs) of psychosocial interventions for people with cancer published between 1999 and May 2009. Candidate PROMs were evaluated for content, evidence of reliability and validity, clinical meaningfulness, comparison data, efficiency, ease of administration, cognitive burden and track record in identifying treatment effects in RCTs of psychosocial interventions. Property ratings were weighted and summed to give an overall score out of 100.

RESULTS: The Hospital Anxiety and Depression Scale (HADS) scored highest overall (weighted score = 77.5), followed by the unofficial short-form of the Profile of Mood States (POMS), the POMS-37 (weighted score = 60), and the Centre for Epidemiological Studies Depression Scale (CES-D) and original POMS (weighted score = 55 each).

CONCLUSIONS: The HADS' efficiency and substantial track record recommend its use where anxiety, mixed affective disorders or general distress are outcomes of interest. However, continuing controversy concerning the HADS depression scale cautions against dependence where depressive disorders are of primary interest. Where cost is a concern, the POMS-37 is recommended to measure anxiety or mixed affective disorders but does not offer a suitable index of general distress and, like the HADS, emphasises anhedonia in measuring depression. Where depression is the sole focus, the CES-D is recommended.
Support Care Cancer
1433-7339 (Electronic)
Publication year:
Symptom status:
Cognitive/mental state
Emotional state
Adults (18-65)
Seniors (65+)
Neoplasms and related symptoms
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
BSI-18 - Brief Symptom Inventory-18 items
BSI-53 - Brief Symptom Inventory-53 items
CES-D - Centre for Epidemiologic Studies-Depression Scale (versions: CES-D-R; CES-D-8; CES-D-10; CES-D-11; CES-D-15; CES-D-20; CES-D-Children; CES-D-SF; CES-D m)   
C-SOSI - Calgary Symptoms of Stress Inventory
DT - Distress Thermometer   
GHQ - General Health Questionnaire (versions: original = GHQ-60; GHQ-12; GHQ-20; GHQ-28; GHQW-30; GHQ-36)
HADS - Hospital Anxiety and Depression Scale   
MHI - Mental Health Inventory (verisons: MHI-5 ; MHI-5 items; MHI-38 - MHI 38 items)
POMS - Profile of Mood States (versions: POMS-11; POMS-14; POMS-37; POMS-65; Brief POMS; POMS-Adolescent; POMS-sf; revised POMS)
SCL-90-R - Symptom Checklist 90-Revised
SPHERE - Somatic and Psychological Health Report