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Background <p>The escalating psychosocial burden is critically amplified in conflict zones such as Syria, with cancer patients already in need of critical psychological care to distinguish between somatic and psychiatric dimensions of their state, overwhelmed by the extreme environmental pressures of the war. This creates a challenge for both patients and physicians, severely hindering effective diagnosis, treatment, and care.</p> Aims <p>This study aimed to evaluate the prevalence of anxiety and depression among Syrian cancer patients and validate the compatibility between Hospital Anxiety and Depression Scale (HADS) and Diagnostic and Statistical Manual of Mental Disorders (DSM-5)- the gold standard of clinical diagnosis.</p> Methods <p>A cross-sectional study was conducted with 101 patients with cancer at specialised centres in Damascus. Participants were assessed using the self-reported HADS, where the researcher was blinded to the participants' scores to eliminate bias. Then followed by independent clinical interviews conducted by another specialist based on the DSM-5 criteria.</p> Results <p>The HADS-D identified a high prevalence of depression (54.5%), significantly exceeding the clinical diagnosis of Major Depressive Disorder (22.8%) via the DSM-5. While the anxiety subscale (HADS-A) demonstrated moderate and acceptable agreement with clinical findings (Cramer's V = .329, <i>P</i> = .001), the depression subscale (HADS-D) revealed a striking systematic discrepancy, indicated by a negative Cohen’s Kappa value of -0.085 (<i>P</i> = .031). High depression scores were significantly associated with older age (&gt; 55&#xa0;years), whereas no demographic or clinical variables showed significant correlations with independent clinical diagnoses.</p> Conclusion <p>The findings highlight a "methodological failure" of the HADS-D in differentiating between somatic cancer symptoms and true psychological distress within the Syrian cultural and crisis context. This study cautions against the exclusive reliance on traditional self-report screening tools in such settings and underscores the vital necessity of expert clinical interviews (DSM-5) to ensure diagnostic accuracy in psycho-oncology.</p>

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Diagnostic discrepancy between patient-reported outcomes and clinical assessment: a critical validation of the Hospital Anxiety and Depression Scale (HADS) in Syrian cancer patients

  • 期刊论文

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  • 发表日期：

    2026年7月6日

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  • Ghazal Alidelbi,
  • Thayr Haydar,
  • Maher Saifo,
  • Yosef Latifa,
  • Mostafa Sallom

摘要

Background

The escalating psychosocial burden is critically amplified in conflict zones such as Syria, with cancer patients already in need of critical psychological care to distinguish between somatic and psychiatric dimensions of their state, overwhelmed by the extreme environmental pressures of the war. This creates a challenge for both patients and physicians, severely hindering effective diagnosis, treatment, and care.

Aims

This study aimed to evaluate the prevalence of anxiety and depression among Syrian cancer patients and validate the compatibility between Hospital Anxiety and Depression Scale (HADS) and Diagnostic and Statistical Manual of Mental Disorders (DSM-5)- the gold standard of clinical diagnosis.

Methods

A cross-sectional study was conducted with 101 patients with cancer at specialised centres in Damascus. Participants were assessed using the self-reported HADS, where the researcher was blinded to the participants' scores to eliminate bias. Then followed by independent clinical interviews conducted by another specialist based on the DSM-5 criteria.

Results

The HADS-D identified a high prevalence of depression (54.5%), significantly exceeding the clinical diagnosis of Major Depressive Disorder (22.8%) via the DSM-5. While the anxiety subscale (HADS-A) demonstrated moderate and acceptable agreement with clinical findings (Cramer's V = .329, P = .001), the depression subscale (HADS-D) revealed a striking systematic discrepancy, indicated by a negative Cohen’s Kappa value of -0.085 (P = .031). High depression scores were significantly associated with older age (> 55 years), whereas no demographic or clinical variables showed significant correlations with independent clinical diagnoses.

Conclusion

The findings highlight a "methodological failure" of the HADS-D in differentiating between somatic cancer symptoms and true psychological distress within the Syrian cultural and crisis context. This study cautions against the exclusive reliance on traditional self-report screening tools in such settings and underscores the vital necessity of expert clinical interviews (DSM-5) to ensure diagnostic accuracy in psycho-oncology.