Two of today's studies rest on instruments that are routinely misread on the ward: the Hospital Anxiety and Depression Scale and the DASS-21. Both are screening and severity measures designed for populations. Neither was built to diagnose an individual, and both are at their least reliable in exactly the situation where they get used most - the acutely unwell, recently operated, poorly slept medical inpatient.
When a referral arrives saying 'HADS-D 14, please review', the score is the reason for the referral rather than the answer to it. Postoperative day one produces raised scores through pain, opioid effects, disrupted sleep and the reasonable distress of having just had cancer surgery. The same score a fortnight later, at home, means something quite different.
The practical move is to ask when the instrument was administered and what else was happening at the time, then assess. If you are the one measuring, repeat it rather than acting on a single reading, and record the circumstances alongside the number.
- Ask the date and clinical context of any screening score quoted in a referral
- Repeat a raised HADS or DASS-21 before treating it as a trajectory rather than a snapshot
- Pain, opioids and broken sleep all inflate these scores independently of mood
- Record the circumstances next to the number so the next reader can interpret it
Why it matters
A screening instrument used as a diagnosis converts a normal reaction into a psychiatric label.
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