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Pragmatic detection of anxiety and depression in a prospective cohort of voice outpatient clinic attenders

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  • Jenny Montgomery
  • Jane Hendry
  • Janet A Wilson
  • Ian J Deary
  • Kenneth MacKenzie

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    Rights statement: This is the peer reviewed version of the following article: Montgomery, J., Hendry, J., Wilson, J. A., Deary, I. J., & MacKenzie, K. (2015). Pragmatic detection of anxiety and depression in a prospective cohort of voice outpatient clinic attenders. Clinical Otolaryngology., which has been published in final form at http://dx.doi.org/10.1111/coa.12459. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

    Accepted author manuscript, 449 KB, PDF document

Original languageEnglish
Pages (from-to)2-7
JournalClinical Otolaryngology
Issue number1
Early online date14 May 2015
Publication statusPublished - Feb 2016


OBJECTIVE: To evaluate diagnostic performance of the emotional domain of the VoiSS questionnaire compared with the Hospital Anxiety and Depression Scale (HADS).

DESIGN: Cross sectional questionnaire study.

SETTING: Tertiary referral centre voice clinic.

PARTICIPANTS: 210 consecutive voice clinic patients.

MAIN OUTCOME MEASURES: Screening with VoiSS and HADS questionnaires. Paired comparison, correlation, multinomial logistic regression and receiver operating characteristic (ROC) curve analysis.

RESULTS: 177 returned complete datasets. 96 patients (54.2%) had functional dysphonia and 81(45.8%) had organic laryngeal disorders. Mean total VoiSS score =39.7/120 (standard deviation (SD) 22.2). Mean emotional VoiSS subscale =7.6/22 (SD 7.5). Mean HAD anxiety =6.5/21 (SD 5.2) and depression mean =7.1/21 (SD 4.8). There were 35 (20%) borderline anxiety and/or depression scores and 30 (17%) scores considered positive for "caseness". There was strong correlation between emotional VoiSS and HADS anxiety (Spearman's Rho= 0.68, p < .001) and HADS depression (Spearman's Rho= 0.62, p < .001). ROC curve analysis exhibited significant association between emotional VoiSS and HADS "caseness" (area under curve =0.88). In addition functional dysphonia patients had lower mean VoiSS and HADS scores than patients with identifiable laryngeal abnormalities.

CONCLUSION: The VoiSS emotional subscale strongly correlates with HADS anxiety and depression scores and could be used as a measure of psychological distress. This could allow targeted psychological strategies, without additional psychometric questionnaires. Functional dysphonia has less association with psychological distress than certain organic laryngological disorders. This article is protected by copyright. All rights reserved.

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