The relationship between the Hopkins symptom checklist-10 and diagnoses of anxiety and depression among inpatients with substance use disorders

Figures & data

Table 1. Sample characteristics in SUD diagnoses and types of co-occurring mood and anxiety disorders (N = 606).

	ICD-10 codes	n	%
SUD diagnoses^a
Alcohol	F10	347	57.3
Opiates	F11	112	18.5
Cannabis	F12	227	37.5
Sedatives	F13	173	28.5
Stimula	F15	191	31.5
Polydrug use^b		287	47.4
Anxiety disorders (n = 132)^c
Phobias	F40.0; F40.1; F40.2	51	8.6
Other anxiety disorders	F41.0; F41.1; F41.2; F41.3; F41.8; F41.9	36	5.9
Obsessive-compulsive disorder	F42.1; F42.2; F42.8	2	<1
Post-traumatic stress disorder	F43.1	43	7.1
Adjustment disorders	F43.0; F43.2	5	<1
Dissossiative disorders	F44.2	1	<1
Somatoform disorders	F45.1; F45.2	5	<1
Mood disorders (n = 105)^d
Bipolar affective disorder	F31.0; F31.1; F31.3; F31.7; F31.8; F31.9	17	2.8
Depressive episode	F32.1; F32.2; F32.5; F32.8; F32.9	11	1.8
Recurrent depressive disorder	F33.0; F33.1; F33.2; F33.4; F33.9	68	11.2
Persistent depressive disorder	F34.0; F34.1; F34.9	10	1.7
Unspecified depressive disorder	F39	1	< 1

^aOther SUDs not specified included cocaine (n = 20) (3.4%), hallucinogens (F16) (n = 11) (1.9%) and multiple substance use (F19) (n = 32) (5.5%). For 26 patients, missing data on SUD diagnosis were replaced with report of most frequently used drug.

^bDefined as having two or more SUD diagnoses.

^c Ten patients had more than one type of anxiety disorder.

^d Two patients had two types of mood disorders.

Table 2. Hopkins symptoms checklist (HSCL-10) and its subscales of anxiety and depression symptoms.

Items HSQL-10	Anxiety	Depression
	Component loadings
Suddenly scared for no reason	0.88
Feeling fearful	0.82
Feeling tense or keyed up	0.81
Feeling faintness, dizziness or weakness	0.66
Sleep difficulties	0.52
Feeling blue		0.92
Feeling hopelessness about the future		0.88
Feeling everything is an effort		0.80
Feeling worthless		0.66
Blaming yourself for things		0.57

Note. The two components correlated at 0.65.

Table 3. Mean scores on the HSCL-10, anxiety and depression dimensions for total sample and subsamples diagnosed with anxiety disorders, PTSD mood disorders and MDD.

Sample (n)	HSCL-10 total	Anxiety	Depression
	Mean (SD)	Mean (SD)	Mean (SD)
Total (606)	2.15 (0.71)	2.10 (0.73)	2.20 (0.81)
Any anxiety disorder (132)	2.41^a***(0.66)	2.41^a***(0.70)	2.41^a*** (0.78)
PTSD (43)	2.48^b** (0.74)	2.55^b*** (0.76)	2.42^b (0.81)
Any mood disorder (105)	2.43^c*** (0.66)	2.32^c*** (0.76)	2.54^c*** (0.76)
MDD (79)	2.43^d*** (0.64)	2.30^d* (0.76)	2.56^d*** (0.76)

Note. *** p < 0.001, ** p < 0.001, * p < 0.05.

^a,b,c,d denotes p-values for the differences between patients diagnosed with respectively ^aany anxiety disorder, ^bPTSD, ^cany mood disorders, ^dMDD and all other patients combined.

Table 4. Bivariate analyses of factors associated with the presence of any anxiety disorders, any mood disorders, PTSD and MDD.

		Any anxiety disorder (n = 132)		PTSD (n = 43)		Any mood disorder (n = 105)		MDD (n = 79)
	n	OR (CI: 95%)	p-value	OR (CI: 95%)	p-value	OR (CI: 95%)	p-value	OR (CI: 95%)	p-value
Demographics
Gender female	173	1.79 (1.12;2.69)	0.005	2.98 (1.58;5.61)	<0.001	1.31 (0.83:2.05)	0.243	1.18 (0.71;1.97)	0.527
Age at intake^a	606	0.96 (0.95;0.98)	<0.001	0.97 (0.95;1.00)	0.023	0.98 (0.97;1.00)	0.055	0.98 (0.96;1.00)	0.023
Education low	189	1.30 (0.87;1.96)	0.205	2.20 (1.15;4.19)	0.017	1.29 (0.82;2.02)	0.275	1.29 (0.78;2.14)	0.232
SUD diagnoses
Alcohol (F10)	351	0.67 (0.45;0.98)	0.040	0.51 (0.27;0.95)	0.035	0.75 (0.49;1.15)	0.185	0.69 (0.43;1.11)	0.130
Opiates (F11)	112	1.12 (0.73;1.91)	0.507	2.32 (1.18;4.54)	0.015	1.30 (0.77;2.17)	0.325	1.36 (0.77;2.41)	0.292
Cannabis (F12)	229	1.45 (0.98;2.13)	0.065	1.49 (0.80;2.79)	0.207	1.14 (0.74;1.75)	0.554	1.23 (0.76;1.99)	0.396
Sedatives (F13)	173	2.07 (1.38;3.09)	<0.001	1.73 (0.91;3.27)	0.094	1.18 (0.75;1.86)	0.473	1.36 (0.82;2.24)	0.236
Stimula (F15)	191	1.44 (0.96;2.15)	0.076	3.36 (1.79;6.33)	<0.001	0.89 (0.56;1.41)	0.623	0.94 (0.56;1.57)	0.185
Polydrug use^b	289	2.00 (1.37;2.99)	<0.001	3.52 (1.74;7.12)	<0.001	1.11 (0.73;1.69)	0.625	1.23 (0.77;1.98)	0.387
Treatment center
Center A	182	0.29 (0.16;0.48I	<0.001	0.36 (0.15;0.87)	0.023	0.40 (0.23;0.69)	<0.001	0.27 (0.13;0.54)	<0.001
Center B	67	0.68 (0.35;1.33)	0.263	1.07 (0.41;2.83)	0.885	1.47 (0.79;2.73)	0.222	1.06 (0.50;2.24)	0.878
Center C	112	0.23 (0.11;0.49)	<0.001	0.98 (0.01;0.72)	0.022	0.58 (0.31;1.08)	0.087	0.69 (0.35;1.35)	0.281
Center D	49	1.49 (0.78;2.86)	0.231	2.44 (1.02;5.80)	0.045	1.11 (0.52;2.37)	0.786	1.37 (0.62;3.05)	0.438
Center E	201	5.06 (3.37;7.62)	<0.001	2.79 (1.495.23)	0.001	2.23 (1.45;3.42)	<0.001	2.65 (1.64;4.28)	<0.001

^a Supplementary bivariate analyses using a dichotomized age variable (over/below 30 years) (not shown in table), indicated that compared with older patients, young patients were at an increased risk of having any anxiety disorder (p < 0.001, OR = 2.63, CI: 95% 1.77; 3.89) and PTSD (p = 0.020, OR = 2.11, CI: 95% 1.13; 3.94). The association between young age and any mood disorder was borderline significant (p = 0.052, OR = 2.11, CI: 95% 1.13; 3.94), while the association with MDD appeared non-significant (p = 0.065, OR = 1.57, CI: 95% (0.97; 2.52).

^bDefined as having two or more SUD diagnoses.

Table 5. Crude and corrected models for HSCL-10 and its subscales in ability to discriminate between diagnostic caseness of any anxiety disorder, PTSD, any mood disorder, and MDD.

	Models
	Crude		Corrected
	AUC (95% CI)	p -value	AUC (95% CI)	p -value
Any anxiety disorder^a
HSCL-10	0.640 (0.589;0.691)	<0.001	0.772 (0.729;0.815)	<0.001
Anxiety dimension	0.658 (0.607;0.798)	<0.001	0.776 (0.733;0.819)	<0.001
Depression dimension	0.601 (0.548;0.653)	<0.001	0.766 (0.722;0.810)	<0.001
PTSD^b
HSCL-10	0.636 (0.554;0.717)	0.003	0.820 (0.742;0.899	<0.001
Anxiety dimension	0.675 (0.594;0.756)	<0.001	0.826 (0.749;0.904)	<0.001
Depression dimension	0.581 (0.498;0.664)	0.077	0.812 (0.734;0.890)	<0.001
Any mood disorder^c
HSCL-10	0.642 (0.587;0.697)	<0.001	0.679 (0.623;0.735)	<0.001
Anxiety dimension	0.598 (0.538;0.659)	0.002	0.652 (0.593;0.711)	<0.001
Depression dimension	0.650 (0.596;0.704)	<0.001	0.691 (0.637;0.745)	<0.001
MDD^d
HSCL-10	0.663 (0.604;0.772)	<0.001	0.717 (0.659;0.776)	<0.001
Anxiety dimension	0.627 (0.562;0.691)	0.015	0.694 (0.633;0.755)	<0.001
Depression dimension	0.661 (0.602;0.720)	<0.001	0.722 (0.663;0.780)	<0.001

Note. The corrected models included: ^a Gender; age; alcohol, polydrug use, treatment center A; C; E. ^b Gender, age, education, alcohol, polydrug use, treatment center A; C; D; E. ^c,d Age, treatment center A; E.

Figure 1. (a). The ability of the HSCL-10 to discriminate between individuals with and without PTSD. Crude model. (b). The ability of the HSCL-10 to discriminate between individuals with and without PTSD. Corrected model.