Objectives\ud (1) To assess the overall performance of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument to identify cases of major depressive disorder (MDD) in mixed cancer outpatients. (2) To determine the sensitivity and specificity of various HADS cut-off scores. (3) To recommend an optimal HADS cut-off score for use in this population.\ud \ud Methods\ud A cross-sectional questionnaire and interview survey of consecutive patients attending outpatient clinics in a regional cancer centre in Edinburgh, Scotland, United Kingdom.\ud \ud Results\ud Thirty (8.3%) of 361 patients met criteria for MDD at interview. With the use of the total HADS score to identify these cases of MDD, the area under the receiver operating characteristic curve was 0.94 (95% CI, 0.91–0.97). A cut-off of 14/15 gave a sensitivity of 0.87 (95% CI, 0.70–0.95), a specificity of 0.85 (95% CI, 0.81–0.89), and a positive predictive value of 0.35, and was considered optimal.\ud \ud Conclusion\ud The HADS can be used effectively as an initial screening tool for the detection of MDD in outpatients attending mixed cancer clinics
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