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Wu, Yin; Levis, Brooke; Daray, Federico M.; Ioannidis, John P. A.; Patten, Scott B.; Cuijpers, Pim; Ziegelstein, Roy C.; Gilbody, Simon; Fischer, Felix H.; Fan, Suiqiong; Sun, Ying; He, Chen; Krishnan, Ankur; Neupane, Dipika; Bhandari, Parash Mani; Negeri, Zelalem; Rice, Danielle B.; Azar, Marleine; Imran, Mahrukh; Boruff, Jill T.; McMillan, Dean; Kloda, Lorie A.; Markham, Sarah; Henry, Melissa; Ismail, Zahinoor; Loiselle, Carmen G.; Mitchell, Nicholas D.; Al-Adawi, Samir; Beck, Kevin R.; Beraldi, Anna; Bernstein, Charles N.; Boye, Birgitte; Büel-Drabe, Natalie; Bunevicius, Adomas; Can, Ceyhun; Carter, Gregory; Cheung, Gary; Clover, Kerrie; Costa-Requena, Gema; Cukor, Daniel; Downing, Marina; Ferentinos, Panagiotis P.; Flint, Alastair J.; Gallagher, Pamela; Gandy, Milena; Grassi, Luigi; Härter, Martin; Hernando, Asuncion; Jackson, Melinda L.; Jenewein, Josef; Jetté, Nathalie; Julião, Miguel; Kjærgaard, Marie; Köhler, Sebastian; Krishna, Lalit K. R.; Lee, Yu; Löbner, Margrit; Loosman, Wim L.; Love, Anthony W.; Löwe, Bernd; Malt, Ulrik F.; Marrie, Ruth Ann; Massardo, Loreto; Matsuoka, Yutaka; Misery, Laurent; Nelson, Christian J.; Ng, Chong Guan; O'Donnell, Meaghan L.; O'Rourke, Suzanne J.; Pabst, Alexander; Pulido, Federico; Quinn, Terence J.; Reme, Silje E.; Reuter, Katrin; Riedel-Heller, Steffi G.; Rooney, Alasdair G.; Schellekens, Melanie P. J.; Scherer, Martin; Schwarzbold, Marcelo L.; Sharpe, Louise; Sharpe, Michael; Simard, Sébastien; Singer, Susanne; Stafford, Lesley; Stone, Jon; Strobel, Natalie A.; Sultan, Serge; Teixeira, Antonio L.; Tiringer, Istvan; Turner, Alyna; Walker, Jane; Walterfang, Mark; Wang, Liang-Jen; Weyerer, Siegfried B.; White, Jennifer; Wiese, Birgitt; Williams, Lana J.; Wong, Lai-Yi; Benedetti, Andrea; Thombs, Brett D.
Psychological assessment, 02/2023, Letnik: 35, Številka: 2Journal Article
The seven-item Hospital Anxiety and Depression Scale Depression subscale (HADS-D) and the total score of the 14-item HADS (HADS-T) are both used for major depression screening. Compared to the HADS-D, the HADS-T includes anxiety items and requires more time to complete. We compared the screening accuracy of the HADS-D and HADS-T for major depression detection. We conducted an individual participant data meta-analysis and fit bivariate random effects models to assess diagnostic accuracy among participants with both HADS-D and HADS-T scores. We identified optimal cutoffs, estimated sensitivity and specificity with 95% confidence intervals, and compared screening accuracy across paired cutoffs via two-stage and individual-level models. We used a 0.05 equivalence margin to assess equivalency in sensitivity and specificity. 20,700 participants (2,285 major depression cases) from 98 studies were included. Cutoffs of ≥7 for the HADS-D (sensitivity 0.79 0.75, 0.83, specificity 0.78 0.75, 0.80) and ≥15 for the HADS-T (sensitivity 0.79 0.76, 0.82, specificity 0.81 0.78, 0.83) minimized the distance to the top-left corner of the receiver operating characteristic curve. Across all sets of paired cutoffs evaluated, differences of sensitivity between HADS-T and HADS-D ranged from −0.05 to 0.01 (0.00 at paired optimal cutoffs), and differences of specificity were within 0.03 for all cutoffs (0.02-0.03). The pattern was similar among outpatients, although the HADS-T was slightly (not nonequivalently) more specific among inpatients. The accuracy of HADS-T was equivalent to the HADS-D for detecting major depression. In most settings, the shorter HADS-D would be preferred. Public Significance Statement The present study suggests that the accuracy of 14-item Hospital Anxiety and Depression Scale (HADS-D) and the seven-item HADS Depression subscale (HADS-D) are equivalent for detecting major depression. Using the seven-item HADS-D for depression screening instead of the full 14-item HADS-T has minimal influence on performance of the measure but would reduce patient and participant burden in most clinical and research settings.
