Comparison of the accuracy of the 7-item HADS Depression subscale and 14-item total HADS for screening for major depression: A systematic review and individual participant data meta-analysis.

Wu, Y. et al. (2023) Comparison of the accuracy of the 7-item HADS Depression subscale and 14-item total HADS for screening for major depression: A systematic review and individual participant data meta-analysis. Psychological Assessment, 35(2), pp. 95-114. (doi: 10.1037/pas0001181) (PMID:36689386)

Abstract

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.

• Item Type: Articles
• Keywords: Depressive disorder, major - diagnosis, anxiety - diagnosis, mass screening, sensitivity and specificity, depression - diagnosis, psychiatric status rating scales, humans.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Quinn, Professor Terry
• Authors: Wu, Y., Levis, B., Daray, F. M., Ioannidis, J. P. A., Patten, S. B., Cuijpers, P., Ziegelstein, R. C., Gilbody, S., Fischer, F. H., Fan, S., Sun, Y., He, C., Krishnan, A., Neupane, D., Bhandari, P. M., Negeri, Z., Riehm, K. E., Rice, D. B., Azar, M., Yan, X. W., Imran, M., Chiovitti, M. J., Boruff, J. T., McMillan, D., Kloda, L. A., Markham, S., Henry, M., Ismail, Z., Loiselle, C. G., Mitchell, N. D., Al-Adawi, S., Beck, K. R., Beraldi, A., Bernstein, C. N., Boye, B., Büel-Drabe, N., Bunevicius, A., Can, C., Carter, G., Chen, C.-K., Cheung, G., Clover, K., Conroy, R. M., Costa-Requena, G., Cukor, D., Dabscheck, E., De Souza, J., Downing, M., Feinstein, A., Ferentinos, P. P., Flint, A. J., Gallagher, P., Gandy, M., Grassi, L., Härter, M., Hernando, A., Jackson, M. L., Jenewein, J., Jetté, N., Julião, M., Kjærgaard, M., Köhler, S., König, H.-H., Krishna, L. K. R., Lee, Y., Löbner, M., Loosman, W. L., Love, A. W., Löwe, B., Malt, U. F., Marrie, R. A., Massardo, L., Matsuoka, Y., Mehnert, A., Michopoulos, I., Misery, L., Nelson, C. J., Ng, C. G., O'Donnell, M. L., O'Rourke, S. J., Öztürk, A., Pabst, A., Pasco, J. A., Peceliuniene, J., Pintor, L., Ponsford, J. L., Pulido, F., Quinn, T. J., Reme, S. E., Reuter, K., Riedel-Heller, S. G., Rooney, A. G., Sánchez-González, R., Saracino, R. M., Schellekens, M. P. J., Scherer, M., Benedetti, A., and Thombs, B. D.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Psychological Assessment
• Publisher: American Psychological Association
• ISSN: 1040-3590
• ISSN (Online): 1939-134X
• Copyright Holders: Copyright © 2023 American Psychological Association
• First Published: First published in Psychological Assessment 53(2):95-114
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher