1. 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
- Author
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Wu, Y, Levis, B, Daray, FM, Ioannidis, JPA, Patten, SB, Cuijpers, P, Ziegelstein, RC, Gilbody, S, Fischer, FH, Fan, S, Sun, Y, He, C, Krishnan, A, Neupane, D, Bhandari, PM, Negeri, Z, Riehm, KE, Rice, DB, Azar, M, Yan, XW, Imran, M, Chiovitti, MJ, Boruff, JT, McMillan, D, Kloda, LA, Markham, S, Henry, M, Ismail, Z, Loiselle, CG, Mitchell, ND, Al-Adawi, S, Beck, KR, Beraldi, A, Bernstein, CN, Boye, B, Buel-Drabe, N, Bunevicius, A, Can, C, Carter, G, Chen, C-K, Cheung, G, Clover, K, Conroy, RM, Costa-Requena, G, Cukor, D, Dabscheck, E, De Souza, J, Downing, M, Feinstein, A, Ferentinos, PP, Flint, AJ, Gallagher, P, Gandy, M, Grassi, L, Haerter, M, Hernando, A, Jackson, ML, Jenewein, J, Jette, N, Juliao, M, Kjaergaard, M, Kohler, S, Konig, H-H, Krishna, LKR, Lee, Y, Loebner, M, Loosman, WL, Love, AW, Loewe, B, Malt, UF, Marrie, RA, Massardo, L, Matsuoka, Y, Mehnert, A, Michopoulos, I, Misery, L, Nelson, CJ, Ng, CG, O'Donnell, ML, O'Rourke, SJ, Ozturk, A, Pabst, A, Pasco, JA, Peceliuniene, J, Pintor, L, Ponsford, JL, Pulido, F, Quinn, TJ, Reme, SE, Reuter, K, Riedel-Heller, SG, Rooney, AG, Sanchez-Gonzalez, R, Saracino, RM, Schellekens, MPJ, Scherer, M, Schwarzbold, ML, Cankorur, VS, Sharpe, L, Sharpe, M, Simard, S, Singer, S, Stafford, L, Stone, J, Strobe, NA, Sultan, S, Teixeira, AL, Tiringer, I, Turner, A, Walker, J, Walterfang, M, Wang, L-J, Weyerer, SB, White, J, Wiese, B, Williams, LJ, Wong, L-Y, Benedetti, A, Thombsi, BD, Wu, Y, Levis, B, Daray, FM, Ioannidis, JPA, Patten, SB, Cuijpers, P, Ziegelstein, RC, Gilbody, S, Fischer, FH, Fan, S, Sun, Y, He, C, Krishnan, A, Neupane, D, Bhandari, PM, Negeri, Z, Riehm, KE, Rice, DB, Azar, M, Yan, XW, Imran, M, Chiovitti, MJ, Boruff, JT, McMillan, D, Kloda, LA, Markham, S, Henry, M, Ismail, Z, Loiselle, CG, Mitchell, ND, Al-Adawi, S, Beck, KR, Beraldi, A, Bernstein, CN, Boye, B, Buel-Drabe, N, Bunevicius, A, Can, C, Carter, G, Chen, C-K, Cheung, G, Clover, K, Conroy, RM, Costa-Requena, G, Cukor, D, Dabscheck, E, De Souza, J, Downing, M, Feinstein, A, Ferentinos, PP, Flint, AJ, Gallagher, P, Gandy, M, Grassi, L, Haerter, M, Hernando, A, Jackson, ML, Jenewein, J, Jette, N, Juliao, M, Kjaergaard, M, Kohler, S, Konig, H-H, Krishna, LKR, Lee, Y, Loebner, M, Loosman, WL, Love, AW, Loewe, B, Malt, UF, Marrie, RA, Massardo, L, Matsuoka, Y, Mehnert, A, Michopoulos, I, Misery, L, Nelson, CJ, Ng, CG, O'Donnell, ML, O'Rourke, SJ, Ozturk, A, Pabst, A, Pasco, JA, Peceliuniene, J, Pintor, L, Ponsford, JL, Pulido, F, Quinn, TJ, Reme, SE, Reuter, K, Riedel-Heller, SG, Rooney, AG, Sanchez-Gonzalez, R, Saracino, RM, Schellekens, MPJ, Scherer, M, Schwarzbold, ML, Cankorur, VS, Sharpe, L, Sharpe, M, Simard, S, Singer, S, Stafford, L, Stone, J, Strobe, NA, Sultan, S, Teixeira, AL, Tiringer, I, Turner, A, Walker, J, Walterfang, M, Wang, L-J, Weyerer, SB, White, J, Wiese, B, Williams, LJ, Wong, L-Y, Benedetti, A, and Thombsi, BD
- 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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
- Published
- 2023