Accuracy of the Hospital Anxiety and Depression Scale Depression subscale (HADS-D) to screen for major depression: systematic review and individual participant data meta-analysis. (10th May 2021)

• Record Type: Journal Article
• Authors: Wu, Yin; Levis, Brooke; Sun, Ying; He, Chen; Krishnan, Ankur; Neupane, Dipika; Bhandari, Parash Mani; Negeri, Zelalem; Benedetti, Andrea; Thombs, Brett D
• Other Names: author non-byline.; Riehm Kira E author non-byline.; Rice Danielle B author non-byline.; Azar Marleine author non-byline.; Yan Xin Wei author non-byline.; Imran Mahrukh author non-byline.; Chiovitti Matthew J author non-byline.; Saadat Nazanin author non-byline.; Boruff Jill T author non-byline.; Cuijpers Pim author non-byline.; Gilbody Simon author non-byline.; Ioannidis John P A author non-byline.; Kloda Lorie A author non-byline.; Patten Scott B author non-byline.; Ziegelstein Roy C author non-byline.; Markham Sarah author non-byline.; Henry Melissa author non-byline.; Ismail Zahinoor author non-byline.; Loiselle Carmen G author non-byline.; Mitchell Nicholas D author non-byline.; Tonelli Marcello author non-byline.; Al-Adawi Samir author non-byline.; Beck Kevin R author non-byline.; Beraldi Anna author non-byline.; Bernstein Charles N author non-byline.; Boye Birgitte author non-byline.; Büel-Drabe Natalie author non-byline.; Bunevicius Adomas author non-byline.; Can Ceyhun author non-byline.; Carter Gregory author non-byline.; Chen Chih-Ken author non-byline.; Cheung Gary author non-byline.; Clover Kerrie author non-byline.; Costa-Requena Gema author non-byline.; Cukor Daniel author non-byline.; Dabscheck Eli author non-byline.; Daray Federico M author non-byline.; De Souza Jennifer author non-byline.; Dorow Marie author non-byline.; Downing Marina G author non-byline.; Feinstein Anthony author non-byline.; Ferentinos Panagiotis P author non-byline.; Fischer Felix H author non-byline.; Flint Alastair J author non-byline.; Fujimori Maiko author non-byline.; Gallagher Pamela author non-byline.; Gandy Milena author non-byline.; Grassi Luigi author non-byline.; Härter Martin author non-byline.; Hernando Asuncion author non-byline.; Jenewein Josef author non-byline.; Jetté Nathalie author non-byline.; Julião Miguel author non-byline.; Keller Monika author non-byline.; Kim Sung-Wan author non-byline.; Kjærgaard Marie author non-byline.; Köhler Sebastian author non-byline.; König Hans-Helmut author non-byline.; Krishna Lalit K R author non-byline.; Lee Yu author non-byline.; Löbner Margrit author non-byline.; Loosman Wim L author non-byline.; Love Anthony W author non-byline.; Löwe Bernd author non-byline.; Malt Ulrik F author non-byline.; Marrie Ruth Ann author non-byline.; Martin-Santos Rocio author non-byline.; Massardo Loreto author non-byline.; Matsuoka Yutaka author non-byline.; Mehnert Anja author non-byline.; Michopoulos Ioannis author non-byline.; Misery Laurent author non-byline.; Navines Ricard author non-byline.; Nelson Christian J author non-byline.; Ng Chong Guan author non-byline.; O'Donnell Meaghan L author non-byline.; O'Rourke Suzanne J author non-byline.; Öztürk Ahmet author non-byline.; Pabst Alexander author non-byline.; Pasco Julie A author non-byline.; Peceliuniene Jurate author non-byline.; Pintor Luis author non-byline.; Ponsford Jennie L author non-byline.; Pulido Federico author non-byline.; Quinn Terence J author non-byline.; Reme Silje E author non-byline.; Reuter Katrin author non-byline.; Rieckmann Nina author non-byline.; Riedel-Heller Steffi G author non-byline.; Rooney Alasdair G author non-byline.; Sánchez-González Roberto author non-byline.; Saracino Rebecca M author non-byline.; Schellekens Melanie P J author non-byline.; Scherer Martin author non-byline.; Schwarzbold Marcelo L author non-byline.; Senturk Cankorur Vesile author non-byline.; Shaaban Juwita author non-byline.; Sharpe Louise author non-byline.; Sharpe Michael author non-byline.; Simard Sébastien author non-byline.; Singer Susanne author non-byline.; Stafford Lesley author non-byline.; Stone Jon author non-byline.; Strobel Natalie A author non-byline.; Sultan Serge author non-byline.; Teixeira Antonio L author non-byline.; Tiringer Istvan author non-byline.; Tschorn Mira author non-byline.; Tung Ka-Yee author non-byline.; Turner Alyna author non-byline.; Wagner Michael author non-byline.; Walker Jane author non-byline.; Walterfang Mark author non-byline.; Wang Liang-Jen author non-byline.; Weyerer Siegfried B author non-byline.; White Jennifer author non-byline.; Williams Lana J author non-byline.; Wong Lai-Yi author non-byline.;
• Is Part Of: BMJ. Volume 373(2021)
• Publication Date: 2021-05-10
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj.n972
• Languages: English
• ISSNs: 0007-1447

Abstract

Abstract: Objective: To evaluate the accuracy of the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) to screen for major depression among people with physical health problems. Design: Systematic review and individual participant data meta-analysis. Data sources: Medline, Medline In-Process and Other Non-Indexed Citations, PsycInfo, and Web of Science (from inception to 25 October 2018). Review methods: Eligible datasets included HADS-D scores and major depression status based on a validated diagnostic interview. Primary study data and study level data extracted from primary reports were combined. For HADS-D cut-off thresholds of 5-15, a bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, in studies that used semi-structured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders ), fully structured interviews (eg, Composite International Diagnostic Interview), and the Mini International Neuropsychiatric Interview. One stage meta-regression was used to examine whether accuracy was associated with reference standard categories and the characteristics of participants. Sensitivity analyses were done to assess whether including published results from studies that did not provide raw data influenced the results. Results: Individual participant data were obtained from 101 of 168 eligible studies (60%; 25 574 participants (72% of eligible participants), 2549 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of seven or higher for semi-structured interviews, fully structured interviews, and the Mini International Neuropsychiatric Interview. Among studies with a semi-structured interview (57 studies, 10 664 participants, 1048 with major depression), sensitivity and specificity were 0.82 (95% confidence interval 0.76 to 0.87) and 0.78 (0.74 to 0.81) for a cut-off value of seven or higher, 0.74 (0.68 to 0.79) and 0.84 (0.81 to 0.87) for a cut-off value of eight or higher, and 0.44 (0.38 to 0.51) and 0.95 (0.93 to 0.96) for a cut-off value of 11 or higher. Accuracy was similar across reference standards and subgroups and when published results from studies that did not contribute data were included. Conclusions: When screening for major depression, a HADS-D cut-off value of seven or higher maximised combined sensitivity and specificity. A cut-off value of eight or higher generated similar combined sensitivity and specificity but was less sensitive and more specific. To identify medically ill patients with depression with the HADS-D, lower cut-off values could be used to avoid false negatives and higher cut-off values to reduce false positives and identify people with higher symptom levels. Trial registration: PROSPERO CRD42015016761.