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

TY - JOUR

T1 - 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

AU - Wu, Yin

AU - Levis, Brooke

AU - Daray, Federico M

AU - Ioannidis, John P A

AU - Patten, Scott B

AU - Cuijpers, Pim

AU - Ziegelstein, Roy C

AU - Gilbody, Simon

AU - Fischer, Felix H

AU - Fan, Suiqiong

AU - Sun, Ying

AU - He, Chen

AU - Krishnan, Ankur

AU - Neupane, Dipika

AU - Bhandari, Parash Mani

AU - Negeri, Zelalem

AU - Riehm, Kira E

AU - Rice, Danielle B

AU - Azar, Marleine

AU - Yan, Xin Wei

AU - Imran, Mahrukh

AU - Chiovitti, Matthew J

AU - Boruff, Jill T

AU - McMillan, Dean

AU - Kloda, Lorie A

AU - Markham, Sarah

AU - Henry, Melissa

AU - Ismail, Zahinoor

AU - Loiselle, Carmen G

AU - Mitchell, Nicholas D

AU - Al-Adawi, Samir

AU - Beck, Kevin R

AU - Beraldi, Anna

AU - Bernstein, Charles N

AU - Boye, Birgitte

AU - Büel-Drabe, Natalie

AU - Bunevicius, Adomas

AU - Can, Ceyhun

AU - Carter, Gregory

AU - Chen, Chih-Ken

AU - Cheung, Gary

AU - Clover, Kerrie

AU - Conroy, Ronán M

AU - Costa-Requena, Gema

AU - Cukor, Daniel

AU - Dabscheck, Eli

AU - De Souza, Jennifer

AU - Downing, Marina

AU - Feinstein, Anthony

AU - Ferentinos, Panagiotis P

AU - Flint, Alastair J

AU - Gallagher, Pamela

AU - Gandy, Milena

AU - Grassi, Luigi

AU - Härter, Martin

AU - Hernando, Asuncion

AU - Jackson, Melinda L

AU - Jenewein, Josef

AU - Jetté, Nathalie

AU - Julião, Miguel

AU - Kjærgaard, Marie

AU - Köhler, Sebastian

AU - König, Hans-Helmut

AU - Krishna, Lalit K R

AU - Lee, Yu

AU - Löbner, Margrit

AU - Loosman, Wim L

AU - Love, Anthony W

AU - Löwe, Bernd

AU - Malt, Ulrik F

AU - Marrie, Ruth Ann

AU - Massardo, Loreto

AU - Matsuoka, Yutaka

AU - Mehnert, Anja

AU - Michopoulos, Ioannis

AU - Misery, Laurent

AU - Nelson, Christian J

AU - Ng, Chong Guan

AU - O'Donnell, Meaghan L

AU - O'Rourke, Suzanne J

AU - Öztürk, Ahmet

AU - Pabst, Alexander

AU - Pasco, Julie A

AU - Peceliuniene, Jurate

AU - Pintor, Luis

AU - Ponsford, Jennie L

AU - Pulido, Federico

AU - Quinn, Terence J

AU - Reme, Silje E

AU - Reuter, Katrin

AU - Riedel-Heller, Steffi G

AU - Rooney, Alasdair G

AU - Sánchez-González, Roberto

AU - Saracino, Rebecca M

AU - Schellekens, Melanie P J

AU - Scherer, Martin

AU - Benedetti, Andrea

AU - Thombs, Brett D

PY - 2023/2

Y1 - 2023/2

N2 - 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).

AB - 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).

U2 - 10.1037/pas0001181

DO - 10.1037/pas0001181

M3 - SCORING: Journal article

C2 - 36689386

VL - 35

SP - 95

EP - 114

JO - PSYCHOL ASSESSMENT

JF - PSYCHOL ASSESSMENT

SN - 1040-3590

IS - 2

ER -