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.
| Original language | English |
|---|---|
| Pages (from-to) | 95-114 |
| Number of pages | 20 |
| Journal | Psychological Assessment |
| Volume | 35 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 1 Feb 2023 |
Keywords
- CANCER-PATIENTS
- DETECTING DEPRESSION
- HADS-D
- HADS-T
- HOSPITAL ANXIETY
- INTERNATIONAL DIAGNOSTIC INTERVIEW
- MENTAL-DISORDERS
- PATIENT HEALTH QUESTIONNAIRE-9
- PSYCHIATRIC MORBIDITY
- PSYCHOLOGICAL DISTRESS
- QUALITY-OF-LIFE
- RATING-SCALES
- depression screening
- diagnostic accuracy
- individual participant data meta-analysis
- Individual participant data meta-analysis
- Depression screening
- Hads-t
- Diagnostic accuracy
- Hads-d
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In: Psychological Assessment, Vol. 35, No. 2, 01.02.2023, p. 95-114.
Research output: Contribution to journal › (Systematic) Review article › peer-review
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, Y.
AU - Levis, B.
AU - Daray, F.M.
AU - Ioannidis, J.P.A.
AU - Patten, S.B.
AU - Cuijpers, P.
AU - Ziegelstein, R.C.
AU - Gilbody, S.
AU - Fischer, F.H.
AU - Fan, S.Q.
AU - Sun, Y.
AU - He, C.
AU - Krishnan, A.
AU - Neupane, D.
AU - Bhandari, P.M.
AU - Negeri, Z.
AU - Riehm, K.E.
AU - Rice, D.B.
AU - Azar, M.
AU - Yan, X.W.
AU - Imran, M.
AU - Chiovitti, M.J.
AU - Boruff, J.T.
AU - McMillan, D.
AU - Kloda, L.A.
AU - Markham, S.
AU - Henry, M.
AU - Ismail, Z.
AU - Loiselle, C.G.
AU - Mitchell, N.D.
AU - Al-Adawi, S.
AU - Beck, K.R.
AU - Beraldi, A.
AU - Bernstein, C.N.
AU - Boye, B.
AU - Buel-Drabe, N.
AU - Bunevicius, A.
AU - Can, C.
AU - Carter, G.
AU - Chen, C.K.
AU - Cheung, G.
AU - Clover, K.
AU - Conroy, R.M.
AU - Costa-Requena, G.
AU - Cukor, D.
AU - Dabscheck, E.
AU - De Souza, J.
AU - Downing, M.
AU - Feinstein, A.
AU - Ferentinos, P.P.
AU - Köhler, Sebastian
N1 - Funding Information: This study was funded by the Canadian Institutes of Health Research (KRS-140045 & PCG-155468). Yin Wu and Brooke Levis were supported by Fonds de recherche du Québec—Santé (FRQ-S) Postdoctoral Training Fellowships. Scott B. Patten was supported by a Senior Health Scholar award from Alberta Innovates, Health Solutions. Benedetti was supported by a FRQ-S researcher salary award. Brett D. Thombs was supported by a Tier 1 Canada Research Chair. The primary study by Marrie et al. was supported by the Canadian Institutes of Health Research (Grant No. THC-135234), Crohn’s and Colitis Canada, a Research Manitoba Chair, and the Waugh Family Chair in Multiple Sclerosis. The primary study by Bernstein et al. was supported by the Canadian Institutes of Health Research (Grant No. THC-135234) and Crohn’s and Colitis Canada. Charles N. Bernstein was supported in part by the Bingham Chair in Gastroenterology. Ruth Ann Marrie was supported by the Waugh Family Chair in Multiple Sclerosis and the Research Manitoba Chair. The primary study by Butnoriene et al. was supported by a grant from the Research Council of Lithuania (Grant No. LIG-03/2011). The primary study by Chen et al. was supported by the National Science Council, Taiwan (NSC 96–2314-B-182 A-090-MY2). The primary study by Cheung et al. was supported by the Waikato Clinical School, University of Auckland, the Waikato Medical Research Foundation and the Waikato Respiratory Research Fund. The primary study by Costa-Requena et al. was supported by the Catalan Agency for Health Technology Assessment and Research (Grant No. 102/19/2004). The primary study by Cukor et al. was supported in part by a Promoting Psychological Research and Training on Health-Disparities Issues at Ethnic Minority Serving Institutions Grants awarded to Daniel Cukor from the American Psychological Association. The primary study by De la Torre et al. was supported by a Research Grant “Ramón Carrillo-Arturo Oñativa for Multicentric Studies” (2015) from the commission “Salud Investiga” of the Ministry of Health and Social Action of Argentina (Grant No. 1853). The primary study by De Souza et al. was supported by Birmingham and Solihull Mental Health Foundation Trust. The primary study by Dorow et al. was supported by the German Federal Ministry of Education and Research (BMBF; Grant/Award Number: 01GY1155A). The primary study by Fischer et al. was supported as part of the recognition of depression and anxiety in heart failure patients study by the German BMBF (Grant No. 01GY1150). The primary study by Honarmand et al. was supported by a grant from the Multiple Sclerosis Society of Canada. The primary study by Gagnon et al. was supported by the Drummond Foundation and the Department of Psychiatry, University Health Network. The primary study by Akechi et al. was supported in part by a Grant-in-Aid for Cancer Research (11-2) from the Japanese Ministry of Health, Labour and Welfare and a Grant-in-Aid for Young Scientists (B) from the Japanese Ministry of Education, Culture, Sports, Science and Technology. The primary study by Kugaya et al. was supported in part by a Grant-in-Aid for Cancer Research (9-31) and the Second-Term Comprehensive 10-year Strategy for Cancer Control from the Japanese Ministry of Health, Labour and Welfare. The primary study Ryan et al. was supported by the Irish Cancer Society (Grant No. CRP08GAL). The primary study by Grassi et al. was supported by the European Commission DG Health and Consumer Protection (Agreement with the University of Ferrara—SI2.307317 2000CVGG2-026), the University of Ferrara, and the Fondazione Cassa di Risparmio di Ferrara. The primary study by Härter et al. was supported by the BMBF, the Federation of German Pension Insurance Institutes, and the Freiburg/Bad Saeckingen Rehabilitation Research Network (Grant No. 01 GD 9802/4). The primary study by Jackson et al. was supported by a research grant from the Austin Medical Research Fund and equipment provided by Air Liquide. Melinda L. Jackson was supported by an National Health and Medical Research Council (NHMRC) Early Career Fellowship (Grant No. APP1036292). The primary studies by Patten et al., Amoozegar et al., and Prisnie et al. were supported by the University of Calgary Cumming School of Medicine, Alberta Health Services, and the Hotchkiss Brain Institute. Nathalie Jetté was supported by an Alberta Heritage for Foundation Medical Research New Investigator Award in Population Health and a Canada Research Chair Tier 2 in Neurological Health Services Research. Nathalie Jetté is also the Bludhorn Professor of International Medicine. The primary study by Keller et al. was supported by the Medical Faculty of the University of Heidelberg (Grant No. 175/2000). The primary study by Kang et al. was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (Grant No. 2009-0087344), and was supported by a grant of the Korea Health 21 R&D, Ministry of Health and Welfare, Republic of Korea (Grant No. A102065). The primary study by Jang et al. was supported by a grant from the Korea Health 21 R&D, Ministry of Health and Welfare, Republic of Korea. The primary study by Douven et al. was supported by Maastricht University, Health Foundation Limburg, and the Adriana van Rinsum-Ponsen Stichting. The primary study by Love et al. (2004) was supported by the Kathleen Cuningham Foundation (National Breast Cancer Foundation), the Cancer Council of Victoria and the National Health and Medical Research Council. The primary study by Love et al. (2002) was supported by a grant from the Bethlehem Griffiths Research Foundation. The primary study by Löwe et al. was supported by the medical faculty of the University of Heidelberg, Germany (Project 121/2000). The primary study by Massardo et al. was supported by Comisión Nacional de Investigación Científica y Tecnológica Grant No. PFB12/2007 and Fondo Nacional de Desarrolo Científico y Tecnológico (Grant No. 1110849). The primary study by Matsuoka et al. was supported by the Japanese Ministry of Health, Labor, and Welfare through Research on Psychiatric and Neurological Disease and Mental Health (Grant No. 16190501, 19230701, and 20300701). The primary study by Hartung et al. was supported by the German Cancer Aid within the psychosocial oncology funding priority program (Grant No. 107465). The primary study by Consoli et al. was supported by grants from the French Society of Dermatology and the University Hospital of Saint Etienne. The primary study by McFarlane et al. was supported by an Australian Government National Health and Medical Research Council program grant. Meaghan L. O’Donnell was supported by grants from NHMRC Program (Grant No. 1073041) during the conduct of the study. The primary study by O’Rourke et al. was supported by the Scottish Home and Health Department, Stroke Association, and Medical Research Council. The primary study by Sia et al. (principal investigators: Pasco and Williams) was supported by the Victorian Health Promotion Foundation (Grant No. ID 91-0095) and the National Health and Medical Research Council, Australia (Grant No. ID 628582, 299831, 251638, 509103, 1026265, 009367, 1104438). The primary study by Sanchez-Gistau et al. was supported by a grant from the Ministry of Health of Spain (Grant No. PI040418) and in part by Catalonia Government, DURSI 2009SGR1119. The primary study by Gould et al. was supported by the Transport Accident Commission Grant. The primary study by Bayon-Perez et al. was supported by a grant from the Instituto de Investigación Hospital 12 de Octubre (i + 12). Federico Pulido was an investigator from the Intensification of Research Activity Program of the Instituto de Investigación Hospital 12 de Octubre (i + 12) during the conduct of the study. The primary study by Lees et al. was supported by a “start-up” research grant from the British Geriatric Society, Scotland. The primary study by Reme et al. was supported by the Research Council of Norway. The primary study by Rooney et al. was supported by the National Health Service Lothian Neuro-Oncology Endowment Fund. The primary study by Schwarzbold et al. was supported by Programa de Apoio a Núcleos de Excelência (PRONEX Program/NENASC Project) and Programa Pesquisa para o SUS of Fundaçao de Amparo a esquisa e Inovacao do Estado de Santa Catarina and the National Science and Technology Institute for Translational Medicine. The primary studies by Patel et al. (2010, 2011) were supported by the University of Sydney Cancer Research Fund. The primary study by Simard et al. was supported by IDEA grants from the Canadian Prostate Cancer Research Initiative and the Canadian Breast Cancer Research Alliance, as well as a studentship from the Canadian Institutes of Health Research. The primary study by Singer et al. (2009) was supported by a grant from the German Federal Ministry for Education and Research (Grant No. 01ZZ0106). The primary study by Singer et al. (2008) was supported by grants from the German Federal Ministry for Education and Research (Grant No. 7DZAIQTX) and of the University of Leipzig (Grant No. formel. 1–57). The primary study by Meyer et al. was supported by the BMBF. The primary study by Stafford et al. (2014) was supported in part by seed funding from the Western and Central Melbourne Integrated Cancer Service. The primary study by Stafford et al. (2007) was supported by the University of Melbourne. The primary study by Stone et al. was supported by the Medical Research Council, U.K. and Chest Heart and Stroke, Scotland. The primary study by Phan et al. was supported by The Government of Western Australia, Department of Health (Grant No. G1000794). The primary study by de Oliveira et al. was supported by CNPq and Fapemig, Brazil. 301: The primary study by de Oliveira et al. was supported by CNPq and Fapemig, Brazil. The primary study by Pedroso et al. was supported by Fundação de Amparo à Pesquisa do Estado de Minas Gerais (Fapemig; APq-03539-13). The primary study by Tiringer et al. was supported by the Hungarian Research Council (ETT 395). The primary study by Turner et al. was supported by a bequest from Jennie Thomas through Hunter Medical Research Institute. The primary study by Walterfang et al. was supported by Melbourne Health. The primary study by Lee et al. (2017) was supported by a grant from the Kaohsiung Chang Gung Memorial Hospital, Taiwan (Grant No. CMRPG8A0581). The primary study by Lee et al. (2016) was supported by a grant from Kaohsiung Chang Gung Memorial Hospital, Taiwan (Grant No. CMRPG891321). No other authors reported funding for primary studies or for their work on this study. No funder had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; and decision to submit the article for publication. Publisher Copyright: © 2023 American Psychological Association
PY - 2023/2/1
Y1 - 2023/2/1
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.
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.
KW - CANCER-PATIENTS
KW - DETECTING DEPRESSION
KW - HADS-D
KW - HADS-T
KW - HOSPITAL ANXIETY
KW - INTERNATIONAL DIAGNOSTIC INTERVIEW
KW - MENTAL-DISORDERS
KW - PATIENT HEALTH QUESTIONNAIRE-9
KW - PSYCHIATRIC MORBIDITY
KW - PSYCHOLOGICAL DISTRESS
KW - QUALITY-OF-LIFE
KW - RATING-SCALES
KW - depression screening
KW - diagnostic accuracy
KW - individual participant data meta-analysis
KW - Individual participant data meta-analysis
KW - Depression screening
KW - Hads-t
KW - Diagnostic accuracy
KW - Hads-d
U2 - 10.1037/pas0001181
DO - 10.1037/pas0001181
M3 - (Systematic) Review article
C2 - 36689386
SN - 1040-3590
VL - 35
SP - 95
EP - 114
JO - Psychological Assessment
JF - Psychological Assessment
IS - 2
ER -