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 Review
| Authors: | Wu, Y.; Levis, B.; Daray, F. M.; Ioannidis, J. P.; 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.s D.; Al-Adawi, S.; Beck, K. R.; Beraldi, A.; Bernstein, C. N.; Boye, B.; Buel-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.; Harter, M.; Hernando, A.; Jackson, M. L.; Jenewein, J.; Jette, N.; Juliao, M.; Kjaergaard, M.; Kohler, S.; Konig, H. H.; Krishna, L. K.; Lee, Y.; Lobner, M.; Loosman, W. L.; Love, A. W.; Lowe, 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.; Ozturk, 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.; Sanchez-Gonzalez, R.; Saracino, R. M.; Schellekens, M. P.; Scherer, M.; Benedetti, A.; Thombs, B. D. |
| Review Title: | 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 |
| 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) Impact Statement Public Significance Statement-The present study suggests that the accuracy of 14-item Hospital Anxiety and Depression Scale (HADS-D) and the seven-item HADS Depression subscale (HADS-D) are equivalent for detecting major depression. Using the seven-item HADS-D for depression screening instead of the full 14-item HADS-T has minimal influence on performance of the measure but would reduce patient and participant burden in most clinical and research settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved) |
| Keywords: | diagnostic accuracy; depression screening; hads-d; hads-t; individual participant data meta-analysis |
| Journal Title: | Psychological Assessment |
| Volume: | 35 |
| Issue: | 2 |
| ISSN: | 1040-3590 |
| Publisher: | American Psychological Association |
| Date Published: | 2023-02-01 |
| Start Page: | 95 |
| End Page: | 114 |
| Language: | English |
| ACCESSION: | 2023-39655-001 |
| DOI: | 10.1037/pas0001181 |
| PROVIDER: | Ovid Technologies |
| PROVIDER: | psycinfo |
| PUBMED: | 36689386 |
| DOI/URL: | |
| Notes: | References -- Source: APA PsycInfo |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work