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

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

doi:10.1136/bmj.n972

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

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

Research output: Contribution to journal › Review article › peer-review

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, 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 (95.76 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.

Original language	Undefined/Unknown
Journal	British Medical Journal
Volume	373
DOIs	https://doi.org/10.1136/bmj.n972
Publication status	Published - 2021

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10.1136/bmj.n972

https://www.bmj.com/content/373/bmj.n972

Cite this

Wu, Y., Levis, B., Sun, Y., He, C., Krishnan, A., Neupane, D., Bhandari, P. M., Negeri, Z., Benedetti, A., Thombs, B. D., Group, A. DEPRES. S. D. HADS. (Ed.), Riehm, K. E. (Ed.), Rice, D. B. (Ed.), Azar, M. (Ed.), Yan, X. W. (Ed.), Imran, M. (Ed.), Chiovitti, M. J. (Ed.), Saadat, N. (Ed.), Boruff, J. T. (Ed.), ... Wong, L.-Y. (Ed.) (2021). 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. British Medical Journal, 373. https://doi.org/10.1136/bmj.n972

@article{3cf7eb8f282947ad82193cd53d785ef2,

title = "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",

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, 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 (95.76 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.",

author = "Yin Wu and Brooke Levis and Ying Sun and Chen He and Ankur Krishnan and Dipika Neupane and Bhandari, {Parash Mani} and Zelalem Negeri and Andrea Benedetti and Thombs, {Brett D} and Group, {and DEPRESsion Screening Data (DEPRESSD) HADS} and Riehm, {Kira E} and Rice, {Danielle B} and Marleine Azar and Yan, {Xin Wei} and Mahrukh Imran and Chiovitti, {Matthew J} and Nazanin Saadat and Boruff, {Jill T} and Pim Cuijpers and Simon Gilbody and Ioannidis, {John P A} and Kloda, {Lorie A} and Patten, {Scott B} and Ziegelstein, {Roy C} and Sarah Markham and Melissa Henry and Zahinoor Ismail and Loiselle, {Carmen G} and Mitchell, {Nicholas D} and Marcello Tonelli and Samir Al-Adawi and Beck, {Kevin R} and Anna Beraldi and Bernstein, {Charles N} and Birgitte Boye and Natalie B{\"u}el-Drabe and Adomas Bunevicius and Ceyhun Can and Gregory Carter and Chih-Ken Chen and Gary Cheung and Kerrie Clover and Gema Costa-Requena and Daniel Cukor and Eli Dabscheck and Daray, {Federico M} and {De Souza}, Jennifer and Marie Dorow and Downing, {Marina G} and Anthony Feinstein and Ferentinos, {Panagiotis P} and Fischer, {Felix H} and Flint, {Alastair J} and Maiko Fujimori and Pamela Gallagher and Milena Gandy and Luigi Grassi and Martin H{\"a}rter and Asuncion Hernando and Josef Jenewein and Nathalie Jett{\'e} and Miguel Juli{\~a}o and Monika Keller and Sung-Wan Kim and Marie Kj{\ae}rgaard and Sebastian K{\"o}hler and Hans-Helmut K{\"o}nig and Krishna, {Lalit K R} and Yu Lee and Margrit L{\"o}bner and Loosman, {Wim L} and Love, {Anthony W} and Bernd L{\"o}we and Malt, {Ulrik F} and Marrie, {Ruth Ann} and Rocio Martin-Santos and Loreto Massardo and Yutaka Matsuoka and Anja Mehnert and Ioannis Michopoulos and Laurent Misery and Ricard Navines and Nelson, {Christian J} and Ng, {Chong Guan} and O{\textquoteright}Donnell, {Meaghan L} and O{\textquoteright}Rourke, {Suzanne J} and Ahmet {\"O}zt{\"u}rk and Alexander Pabst and Pasco, {Julie A} and Jurate Peceliuniene and Luis Pintor and Ponsford, {Jennie L} and Federico Pulido and Quinn, {Terence J} and Reme, {Silje E} and Katrin Reuter and Nina Rieckmann and Riedel-Heller, {Steffi G} and Rooney, {Alasdair G} and Roberto S{\'a}nchez-Gonz{\'a}lez and Saracino, {Rebecca M} and Schellekens, {Melanie P J} and Martin Scherer and Schwarzbold, {Marcelo L} and {Senturk Cankorur}, Vesile and Juwita Shaaban and Louise Sharpe and Michael Sharpe and S{\'e}bastien Simard and Susanne Singer and Lesley Stafford and Jon Stone and Strobel, {Natalie A} and Serge Sultan and Teixeira, {Antonio L} and Istvan Tiringer and Mira Tschorn and Ka-Yee Tung and Alyna Turner and Michael Wagner and Jane Walker and Mark Walterfang and Liang-Jen Wang and Weyerer, {Siegfried B} and Jennifer White and Williams, {Lana J} and Lai-Yi Wong",

year = "2021",

doi = "10.1136/bmj.n972",

language = "Undefined/Unknown",

volume = "373",

journal = "British Medical Journal",

publisher = "BMJ Publishing Group Ltd",

}

Wu, Y, Levis, B, Sun, Y, He, C, Krishnan, A, Neupane, D, Bhandari, PM, Negeri, Z, Benedetti, A, Thombs, BD, Group, ADEPRESSDHADS (ed.), Riehm, KE (ed.), Rice, DB (ed.), Azar, M (ed.), Yan, XW (ed.), Imran, M (ed.), Chiovitti, MJ (ed.), Saadat, N (ed.), Boruff, JT (ed.), Cuijpers, P (ed.), Gilbody, S (ed.), Ioannidis, JPA (ed.), Kloda, LA (ed.), Patten, SB (ed.), Ziegelstein, RC (ed.), Markham, S (ed.), Henry, M (ed.), Ismail, Z (ed.), Loiselle, CG (ed.), Mitchell, ND (ed.), Tonelli, M (ed.), Al-Adawi, S (ed.), Beck, KR (ed.), Beraldi, A (ed.), Bernstein, CN (ed.), Boye, B (ed.), Büel-Drabe, N (ed.), Bunevicius, A (ed.), Can, C (ed.), Carter, G (ed.), Chen, C-K (ed.), Cheung, G (ed.), Clover, K (ed.), Costa-Requena, G (ed.), Cukor, D (ed.), Dabscheck, E (ed.), Daray, FM (ed.), De Souza, J (ed.), Dorow, M (ed.), Downing, MG (ed.), Feinstein, A (ed.), Ferentinos, PP (ed.), Fischer, FH (ed.), Flint, AJ (ed.), Fujimori, M (ed.), Gallagher, P (ed.), Gandy, M (ed.), Grassi, L (ed.), Härter, M (ed.), Hernando, A (ed.), Jenewein, J (ed.), Jetté, N (ed.), Julião, M (ed.), Keller, M (ed.), Kim, S-W (ed.), Kjærgaard, M (ed.), Köhler, S (ed.), König, H-H (ed.), Krishna, LKR (ed.), Lee, Y (ed.), Löbner, M (ed.), Loosman, WL (ed.), Love, AW (ed.), Löwe, B (ed.), Malt, UF (ed.), Marrie, RA (ed.), Martin-Santos, R (ed.), Massardo, L (ed.), Matsuoka, Y (ed.), Mehnert, A (ed.), Michopoulos, I (ed.), Misery, L (ed.), Navines, R (ed.), Nelson, CJ (ed.), Ng, CG (ed.), O’Donnell, ML (ed.), O’Rourke, SJ (ed.), Öztürk, A (ed.), Pabst, A (ed.), Pasco, JA (ed.), Peceliuniene, J (ed.), Pintor, L (ed.), Ponsford, JL (ed.), Pulido, F (ed.), Quinn, TJ (ed.), Reme, SE (ed.), Reuter, K (ed.), Rieckmann, N (ed.), Riedel-Heller, SG (ed.), Rooney, AG (ed.), Sánchez-González, R (ed.), Saracino, RM (ed.), Schellekens, MPJ (ed.), Scherer, M (ed.), Schwarzbold, ML (ed.), Senturk Cankorur, V (ed.), Shaaban, J (ed.), Sharpe, L (ed.), Sharpe, M (ed.), Simard, S (ed.), Singer, S (ed.), Stafford, L (ed.), Stone, J (ed.), Strobel, NA (ed.), Sultan, S (ed.), Teixeira, AL (ed.), Tiringer, I (ed.), Tschorn, M (ed.), Tung, K-Y (ed.), Turner, A (ed.), Wagner, M (ed.), Walker, J (ed.), Walterfang, M (ed.), Wang, L-J (ed.), Weyerer, SB (ed.), White, J (ed.), Williams, LJ (ed.) & Wong, L-Y (ed.) 2021, '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', British Medical Journal, vol. 373. https://doi.org/10.1136/bmj.n972

TY - JOUR

T1 - 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

AU - Wu, Yin

AU - Levis, Brooke

AU - Sun, Ying

AU - He, Chen

AU - Krishnan, Ankur

AU - Neupane, Dipika

AU - Bhandari, Parash Mani

AU - Negeri, Zelalem

AU - Benedetti, Andrea

AU - Thombs, Brett D

A2 - Group, and DEPRESsion Screening Data (DEPRESSD) HADS

A2 - Riehm, Kira E

A2 - Rice, Danielle B

A2 - Azar, Marleine

A2 - Yan, Xin Wei

A2 - Imran, Mahrukh

A2 - Chiovitti, Matthew J

A2 - Saadat, Nazanin

A2 - Boruff, Jill T

A2 - Cuijpers, Pim

A2 - Gilbody, Simon

A2 - Ioannidis, John P A

A2 - Kloda, Lorie A

A2 - Patten, Scott B

A2 - Ziegelstein, Roy C

A2 - Markham, Sarah

A2 - Henry, Melissa

A2 - Ismail, Zahinoor

A2 - Loiselle, Carmen G

A2 - Mitchell, Nicholas D

A2 - Tonelli, Marcello

A2 - Al-Adawi, Samir

A2 - Beck, Kevin R

A2 - Beraldi, Anna

A2 - Bernstein, Charles N

A2 - Boye, Birgitte

A2 - Büel-Drabe, Natalie

A2 - Bunevicius, Adomas

A2 - Can, Ceyhun

A2 - Carter, Gregory

A2 - Chen, Chih-Ken

A2 - Cheung, Gary

A2 - Clover, Kerrie

A2 - Costa-Requena, Gema

A2 - Cukor, Daniel

A2 - Dabscheck, Eli

A2 - Daray, Federico M

A2 - De Souza, Jennifer

A2 - Dorow, Marie

A2 - Downing, Marina G

A2 - Feinstein, Anthony

A2 - Ferentinos, Panagiotis P

A2 - Fischer, Felix H

A2 - Flint, Alastair J

A2 - Fujimori, Maiko

A2 - Gallagher, Pamela

A2 - Gandy, Milena

A2 - Grassi, Luigi

A2 - Härter, Martin

A2 - Hernando, Asuncion

A2 - Jenewein, Josef

A2 - Jetté, Nathalie

A2 - Julião, Miguel

A2 - Keller, Monika

A2 - Kim, Sung-Wan

A2 - Kjærgaard, Marie

A2 - Köhler, Sebastian

A2 - König, Hans-Helmut

A2 - Krishna, Lalit K R

A2 - Lee, Yu

A2 - Löbner, Margrit

A2 - Loosman, Wim L

A2 - Love, Anthony W

A2 - Löwe, Bernd

A2 - Malt, Ulrik F

A2 - Marrie, Ruth Ann

A2 - Martin-Santos, Rocio

A2 - Massardo, Loreto

A2 - Matsuoka, Yutaka

A2 - Mehnert, Anja

A2 - Michopoulos, Ioannis

A2 - Misery, Laurent

A2 - Navines, Ricard

A2 - Nelson, Christian J

A2 - Ng, Chong Guan

A2 - O’Donnell, Meaghan L

A2 - O’Rourke, Suzanne J

A2 - Öztürk, Ahmet

A2 - Pabst, Alexander

A2 - Pasco, Julie A

A2 - Peceliuniene, Jurate

A2 - Pintor, Luis

A2 - Ponsford, Jennie L

A2 - Pulido, Federico

A2 - Quinn, Terence J

A2 - Reme, Silje E

A2 - Reuter, Katrin

A2 - Rieckmann, Nina

A2 - Riedel-Heller, Steffi G

A2 - Rooney, Alasdair G

A2 - Sánchez-González, Roberto

A2 - Saracino, Rebecca M

A2 - Schellekens, Melanie P J

A2 - Scherer, Martin

A2 - Schwarzbold, Marcelo L

A2 - Senturk Cankorur, Vesile

A2 - Shaaban, Juwita

A2 - Sharpe, Louise

A2 - Sharpe, Michael

A2 - Simard, Sébastien

A2 - Singer, Susanne

A2 - Stafford, Lesley

A2 - Stone, Jon

A2 - Strobel, Natalie A

A2 - Sultan, Serge

A2 - Teixeira, Antonio L

A2 - Tiringer, Istvan

A2 - Tschorn, Mira

A2 - Tung, Ka-Yee

A2 - Turner, Alyna

A2 - Wagner, Michael

A2 - Walker, Jane

A2 - Walterfang, Mark

A2 - Wang, Liang-Jen

A2 - Weyerer, Siegfried B

A2 - White, Jennifer

A2 - Williams, Lana J

A2 - Wong, Lai-Yi

PY - 2021

Y1 - 2021

N2 - 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, 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 (95.76 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.

AB - 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, 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 (95.76 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.

U2 - 10.1136/bmj.n972

DO - 10.1136/bmj.n972

M3 - Review article

VL - 373

JO - British Medical Journal

JF - British Medical Journal

ER -