Eliana Brehaut1, Dipika Neupane2, Brooke Levis3, Yin Wu4, Ying Sun5, Ankur Krishnan6, Chen He7, Parash Mani Bhandari8, Zelalem Negeri9, Kira E Riehm10, Danielle B Rice11, Marleine Azar12, Xin Wei Yan13, Mahrukh Imran14, Matthew J Chiovitti15, Nazanin Saadat16, Pim Cuijpers17, John P A Ioannidis18, Sarah Markham19, Scott B Patten20, Roy C Ziegelstein21, Melissa Henry22, Zahinoor Ismail23, Carmen G Loiselle24, Nicholas D Mitchell25, Marcello Tonelli26, Jill T Boruff27, Lorie A Kloda28, Anna Beraldi29, Anna P B M Braeken30, Gregory Carter31, Kerrie Clover32, Ronán M Conroy33, Daniel Cukor34, Carlos E da Rocha E Silva35, Jennifer De Souza36, Marina G Downing37, Anthony Feinstein38, Panagiotis P Ferentinos39, Felix H Fischer40, Alastair J Flint41, Maiko Fujimori42, Pamela Gallagher43, Simone Goebel44, Nathalie Jetté45, Miguel Julião46, Monika Keller47, Marie Kjærgaard48, Anthony W Love49, Bernd Löwe50, Rocio Martin-Santos51, Ioannis Michopoulos52, Ricard Navines53, Suzanne J O'Rourke54, Ahmet Öztürk55, Luis Pintor56, Jennie L Ponsford57, Alasdair G Rooney58, Roberto Sánchez-González59, Marcelo L Schwarzbold60, Michael Sharpe61, Sébastien Simard62, Susanne Singer63, Jon Stone64, Ka-Yee Tung65, Alyna Turner66, Jane Walker67, Mark Walterfang68, Jennifer White69, Andrea Benedetti70, Brett D Thombs71. 1. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: eliana.brehaut@mail.mcgill.ca. 2. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada. Electronic address: dipika.neupane@mail.mcgill.ca. 3. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Staffordshire, UK. Electronic address: brooke.levis@mail.mcgill.ca. 4. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada. Electronic address: yin.wu@mail.mcgill.ca. 5. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: ying.sun2@mail.mcgill.ca. 6. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: ankur.krishnan@mail.mcgill.ca. 7. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: chen.he3@mail.mcgill.ca. 8. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada. Electronic address: parash.bhandari@mail.mcgill.ca. 9. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada. Electronic address: zelalem.negeri@mail.mcgill.ca. 10. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. Electronic address: kirariehm@gmail.com. 11. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada. Electronic address: danielle.rice@mail.mcgill.ca. 12. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada. Electronic address: marleine.azar@mail.mcgill.ca. 13. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: xin.yan@mail.mcgill.ca. 14. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: mahrukh.imran@mail.mcgill.ca. 15. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: matthew.chiovitti@mail.mcgill.ca. 16. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: nazanin.saadat@mail.mcgill.ca. 17. Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands. Electronic address: p.cuijpers@vu.nl. 18. Department of Medicine, Department of Epidemiology and Population Health, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, CA, USA. Electronic address: jioannid@stanford.edu. 19. Department of Biostatistics and Health Informatics, King's College London, London, UK. Electronic address: sarah.markham@kcl.ac.uk. 20. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada; Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, Canada. Electronic address: patten@ucalgary.ca. 21. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: rziegel2@jhmi.edu. 22. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Electronic address: melissa.henry@mcgill.ca. 23. Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, Clinical Neuroscience and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: ismailz@ucalgary.ca. 24. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Ingram School of Nursing, McGill University, Montréal, Québec, Canada; Centre for Nursing Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Oncology, Faculty of Medicine, McGill University, Montréal, Québec, Canada. Electronic address: carmen.g.loiselle@mcgill.ca. 25. Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada. Electronic address: ndm@ualberta.ca. 26. Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: cello@ucalgary.ca. 27. Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada. Electronic address: jill.boruff@mcgill.ca. 28. Library, Concordia University, Montréal, Québec, Canada. Electronic address: lorie.kloda@concordia.ca. 29. kbo Lech-Mangfall-Klinik für Psychatrie, Psychotherapie und Psychsomatik, Garmisch-Partenkirchen, Bayern, Germany. Electronic address: Anna.Beraldi@psychiatrie-gap.de. 30. Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands; Department of Health Services Research, CAPHRI School for Public Health and Primary, Maastricht University, Maastricht, The Netherlands. Electronic address: v.braeken@maastrichtuniversity.nl. 31. School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Calvary Mater Newcastle, Australia. Electronic address: Gregory.Carter@newcastle.edu.au. 32. Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia. Electronic address: Kerrie.Clover@calvarymater.org.au. 33. Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Ireland. Electronic address: rconroy@rcsi.com. 34. Rogosin Institute, New York, NY, USA. Electronic address: dac9227@nyp.org. 35. Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: ceduardodarochaesilva@gmail.com. 36. Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK; University of Birmingham, Birmingham, UK. Electronic address: jennifer.desouza@nhs.net. 37. School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, VIC, Australia. Electronic address: marina.downing@monash.edu. 38. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: ant.feinstein@utoronto.ca. 39. 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece; Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK. Electronic address: pferentinos@med.uoa.gr. 40. Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany. Electronic address: felix.fischer@charite.de. 41. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada. Electronic address: Alastair.Flint@uhn.ca. 42. Section of Psychological Science, Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan. Electronic address: mfujimor@ncc.go.jp. 43. School of Psychology, Dublin City University, Dublin, Ireland. Electronic address: pamela.gallagher@dcu.ie. 44. Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Christian-Albrechts University, Kiel, Germany. Electronic address: simone.goebel@web.de. 45. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: nathalie.jette@mssm.edu. 46. Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Portugal. Electronic address: migueljuliao@gmail.com. 47. Division of Psychooncology, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany. Electronic address: monika.keller@uni-heidelberg.de. 48. Endocrinology Research Group, Medical Clinic, University Hospital of North Norway, Norway; Department of Internal Medicine, Kolding Hospital, Hospital Lillebaelt, Denmark. Electronic address: marianguaq@gmail.com. 49. Department of Psychology, Victoria University, Victoria, Australia. Electronic address: anthony.love@vu.edu.au. 50. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: b.loewe@uke.de. 51. Department of Psychiatry and Psychology, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain. Electronic address: rmsantos@clinic.cat. 52. 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: yanmih@yahoo.com. 53. Department of Psychiatry and Psychology, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain. Electronic address: rnavines@clinic.cat. 54. School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK. Electronic address: Suzanne.O'Rourke@ed.ac.uk. 55. Bezmialem Vakif University, Istanbul, Turkey. Electronic address: ozturk.ahmet@izu.edu.tr. 56. Instituto de Investigaciones Biomédicas Augusto Pi i Sunyer (IDIBAPS), Barcelona, Spain; Consultation Liaison Psychiatry Unit, Hospital Clínico de Barcelona, Barcelona, Spain. Electronic address: LPINTOR@clinic.cat. 57. School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, VIC, Australia. Electronic address: jennie.ponsford@monash.edu. 58. Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Robert Fergusson Unit, Royal Edinburgh Hospital, NHS Lothian, Edinburgh, UK. Electronic address: ally.rooney@ed.ac.uk. 59. Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Centre Emili Mira, Parc de Salut Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Barcelona, Spain. Electronic address: rsanchezgonzalez@psmar.cat. 60. Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. Electronic address: schwlib@gmail.com. 61. Department of Psychological Medicine, University of Oxford, Oxford, UK. Electronic address: michael.sharpe@psych.ox.ac.uk. 62. Département des sciences de la santé, Université du Québec à Chicoutimi (UQAC), Québec, Canada; Centre intersectoriel en santé durable (CISD), Québec, Canada; Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada. Electronic address: Sebastien1_Simard@uqac.ca. 63. University Medical Centre Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics, Mainz, Germany. Electronic address: singers@uni-mainz.de. 64. Department of Neurology, University of Edinburgh, Edinburgh, UK. Electronic address: jon.stone@ed.ac.uk. 65. Kwai Chung Hospital, Hong Kong, SAR, China. Electronic address: tky028a@ha.org.hk. 66. Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia. Electronic address: a.turner@deakin.edu.au. 67. Department of Psychiatry, University of Oxford, Oxford, UK. Electronic address: jane.walker@psych.ox.ac.uk. 68. Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia; Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia. Electronic address: mark.walterfang@mh.org.au. 69. Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia. 70. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada. Electronic address: andrea.benedetti@mcgill.ca. 71. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada; Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada. Electronic address: brett.thombs@mcgill.ca.
Abstract
OBJECTIVES: Validated diagnostic interviews are required to classify depression status and estimate prevalence of disorder, but screening tools are often used instead. We used individual participant data meta-analysis to compare prevalence based on standard Hospital Anxiety and Depression Scale - depression subscale (HADS-D) cutoffs of ≥8 and ≥11 versus Structured Clinical Interview for DSM (SCID) major depression and determined if an alternative HADS-D cutoff could more accurately estimate prevalence. METHODS: We searched Medline, Medline In-Process & Other Non-Indexed Citations via Ovid, PsycINFO, and Web of Science (inception-July 11, 2016) for studies comparing HADS-D scores to SCID major depression status. Pooled prevalence and pooled differences in prevalence for HADS-D cutoffs versus SCID major depression were estimated. RESULTS: 6005 participants (689 SCID major depression cases) from 41 primary studies were included. Pooled prevalence was 24.5% (95% Confidence Interval (CI): 20.5%, 29.0%) for HADS-D ≥8, 10.7% (95% CI: 8.3%, 13.8%) for HADS-D ≥11, and 11.6% (95% CI: 9.2%, 14.6%) for SCID major depression. HADS-D ≥11 was closest to SCID major depression prevalence, but the 95% prediction interval for the difference that could be expected for HADS-D ≥11 versus SCID in a new study was -21.1% to 19.5%. CONCLUSIONS: HADS-D ≥8 substantially overestimates depression prevalence. Of all possible cutoff thresholds, HADS-D ≥11 was closest to the SCID, but there was substantial heterogeneity in the difference between HADS-D ≥11 and SCID-based estimates. HADS-D should not be used as a substitute for a validated diagnostic interview.
OBJECTIVES: Validated diagnostic interviews are required to classify depression status and estimate prevalence of disorder, but screening tools are often used instead. We used individual participant data meta-analysis to compare prevalence based on standard Hospital Anxiety and Depression Scale - depression subscale (HADS-D) cutoffs of ≥8 and ≥11 versus Structured Clinical Interview for DSM (SCID) major depression and determined if an alternative HADS-D cutoff could more accurately estimate prevalence. METHODS: We searched Medline, Medline In-Process & Other Non-Indexed Citations via Ovid, PsycINFO, and Web of Science (inception-July 11, 2016) for studies comparing HADS-D scores to SCID major depression status. Pooled prevalence and pooled differences in prevalence for HADS-D cutoffs versus SCID major depression were estimated. RESULTS: 6005 participants (689 SCID major depression cases) from 41 primary studies were included. Pooled prevalence was 24.5% (95% Confidence Interval (CI): 20.5%, 29.0%) for HADS-D ≥8, 10.7% (95% CI: 8.3%, 13.8%) for HADS-D ≥11, and 11.6% (95% CI: 9.2%, 14.6%) for SCID major depression. HADS-D ≥11 was closest to SCID major depression prevalence, but the 95% prediction interval for the difference that could be expected for HADS-D ≥11 versus SCID in a new study was -21.1% to 19.5%. CONCLUSIONS: HADS-D ≥8 substantially overestimates depression prevalence. Of all possible cutoff thresholds, HADS-D ≥11 was closest to the SCID, but there was substantial heterogeneity in the difference between HADS-D ≥11 and SCID-based estimates. HADS-D should not be used as a substitute for a validated diagnostic interview.
Authors: Anne M de Graaff; Pim Cuijpers; Mariska Leeflang; Irene Sferra; Jana R Uppendahl; Ralph de Vries; Marit Sijbrandij Journal: Glob Ment Health (Camb) Date: 2021-11-23