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
Document Type
Article
Publication Date
2-1-2023
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. 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.
Keywords
HADS-D, HADS-T, Individual participant data meta-analysis, Depression screening, Diagnostic accuracy
Divisions
psychological
Funders
Canadian Institutes of Health Research (CIHR) (KRS-140045),Canadian Institutes of Health Research (CIHR) (PCG-155468),Canadian Institutes of Health Research (CIHR) (THC-135234)
Publication Title
Psychological Assessment
Volume
35
Issue
2
Publisher
Amer Psychological Assoc
Publisher Location
750 FIRST ST NE, WASHINGTON, DC 20002-4242 USA