Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis

Eliana Brehaut; Dipika Neupane; Brooke Levis; Yin Wu; Ying Sun; Ankur Krishnan; Chen He; Parash Mani Bhandari; Zelalem Negeri; Kira E. Riehm; Danielle B. Rice; Marleine Azar; Xin Wei Yan; Mahrukh Imran; Matthew J. Chiovitti; Nazanin Saadat; Pim Cuijpers; John P.A. Ioannidis; Sarah Markham; Scott B. Patten; Roy C. Ziegelstein; Melissa Henry; Zahinoor Ismail; Carmen G. Loiselle; Nicholas D. Mitchell; Marcello Tonelli; Jill T. Boruff; Lorie A. Kloda; Anna Beraldi; Anna P.B.M. Braeken; Gregory Carter; Kerrie Clover; Ronán M. Conroy; Daniel Cukor; Carlos E. da Rocha e Silva; Jennifer De Souza; Marina G. Downing; Anthony Feinstein; Panagiotis P. Ferentinos; Felix H. Fischer; Alastair J. Flint; Maiko Fujimori; Pamela Gallagher; Simone Goebel; Nathalie Jetté; Miguel Julião; Monika Keller; Marie Kjærgaard; Anthony W. Love; Bernd Löwe; Rocio Martin-Santos; Ioannis Michopoulos; Ricard Navines; Suzanne J. O’Rourke; Ahmet Öztürk; Luis Pintor; Jennie L. Ponsford; Alasdair G. Rooney; Roberto Sánchez-González; Marcelo L. Schwarzbold; Michael Sharpe; Sébastien Simard; Susanne Singer; Jon Stone; Ka-Yee Tung; Alyna Turner; Jane Walker; Mark Walterfang; Jennifer White; Andrea Benedetti; Brett D. Thombs

doi:10.1016/j.jpsychores.2020.110256

Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis

Eliana Brehaut, Dipika Neupane, Brooke Levis, Yin Wu, Ying Sun, Ankur Krishnan, Chen He, Parash Mani Bhandari, Zelalem Negeri, Kira E. Riehm, Danielle B. Rice, Marleine Azar, Xin Wei Yan, Mahrukh Imran, Matthew J. Chiovitti, Nazanin Saadat, Pim Cuijpers, John P.A. Ioannidis, Sarah Markham, Scott B. PattenRoy C. Ziegelstein, Melissa Henry, Zahinoor Ismail, Carmen G. Loiselle, Nicholas D. Mitchell, Marcello Tonelli, Jill T. Boruff, Lorie A. Kloda, Anna Beraldi, Anna P.B.M. Braeken, Gregory Carter, Kerrie Clover, Ronán M. Conroy, Daniel Cukor, Carlos E. da Rocha e Silva, Jennifer De Souza, Marina G. Downing, Anthony Feinstein, Panagiotis P. Ferentinos, Felix H. Fischer, Alastair J. Flint, Maiko Fujimori, Pamela Gallagher, Simone Goebel, Nathalie Jetté, Miguel Julião, Monika Keller, Marie Kjærgaard, Anthony W. Love, Bernd Löwe, Rocio Martin-Santos, Ioannis Michopoulos, Ricard Navines, Suzanne J. O’Rourke, Ahmet Öztürk, Luis Pintor, Jennie L. Ponsford, Alasdair G. Rooney, Roberto Sánchez-González, Marcelo L. Schwarzbold, Michael Sharpe, Sébastien Simard, Susanne Singer, Jon Stone, Ka-Yee Tung, Alyna Turner, Jane Walker, Mark Walterfang, Jennifer White, Andrea Benedetti, Brett D. Thombs

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

ObjectivesValidated 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.
MethodsWe 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.
Results6005 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%.
ConclusionsHADS-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.

Original language	English
Journal	Journal of Psychosomatic Research
Volume	139
Early online date	23 Sept 2020
DOIs	https://doi.org/10.1016/j.jpsychores.2020.110256
Publication status	E-pub ahead of print - 23 Sept 2020

Keywords / Materials (for Non-textual outputs)

depression
Hospital Anxiety and Depression Scale
individual participant data
meta-analysis
screening tools

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10.1016/j.jpsychores.2020.110256

BrehautEtalJPR2020DepressionPrevalenceAccepted author manuscript, 598 KBLicence: CC BY-NC-ND

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Brehaut, E., Neupane, D., Levis, B., Wu, Y., Sun, Y., Krishnan, A., He, C., Bhandari, P. M., Negeri, Z., Riehm, K. E., Rice, D. B., Azar, M., Yan, X. W., Imran, M., Chiovitti, M. J., Saadat, N., Cuijpers, P., Ioannidis, J. P. A., Markham, S., ... Thombs, B. D. (2020). Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis. Journal of Psychosomatic Research, 139. Advance online publication. https://doi.org/10.1016/j.jpsychores.2020.110256

@article{c10fbca5c1c44053876e5d7aced7150a,

title = "Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis",

abstract = "ObjectivesValidated 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.MethodsWe 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.Results6005 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%.ConclusionsHADS-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.",

keywords = "depression, Hospital Anxiety and Depression Scale, individual participant data, meta-analysis, screening tools",

author = "Eliana Brehaut and Dipika Neupane and Brooke Levis and Yin Wu and Ying Sun and Ankur Krishnan and Chen He and Bhandari, {Parash Mani} and Zelalem Negeri 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 Pim Cuijpers and Ioannidis, {John P.A.} and Sarah Markham and Patten, {Scott B.} and Ziegelstein, {Roy C.} and Melissa Henry and Zahinoor Ismail and Loiselle, {Carmen G.} and Mitchell, {Nicholas D.} and Marcello Tonelli and Boruff, {Jill T.} and Kloda, {Lorie A.} and Anna Beraldi and Braeken, {Anna P.B.M.} and Gregory Carter and Kerrie Clover and Conroy, {Ron{\'a}n M.} and Daniel Cukor and {da Rocha e Silva}, {Carlos E.} and {De Souza}, Jennifer 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 Simone Goebel and Nathalie Jett{\'e} and Miguel Juli{\~a}o and Monika Keller and Marie Kj{\ae}rgaard and Love, {Anthony W.} and Bernd L{\"o}we and Rocio Martin-Santos and Ioannis Michopoulos and Ricard Navines and O{\textquoteright}Rourke, {Suzanne J.} and Ahmet {\"O}zt{\"u}rk and Luis Pintor and Ponsford, {Jennie L.} and Rooney, {Alasdair G.} and Roberto S{\'a}nchez-Gonz{\'a}lez and Schwarzbold, {Marcelo L.} and Michael Sharpe and S{\'e}bastien Simard and Susanne Singer and Jon Stone and Ka-Yee Tung and Alyna Turner and Jane Walker and Mark Walterfang and Jennifer White and Andrea Benedetti and Thombs, {Brett D.}",

year = "2020",

month = sep,

day = "23",

doi = "10.1016/j.jpsychores.2020.110256",

language = "English",

volume = "139",

journal = "Journal of Psychosomatic Research",

issn = "0022-3999",

publisher = "Elsevier",

}

Brehaut, E, Neupane, D, Levis, B, Wu, Y, Sun, Y, Krishnan, A, He, C, Bhandari, PM, Negeri, Z, Riehm, KE, Rice, DB, Azar, M, Yan, XW, Imran, M, Chiovitti, MJ, Saadat, N, Cuijpers, P, Ioannidis, JPA, Markham, S, Patten, SB, Ziegelstein, RC, Henry, M, Ismail, Z, Loiselle, CG, Mitchell, ND, Tonelli, M, Boruff, JT, Kloda, LA, Beraldi, A, Braeken, APBM, Carter, G, Clover, K, Conroy, RM, Cukor, D, da Rocha e Silva, CE, De Souza, J, Downing, MG, Feinstein, A, Ferentinos, PP, Fischer, FH, Flint, AJ, Fujimori, M, Gallagher, P, Goebel, S, Jetté, N, Julião, M, Keller, M, Kjærgaard, M, Love, AW, Löwe, B, Martin-Santos, R, Michopoulos, I, Navines, R, O’Rourke, SJ, Öztürk, A, Pintor, L, Ponsford, JL, Rooney, AG, Sánchez-González, R, Schwarzbold, ML, Sharpe, M, Simard, S, Singer, S, Stone, J, Tung, K-Y, Turner, A, Walker, J, Walterfang, M, White, J, Benedetti, A & Thombs, BD 2020, 'Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis', Journal of Psychosomatic Research, vol. 139. https://doi.org/10.1016/j.jpsychores.2020.110256

TY - JOUR

T1 - Depression prevalence using the HADS-D compared to SCID major depression classification

T2 - An individual participant data meta-analysis

AU - Brehaut, Eliana

AU - Neupane, Dipika

AU - Levis, Brooke

AU - Wu, Yin

AU - Sun, Ying

AU - Krishnan, Ankur

AU - He, Chen

AU - Bhandari, Parash Mani

AU - Negeri, Zelalem

AU - Riehm, Kira E.

AU - Rice, Danielle B.

AU - Azar, Marleine

AU - Yan, Xin Wei

AU - Imran, Mahrukh

AU - Chiovitti, Matthew J.

AU - Saadat, Nazanin

AU - Cuijpers, Pim

AU - Ioannidis, John P.A.

AU - Markham, Sarah

AU - Patten, Scott B.

AU - Ziegelstein, Roy C.

AU - Henry, Melissa

AU - Ismail, Zahinoor

AU - Loiselle, Carmen G.

AU - Mitchell, Nicholas D.

AU - Tonelli, Marcello

AU - Boruff, Jill T.

AU - Kloda, Lorie A.

AU - Beraldi, Anna

AU - Braeken, Anna P.B.M.

AU - Carter, Gregory

AU - Clover, Kerrie

AU - Conroy, Ronán M.

AU - Cukor, Daniel

AU - da Rocha e Silva, Carlos E.

AU - De Souza, Jennifer

AU - Downing, Marina G.

AU - Feinstein, Anthony

AU - Ferentinos, Panagiotis P.

AU - Fischer, Felix H.

AU - Flint, Alastair J.

AU - Fujimori, Maiko

AU - Gallagher, Pamela

AU - Goebel, Simone

AU - Jetté, Nathalie

AU - Julião, Miguel

AU - Keller, Monika

AU - Kjærgaard, Marie

AU - Love, Anthony W.

AU - Löwe, Bernd

AU - Martin-Santos, Rocio

AU - Michopoulos, Ioannis

AU - Navines, Ricard

AU - O’Rourke, Suzanne J.

AU - Öztürk, Ahmet

AU - Pintor, Luis

AU - Ponsford, Jennie L.

AU - Rooney, Alasdair G.

AU - Sánchez-González, Roberto

AU - Schwarzbold, Marcelo L.

AU - Sharpe, Michael

AU - Simard, Sébastien

AU - Singer, Susanne

AU - Stone, Jon

AU - Tung, Ka-Yee

AU - Turner, Alyna

AU - Walker, Jane

AU - Walterfang, Mark

AU - White, Jennifer

AU - Benedetti, Andrea

AU - Thombs, Brett D.

PY - 2020/9/23

Y1 - 2020/9/23

N2 - ObjectivesValidated 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.MethodsWe 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.Results6005 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%.ConclusionsHADS-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.

AB - ObjectivesValidated 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.MethodsWe 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.Results6005 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%.ConclusionsHADS-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.

KW - depression

KW - Hospital Anxiety and Depression Scale

KW - individual participant data

KW - meta-analysis

KW - screening tools

U2 - 10.1016/j.jpsychores.2020.110256

DO - 10.1016/j.jpsychores.2020.110256

M3 - Article

SN - 0022-3999

VL - 139

JO - Journal of Psychosomatic Research

JF - Journal of Psychosomatic Research

ER -

Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis

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Keywords / Materials (for Non-textual outputs)

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