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

Wu Y 1 , Levis B 1 , Daray FM 2 , Ioannidis JPA 3 , Patten SB 4 , Cuijpers P 5 Show all authors , Ziegelstein RC 6 , Gilbody S 7 , Fischer FH 8 , Fan S 1 , Sun Y 1 , He C 1 , Krishnan A 1 , Neupane D 1 , Bhandari PM 1 , Negeri Z 1 , Riehm KE 1 , Rice DB 1 , Azar M 1 , Yan XW 1 , Imran M 1 , Chiovitti MJ 1 , Boruff JT 9 , McMillan D 7 , Kloda LA 10 , Markham S 11 , Henry M 1 , Ismail Z 12 , Loiselle CG 13 , Mitchell ND 14 , Al-Adawi S 15 , Beck KR 16 , Beraldi A 17 , Bernstein CN 18 , Boye B 19 , Büel-Drabe N 20 , Bunevicius A 21 , Can C 22 , Carter G 23 , Chen CK 24 , Cheung G 25 , Clover K 26 , Conroy RM 27 , Costa-Requena G 28 , Cukor D 29 , Dabscheck E 30 , De Souza J 31 , Downing M 32 , Feinstein A 33 , Ferentinos PP 34 , Flint AJ 35 , Gallagher P 36 , Gandy M 37 , Grassi L 38 , Härter M 39 , Hernando A 40 , Jackson ML 41 , Jenewein J 42 , Jetté N 43 , Julião M 44 , Kjærgaard M 45 , Köhler S 46 , König HH 47 , Krishna LKR 48 , Lee Y 49 , Löbner M 50 , Loosman WL 51 , Love AW 52 , Löwe B 53 , Malt UF 54 , Marrie RA 55 , Massardo L 56 , Matsuoka Y 57 , Mehnert A 58 , Michopoulos I 34 , Misery L 59 , Nelson CJ 60 , Ng CG 61 , O'Donnell ML 62 , O'Rourke SJ 63 , Öztürk A 64 , Pabst A 65 , Pasco JA 66 , Peceliuniene J 67 , Pintor L 68 , Ponsford JL 32 , Pulido F 69 , Quinn TJ 70 , Reme SE 71 , Reuter K 72 , Riedel-Heller SG 65 , Rooney AG 73 , Sánchez-González R 74 , Saracino RM 60 , Schellekens MPJ 75 , Scherer M 76 , Benedetti A 77 , Thombs BD 1 , Et Al

Affiliations 

  • 1 Lady Davis Institute for Medical Research, Jewish General Hospital
  • 2 Institute of Pharmacology, School of Medicine, University of Buenos Aires
  • 3 Department of Medicine, Stanford University
  • 4 Department of Community Health Sciences, University of Calgary
  • 5 Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit
  • 6 Department of Medicine, Johns Hopkins University School of Medicine
  • 7 Department of Health Sciences, Hull York Medical School, University of York
  • 8 Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin
  • 9 Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University
  • 10 Library, Concordia University
  • 11 Department of Biostatistics and Health Informatics, King's College London
  • 12 Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary
  • 13 Ingram School of Nursing, McGill University
  • 14 Department of Psychiatry, University of Alberta
  • 15 Department of Behavioural Medicine, College of Medicine & Health Sciences, Sultan Qaboos University
  • 16 Department of Psychiatry, Singapore General Hospital, Singapore
  • 17 kbo Lech-Mangfall-Klinik für Psychatrie, Psychotherapie und Psychsomatik, Garmisch-Partenkirchen
  • 18 Department of Medicine, University of Manitoba
  • 19 Department of Behavioural Medicine, University of Oslo
  • 20 Department of Psychiatry and Psychotherapy, University Hospital Zürich
  • 21 Neuroscience Institute, Lithuanian University of Health Sciences
  • 22 Adana City Training and Research Hospital
  • 23 School of Medicine and Public Health, University of Newcastle
  • 24 Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
  • 25 Department of Psychological Medicine, University of Auckland
  • 26 Centre for Brain and Mental Health Research, University of Newcastle
  • 27 Division of Population Health Sciences, Royal College of Surgeons in Ireland
  • 28 Department of Psychiatry, Clinical Psychology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigacióo Biomédica en Red de Salud Mental
  • 29 Rogosin Institute
  • 30 The Alfred Hospital
  • 31 Birmingham and Solihull Mental Health Foundation Trust
  • 32 School of Psychological Sciences, Monash University
  • 33 Department of Psychiatry, University of Toronto
  • 34 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens
  • 35 University Health Network
  • 36 School of Psychology, Dublin City University
  • 37 The School of Psychological Sciences, Macquarie University
  • 38 Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara
  • 39 Department of Medical Psychology, University Medical Center Hamburg, University of Hamburg
  • 40 HIV Unit, Instituto de Investigacion Hospital 12 de Octubre
  • 41 Turner Institute for Brain and Mental Health, Monash University
  • 42 Department of Medical Psychology and Psychotherapy, Medical University of Graz
  • 43 Department of Neurology, Icahn School of Medicine at Mount Sinai
  • 44 Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra
  • 45 Endocrinology Research Group, Medical Clinic, University Hospital of North Norway
  • 46 Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University
  • 47 Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf
  • 48 Department of Palliative Medicine, National Cancer Centre
  • 49 Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
  • 50 Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig
  • 51 Onze Lieve vrouw Gasthuis
  • 52 Department of Psychology, Victoria University
  • 53 Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf
  • 54 Department of Research and Education Division of Surgery and Clinical Neuroscience, University of Oslo
  • 55 Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba
  • 56 Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia, Universidad San Sebastián
  • 57 Division of Health Care Research, Center for Public Health Sciences, National Cancer Center
  • 58 Department of Medical Psychology and Medical Sociology, University of Leipzig
  • 59 Department of Dermatology, University Hospital of Brest
  • 60 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
  • 61 Department of Psychological Medicine, Faculty of Medicine, University of Malaya
  • 62 Phoenix Australia
  • 63 School of Health in Social Sciences, University of Edinburgh
  • 64 Istanbul Sabahattin Zaim University
  • 65 Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig
  • 66 The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University
  • 67 Faculty of Medicine, Clinic of Internal Diseases, Family Medicine and Oncology, Vilnius University
  • 68 Instituto de Investigaciones Biomédicas Augusto Pi i Sunyer
  • 69 HIV Unit, Hospital 12 de Octubre, imas12, UCM
  • 70 Institute of Cardiovascular and Medical Sciences, University of Glasgow
  • 71 Department of Psychology, Faculty of Social Sciences, University of Oslo
  • 72 Private Practice for Psychotherapy and Psycho-oncology, Freiburg, Baden-Württemberg
  • 73 Division of Psychiatry, University of Edinburgh
  • 74 Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Centre Emili Mira, Parc de Salut Mar
  • 75 Scientific Research Department, Helen Dowling Institute
  • 76 Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf
  • 77 Department of Epidemiology, Biostatistics and Occupational Health, McGill University
Psychol Assess, 2023 Feb;35(2):95-114.
PMID: 36689386 DOI: 10.1037/pas0001181

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).

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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