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^*

^*Corresponding author for this work

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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.

Original language	English
Article number	110256
Pages (from-to)	1-10
Number of pages	10
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	Published - Dec 2020

Funding

This study was funded by the Canadian Institutes of Health Research (CIHR, KRS-144045 & PCG 155468 ). Ms. Neupane was supported by a G.R. Caverhill Fellowship from the Faculty of Medicine, McGill University . Drs. Levis and Wu were supported by Fonds de recherche du Québec - Santé (FRQS) Postdoctoral Training Fellowships. Mr. Bhandari was supported by a studentship from the Research Institute of the McGill University Health Centre . Ms. Rice was supported by a Vanier Canada Graduate Scholarship . Dr. Patten was supported by a Senior Health Scholar award from Alberta Innovates, Health Solutions . The primary study by Scott et al. was supported by the Cumming School of Medicine and Alberta Health Services through the Calgary Health Trust , and funding from the Hotchkiss Brain Institute . The primary study by Amoozegar et al. was supported by the Alberta Health Services , the University of Calgary Faculty of Medicine , and the Hotchkiss Brain Institute . The primary study by Cheung et al. was supported by the Waikato Clinical School, University of Auckland , the Waikato Medical Research Foundation and the Waikato Respiratory Research Fund . The primary study by Cukor et al. was supported in part by a Promoting Psychological Research and Training on Health-Disparities Issues at Ethnic Minority Serving Institutions Grants (ProDIGs) awarded to Dr. Cukor from the American Psychological Association. The primary study by De Souza et al. was supported by Birmingham and Solihull Mental Health Foundation Trust . The primary study by Honarmand et al. was supported by a grant from the Multiple Sclerosis Society of Canada . The primary study by Fischer et al. was supported as part of the RECODEHF study by the German Federal Ministry of Education and Research ( 01GY1150 ). The primary study by Gagnon et al. was supported by the Drummond Foundation and the Department of Psychiatry, University Health Network . The primary study by Akechi et al. was supported in part by a Grant-in-Aid for Cancer Research (11−2) from the Japanese Ministry of Health, Labour and Welfare and a Grant-in-Aid for Young Scientists (B) from the Japanese Ministry of Education, Culture, Sports, Science and Technology . The primary study by Kugaya et al. was supported in part by a Grant-in-Aid for Cancer Research (9–31) and the Second-Term Comprehensive 10-year Strategy for Cancer Control from the Japanese Ministry of Health, Labour and Welfare . The primary study Ryan et al. was supported by the Irish Cancer Society (Grant CRP08GAL ). The primary study by Keller et al. was supported by the Medical Faculty of the University of Heidelberg (grant no. 175/2000 ). The primary study by Love et al. (2004) was supported by the Kathleen Cuningham Foundation (National Breast Cancer Foundation) , the Cancer Council of Victoria and the National Health and Medical Research Council . The primary study by Love et al. (2002) was supported by a grant from the Bethlehem Griffiths Research Foundation . The primary study by Löwe et al. was supported by the medical faculty of the University of Heidelberg, Germany (Project 121/2000 ). The primary study by Navines et al. was supported in part by the Spanish grants from the Fondo de Investigación en Salud, Instituto de Salud Carlos III ( EO PI08/90869 and PSIGEN-VHC Study : FIS-E08/00268 ) and the support of FEDER (one way to make Europe). The primary study by O'Rourke et al. was supported by the Scottish Home and Health Department , Stroke Association , and Medical Research Council . The primary study by Sanchez-Gistau et al. was supported by a grant from the Ministry of Health of Spain ( PI040418 ) and in part by Catalonia Government , DURSI 2009SGR1119 . The primary study by Gould et al. was supported by the Transport Accident Commission Grant . The primary study by Rooney et al. was supported by the NHS Lothian Neuro-Oncology Endowment Fund . The primary study by Schwarzbold et al. was supported by PRONEX Program (NENASC Project) and PPSUS Program of Fundaçao de Amparo a esquisa e Inovacao do Estado de Santa Catarina (FAPESC) and the National Science and Technology Institute for Translational Medicine (INCT-TM). The primary study by Simard et al. was supported by IDEA grants from the Canadian Prostate Cancer Research Initiative and the Canadian Breast Cancer Research Alliance , as well as a studentship from the Canadian Institutes of Health Research . The primary study by Singer et al. (2009) was supported by a grant from the German Federal Ministry for Education and Research (no. 01ZZ0106 ). The primary study by Singer et al. (2008) was supported by grants from the German Federal Ministry for Education and Research (# 7DZAIQTX ) and of the University of Leipzig (# formel. 1–57). The primary study by Meyer et al. was supported by the Federal Ministry of Education and Research (BMBF). The primary study by Stone et al. was supported by the Medical Research Council, UK and Chest Heart and Stroke, Scotland . The primary study by Turner et al. was supported by a bequest from Jennie Thomas through Hunter Medical Research Institute . The primary study by Walterfang et al. was supported by Melbourne Health. Drs. Benedetti and Thombs were supported by FRQS researcher salary awards. No other authors reported funding for primary studies or for their work on this study. No funder had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf and declare that: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years with the following exceptions: (1) Dr. Ismail declares that he has received personal fees from Avanir, Janssen, Lundbeck, Otsuka, Sunovion, outside the submitted work. (2) Dr. Tonelli declares that he has received a grant from Merck Canada, outside the submitted work. (3) Dr. Feinstein reports that he received speaker's honorariums from Biogen, Sanofi-Genzyme, Merck-Serono, Novartis, Roche, and is on the advisory board for Akili Interactive, outside the submitted work; He has also received royalties from the Cambridge University Press for the Clinical Neuropsychiatry of Multiple Sclerosis, 2nd Edition. (4) Dr. Löwe declares that the primary study by Löwe et al. was supported by unrestricted educational grants from Pfizer, Germany. (5) Dr. Stone declares that he has received personal fees from UptoDate, outside the submitted work. No other relationships or activities that could appear to have influenced the submitted work.

Funders	Funder number
Birmingham and Solihull Mental Health Foundation Trust
Calgary Health Trust
Catalonia Government
Chest Heart and Stroke
Cumming School of Medicine and Alberta Health Services
Drummond Foundation
Kathleen Cuningham Foundation
Melbourne Health
NHS Lothian Neuro-Oncology Endowment Fund
PPSUS Program of Fundaçao de Amparo a esquisa e Inovacao do Estado de Santa Catarina
Vanier Canada Graduate Scholarship
Pfizer
American Psychological Association
Alberta Health Services
McGill University
Bethlehem Griffiths Research Foundation	121/2000
Hotchkiss Brain Institute
McGill University Health Centre
Ministerio de Sanidad, Consumo y Bienestar Social	PI040418
Canadian Institutes of Health Research	PCG 155468, KRS-144045
Canadian Breast Cancer Research Alliance
Fonds de Recherche du Québec - Santé
Multiple Sclerosis Society of Canada
Stroke Association
National Health and Medical Research Council
Cancer Council Victoria
National Breast Cancer Foundation
Transport Accident Commission
University of Auckland
Irish Cancer Society	CRP08GAL
Universität Heidelberg	175/2000
Ministry of Education, Culture, Sports, Science and Technology	9–31
Bundesministerium für Bildung und Forschung	01ZZ0106, 01GY1150, 7DZAIQTX
Canadian Prostate Cancer Research Initiative
Scottish Office Home and Health Department
Ministry of Health, Labour and Welfare
Instituto de Salud Carlos III	FIS-E08/00268, EO PI08/90869
Fundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarina
Agencia de Innovación y Desarrollo de Andalucía
Departament d'Universitats, Recerca i Societat de la Informació	2009SGR1119
Medical Research Council Canada
Instituto Nacional de Ciência e Tecnologia Translacional em Medicina
European Regional Development Fund
Universität Leipzig
Alberta Innovates

Keywords

Depression
Hospital Anxiety and Depression Scale
Individual participant data
Meta-analysis
Screening tools

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jpsychores.2020.110256

Depression prevalence using the HADSD compared to SCID major depression classificationFinal published version, 854 KBLicence: Article 25fa Dutch Copyright Act

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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, 1-10. Article 110256. https://doi.org/10.1016/j.jpsychores.2020.110256

@article{5b73c45605f24ad8acc6e9c49b376a7a,

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

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.",

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'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 Tung, {Ka Yee} and Alyna Turner and Jane Walker and Mark Walterfang and Jennifer White and Andrea Benedetti and Thombs, {Brett D.}",

year = "2020",

month = dec,

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

language = "English",

volume = "139",

pages = "1--10",

journal = "Journal of Psychosomatic Research",

issn = "0022-3999",

publisher = "Elsevier Inc.",

}

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, KY, 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, 110256, pp. 1-10. 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 - 2020/12

Y1 - 2020/12

N2 - 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.

AB - 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.

KW - Depression

KW - Hospital Anxiety and Depression Scale

KW - Individual participant data

KW - Meta-analysis

KW - Screening tools

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UR - http://www.scopus.com/inward/citedby.url?scp=85092521996&partnerID=8YFLogxK

U2 - 10.1016/j.jpsychores.2020.110256

DO - 10.1016/j.jpsychores.2020.110256

M3 - Article

AN - SCOPUS:85092521996

SN - 0022-3999

VL - 139

SP - 1

EP - 10

JO - Journal of Psychosomatic Research

JF - Journal of Psychosomatic Research

M1 - 110256

ER -

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

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