Abstract
Objectives: Optimal cutoff thresholds are selected to separate ‘positive’ from ‘negative’ screening results. We evaluated how depression screening tool studies select optimal cutoffs. Methods: We included studies from previously conducted meta-analyses of Patient Health Questionnaire-9, Edinburgh Postnatal Depression Scale, or Hospital Anxiety and Depression Scale—Depression accuracy. Outcomes included whether an optimal cutoff was selected, method used, recommendations made, and reporting guideline and protocol citation. Results: Of 212 included studies, 172 (81%) attempted to identify an optimal cutoff, and 147 of these 172 (85%) reported one or more methods. Methods were heterogeneous with Youden's J (N = 35, 23%) most common. Only 23 of 147 (16%) studies described a rationale for their method. Rationales focused on balancing sensitivity and specificity without describing why desirable. 131 of 172 studies (76%) identified an optimal cutoff other than the standard; most did not make use recommendations (N = 56; 43%) or recommended using a non-standard cutoff (N = 53; 40%). Only 4 studies cited a reporting guideline, and 4 described a protocol with optimal cutoff selection methods, but none used the protocol method in the published study. Conclusions: Research is needed to guide how selection of cutoffs for depression screening tools can be standardized and reflect clinical considerations.
| Original language | English |
|---|---|
| Article number | e1956 |
| Pages (from-to) | 1-13 |
| Number of pages | 13 |
| Journal | International Journal of Methods in Psychiatric Research |
| Volume | 32 |
| Issue number | 3 |
| Early online date | 3 Dec 2022 |
| DOIs | |
| Publication status | Published - Sept 2023 |
Bibliographical note
Funding Information:The DEPRESSD Project has received funding from the Canadian Institutes of Health Research (KRS‐134297, PJT‐162206, KRS‐140994, DA5‐170278, KRS‐144045, PBB‐175358, PCG‐155468, PBB‐175359, PJT‐178167) and the New Frontiers in Research Fund (NFRFR‐2021‐00336). EB was supported by a McGill University Arts Research Internship Award, BL and YW by Fonds de recherche du Québec—Santé (FRQ‐S) Postdoctoral Training Fellowships, AB by an FRQ‐S Senior Researcher Award, and Dr. Thombs by a Tier 1 Canada Research Chair, all outside of the present work. No funders had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors had full access to the data and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Publisher Copyright:
© 2022 The Authors. International Journal of Methods in Psychiatric Research published by John Wiley & Sons Ltd.
Funding
The DEPRESSD Project has received funding from the Canadian Institutes of Health Research (KRS‐134297, PJT‐162206, KRS‐140994, DA5‐170278, KRS‐144045, PBB‐175358, PCG‐155468, PBB‐175359, PJT‐178167) and the New Frontiers in Research Fund (NFRFR‐2021‐00336). EB was supported by a McGill University Arts Research Internship Award, BL and YW by Fonds de recherche du Québec—Santé (FRQ‐S) Postdoctoral Training Fellowships, AB by an FRQ‐S Senior Researcher Award, and Dr. Thombs by a Tier 1 Canada Research Chair, all outside of the present work. No funders had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors had full access to the data and can take responsibility for the integrity of the data and the accuracy of the data analysis.
| Funders | Funder number |
|---|---|
| New Frontiers in Research Fund | NFRFR‐2021‐00336 |
| McGill University | |
| Canadian Institutes of Health Research | KRS‐134297, DA5‐170278, KRS‐140994, PBB‐175359, PJT‐162206, PBB‐175358, KRS‐144045, PJT‐178167 |
| Canadian Institutes of Health Research | |
| Fonds de Recherche du Québec - Santé | |
| Canada Research Chairs |
Keywords
- edinburgh postnatal depression scale
- hospital anxiety and depression scale
- major depression
- optimal cutoff selection
- patient health questionnaire-9
- screening