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

Area of Science:

• Mental Health Research
• Psychometric Validation
• Epidemiology

Background:

• Validated diagnostic interviews are essential for accurate depression classification and prevalence estimation.
• Screening tools like the Hospital Anxiety and Depression Scale - depression subscale (HADS-D) are often used as proxies.
• The accuracy of HADS-D in estimating major depression prevalence compared to diagnostic standards requires thorough investigation.

Purpose of the Study:

• To compare depression prevalence estimates derived from standard HADS-D cutoffs (≥8 and ≥11) with those from the Structured Clinical Interview for DSM (SCID).
• To determine if an alternative HADS-D cutoff could provide a more accurate estimation of major depression prevalence.
• To assess the reliability and validity of HADS-D as a screening tool for major depression.

Main Methods:

• An individual participant data meta-analysis was conducted.
• Studies comparing HADS-D scores with SCID major depression status were systematically searched and included.
• Pooled prevalence and differences in prevalence were estimated for various HADS-D cutoffs against SCID diagnoses.

Main Results:

• The meta-analysis included 6005 participants from 41 studies, with 689 SCID-diagnosed major depression cases.
• HADS-D ≥8 substantially overestimated depression prevalence (24.5%) compared to SCID (11.6%).
• HADS-D ≥11 (10.7%) was closest to SCID prevalence, but exhibited substantial heterogeneity in differences (-21.1% to 19.5%).

Conclusions:

• The HADS-D cutoff of ≥8 significantly overestimates major depression prevalence.
• While HADS-D ≥11 showed the closest prevalence to SCID, significant heterogeneity limits its reliability.
• The HADS-D should not be used as a substitute for validated diagnostic interviews in assessing major depression.