@article{2982743,
    title = "Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis",
    author = "Brehaut, E. and Neupane, D. and Levis, B. and Wu, Y. and Sun, Y. and Krishnan, A. and He, C. and Bhandari, P.M. and Negeri, Z. and Riehm, K.E. and Rice, D.B. and Azar, M. and Yan, X.W. and Imran, M. and Chiovitti, M.J. and Saadat, N. and Cuijpers, P. and Ioannidis, J.P.A. and Markham, S. and Patten, S.B. and Ziegelstein, R.C. and Henry, M. and Ismail, Z. and Loiselle, C.G. and Mitchell, N.D. and Tonelli, M. and Boruff, J.T. and Kloda, L.A. and Beraldi, A. and Braeken, A.P.B.M. and Carter, G. and Clover, K. and Conroy, R.M. and Cukor, D. and da Rocha e Silva, C.E. and De Souza, J. and Downing, M.G. and Feinstein, A. and Ferentinos, P.P. and Fischer, F.H. and Flint, A.J. and Fujimori, M. and Gallagher, P. and Goebel, S. and Jetté, N. and Julião, M. and Keller, M. and Kjærgaard, M. and Love, A.W. and Löwe, B. and Martin-Santos, R. and Michopoulos, I. and Navines, R. and O'Rourke, S.J. and Öztürk, A. and Pintor, L. and Ponsford, J.L. and Rooney, A.G. and Sánchez-González, R. and Schwarzbold, M.L. and Sharpe, M. and Simard, S. and Singer, S. and Stone, J. and Tung, K.-Y. and Turner, A. and Walker, J. and Walterfang, M. and White, J. and Benedetti, A. and Thombs, B.D.",
    journal = "Journal of Psychosomatic Research",
    year = "2020",
    volume = "139",
    publisher = "ELSEVIER SCIENCE INC 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA",
    issn = "0022-3999",
    doi = "10.1016/j.jpsychores.2020.110256",
    keywords = "Article;  confidence interval;  diagnostic accuracy;  disease classification;  Hospital Anxiety and Depression Scale;  human;  major depression;  meta analysis;  patient information;  predictive value;  prevalence;  Structured Clinical Interview for DSM Disorders;  systematic review;  adult;  aged;  classification;  depression;  female;  major depression;  male;  middle aged, Adult;  Aged;  Depression;  Depressive Disorder, Major;  Female;  Humans;  Male;  Middle Aged;  Prevalence",
    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. © 2020 Elsevier Inc."
}