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.

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 AbstractThe 7-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 (CIs), 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 to 0.03).The pattern was similar among outpatients, although the HADS-T was slightly (not non-equivalently) 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.