Deakin University

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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

journal contribution
posted on 2023-03-31, 04:16 authored by Y Wu, B Levis, FM Daray, JPA Ioannidis, SB Patten, P Cuijpers, RC Ziegelstein, S Gilbody, FH Fischer, S Fan, Y Sun, C He, A Krishnan, D Neupane, PM Bhandari, Z Negeri, KE Riehm, DB Rice, M Azar, XW Yan, M Imran, MJ Chiovitti, JT Boruff, D McMillan, LA Kloda, S Markham, M Henry, Z Ismail, CG Loiselle, ND Mitchell, S Al-Adawi, KR Beck, A Beraldi, CN Bernstein, B Boye, N Büel-Drabe, A Bunevicius, C Can, G Carter, CK Chen, G Cheung, K Clover, RM Conroy, G Costa-Requena, D Cukor, E Dabscheck, J De Souza, M Downing, A Feinstein, PP Ferentinos, AJ Flint, P Gallagher, M Gandy, L Grassi, M Härter, A Hernando, ML Jackson, J Jenewein, N Jetté, M Julião, M Kjærgaard, S Köhler, HH König, LKR Krishna, Y Lee, M Löbner, WL Loosman, AW Love, B Löwe, UF Malt, RA Marrie, L Massardo, Y Matsuoka, A Mehnert, I Michopoulos, L Misery, CJ Nelson, CG Ng, ML O’Donnell, SJ O’Rourke, A Öztürk, A Pabst, Julie PascoJulie Pasco, J Peceliuniene, L Pintor, JL Ponsford, F Pulido, TJ Quinn, SE Reme, K Reuter, SG Riedel-Heller, AG Rooney, R Sánchez-González, RM Saracino, MPJ Schellekens, M Scherer, ML Schwarzbold, VS Cankorur, L Sharpe, M Sharpe
The seven-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, 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 (0.02–0.03). The pattern was similar among outpatients, although the HADS-T was slightly (not nonequivalently) 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.



Psychological Assessment






Washington, D.C.







Publication classification

C1 Refereed article in a scholarly journal




American Psychological Association