Articlebronze2011

Measuring depression severity in general practice: discriminatory performance of the PHQ-9, HADS-D, and BDI-II

Isobel M. Cameron · Amanda H. Cardy · John R. Crawford · Schalk W. du Toit · Kenneth Lawton · Kenneth Mitchell +4 more

109 citations0/0 files storedBritish Journal of General Practice

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Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Psychometric Methodologies and Testing Mental Health Treatment and Access

Abstract

BACKGROUND: The UK Quality and Outcomes Framework (QOF) rewards practices for measuring symptom severity in patients with depression, but the endorsed scales have not been comprehensively validated for this purpose. AIM: To assess the discriminatory performance of the QOF depression severity measures. DESIGN AND SETTING: Psychometric assessment in nine Scottish general practices. METHOD: Adult primary care patients diagnosed with depression were invited to participate. The HADS-D, PHQ-9, and BDI-II were assessed against the HRSD-17 interview. Discriminatory performance was determined relative to the HRSD-17 cut-offs for symptoms of at least moderate severity, as per criteria set by the American Psychiatric Association (APA) and NICE. Receiver operating characteristic curves were plotted and area under the curve (AUC), sensitivity, specificity, and likelihood ratios (LRs) calculated. RESULTS: A total of 267 were recruited per protocol, mean age = 49.8 years (standard deviation [SD] = 14.1), 70% female, mean HRSD-17=12.6 (SD = 7.62, range = 0-34). For APA criteria, AUCs were: HADS-D = 0.84; PHQ-9 = 0.90; and BDI-II = 0.86. Optimal sensitivity and specificity were reached where HADS-D ≥9 (74%, 76%); PHQ-9 ≥12 (77%, 79%), and BDI-II ≥23 (74%, 75%). For NICE criteria: HADS-D AUC = 0.89; PHQ-9 AUC = 0.93; and BDI-II AUC = 0.90. Optimal sensitivity and specificity were reached where HADS-D ≥10 (82%, 75%), PHQ-9 ≥15 (89%, 83%), and BDI-II ≥28 (83%, 80%). LRs did not provide evidence of sufficient accuracy for clinical use. CONCLUSION: As selecting treatment according to depression severity is informed by an evidence base derived from trials using HRSD-17, and none of the measures tested aligned adequately with that tool, they are inappropriate for use.

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References

1983The Hospital Anxiety and Depression Scale 2001The PHQ-9 1960A RATING SCALE FOR DEPRESSION 2002The validity of the Hospital Anxiety and Depression Scale 1996Beck Depression Inventory–II 1996Comparison of Beck Depression Inventories-IA and-II in Psychiatric Outpatients 2010The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review 1997International experiences with the Hospital Anxiety and Depression Scale-A review of validation data and clinical results

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