Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians? diagnoses
Abstract
Background The aim of this study was to compare the validity of the Hospital Anxiety and Depression Scale (HADS), the WHO (five) Well Being Index (WBI-5), the Patient Health Questionnaire (PHQ), and physicians' recognition of depressive disorders, and to recommend specific cut-off points for clinical decision making.Methods A total of 501 outpatients completed each of the three depression screening questionnaires and received the Structured Clinical Interview for DSM-IV (SCID) as the criterion standard. In addition, treating physicians were asked to give their psychiatric diagnoses. Criterion validity and Receiver Operating Characteristics (ROC) were determined. Areas under the curves (AUCs) were compared statistically.Results All depression scales showed excellent internal consistencies (Cronbach's alpha: 0.85-0.90). For 'major depressive disorder', the operating characteristics of the PHQ were significantly superior to both the HADS and the WBI-5. For 'any depressive disorder', the PHQ showed again the best operating characteristics but the overall difference did not reach statistical significance at the 5% level. Cut-off points that can be recommended for the screening of 'major depressive disorder' had sensitivities of 98% (PHQ), 94% (WBI-5), and 85% (HADS). Corresponding specificities were 80% (PHQ), 78% (WBI-5), and 76% (HADS). In contrast, physicians' recognition of 'major depressive disorder' was poor (sensitivity, 40%; specificity, 87%).Limitations Our sample may not be representative of medical outpatients, but sensitivity and specificity are independent of disorder prevalence.Conclusions All three questionnaires performed well in depression screening, but significant differences in criterion validity existed. These results may be helpful in the selection of questionnaires and cut-off points.
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The PHQ-9 is a 9-item questionnaire that measures the frequency of depression symptoms.
“The PHQ-9 [81–83] is a 9-item questionnaire measuring the frequency of depression symptoms on a 4-point Likert scale (0 = not at all, 3 = almost every day) for the past week.”
The PHQ-9 is a valid measure in outpatient adult mental health settings, both as an initial screening tool and as a follow-up measure to monitor treatment progress.
“Several studies support its validity in outpatient adult mental health settings, both as an initial screening tool and as a follow-up measure to monitor treatment progress. 22-25”
From Dialectical behaviour therapy skills training: A feasibility study with active duty military. (2022) · cites this paper as [23]
Previous studies of the PHQ-9 have shown that all items load in one single factor and that it has an internal consistency with Cronbach's α of 0.79 to 0.89.
“Previous studies of the PHQ-9 that examined psychometric properties have shown that all items load in one single factor and that it has an internal consistency with Cronbach's α of 0.79 to 0.89. 16,19,26”
From Comparison of two self-rating scales to detect depression: HADS and PHQ-9 (2009) · cites this paper as [16]
Alternatively, the PHQ-9 scale may be over-inclusive.
“alternatively, the PHQ-9 scale may be over-inclusive, as indicated by, for example, Löwe et al . 16”
From Comparison of two self-rating scales to detect depression: HADS and PHQ-9 (2009) · cites this paper as [16]
Some studies recommend a higher PHQ-9 cut-off such as ≥11 or ≥12 to improve the balance between sensitivity and specificity.
“However, some studies recommend a higher cut-off such as ≥ 11 or ≥ 12 to improve the balance between sensitivity and specificity. 16,24”
From Comparison of two self-rating scales to detect depression: HADS and PHQ-9 (2009) · cites this paper as [16]
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- Authors
- LOWE, B.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2004-02
- Volume
- 78
- Issue
- 2
- Pages
- 131-140
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2087381130
- Cited by
- 1,060
- References
- 52
- Citations by year
- 2026: 24 · 2025: 32 · 2024: 50 · 2023: 52 · 2022: 48 · 2021: 44 · 2020: 44 · 2019: 47 · 2018: 45 · 2017: 52 · 2016: 49 · 2015: 60 · 2014: 47 · 2013: 63 · 2012: 65
- FWCI
- 19.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- depression screening, major depressive disorder, Patient Health Questionnaire, Hospital Anxiety and Depression Scale, physician diagnosis, criterion validity, cut-off values, sensitivity and specificity, outpatients
- MeSH terms
- Adolescent, Adult, Depressive Disorder, Humans, Mass Screening, Primary Health Care, Surveys and Questionnaires, ROC Curve, Sensitivity and Specificity, Reproducibility of Results, Diagnostic Techniques and Procedures, Diagnostic and Statistical Manual of Mental Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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