Cited by 1,060Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and AccessTreatment of Major Depression

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Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians? diagnoses

LOWE, B·2004·Journal of Affective Disorders

DOI 10.1016/s0165-0327(02)00237-9

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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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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)
DOI: 10.1016/s0165-0327(02)00237-9
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Funders: Pfizer
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Health Sciences › Medicine › Pharmacology (medical) › 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

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Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians? diagnoses

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