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Cited by 109Cardiac Health and Mental HealthAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

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Detecting Depression in Patients with Coronary Heart Disease: a Diagnostic Evaluation of the PHQ-9 and HADS-D in Primary Care, Findings From the UPBEAT-UK Study

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Haddad, Mark, Walters, Paul, Phillips, Rachel, Tsakok, Jacqueline, Williams, Paul, Mann, Anthony, Tylee, André·2013·PLoS ONE
DOI 10.1371/journal.pone.0078493PMC PMC3795055
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Abstract

OBJECTIVE: People with coronary heart disease (CHD) are at heightened risk of depression, and this co-occurrence of conditions is associated with poorer outcomes including raised mortality. This study compares the diagnostic accuracy of two depression case finding instruments in CHD patients relative to a diagnostic standard, the revised Clinical Interview Schedule (CIS-R). METHODS: The Patient Health Questionnaire (PHQ-9), the Hospital Anxiety and Depression Scale depression subscale (HADS-D) and the CIS-R depression module were administered to 803 patients identified from the CHD registers of GP practices in Greater London. RESULTS: Of 730 recruited patients without previously identified depression, 32 (4.4%) met ICD-10 depressive episode criteria according to the CIS-R. For the PHQ-9 and HADS-D lower cut-points than those routinely recommended were associated with improved case identifying properties. The PHQ-9 appeared the superior instrument using a cut-point of ≥8 (sensitivity=94%; specificity=84%). Using categorical scoring the PHQ-9 was 59% sensitive and 95% specific. For the HADS-D using cut-point ≥5, sensitivity was 81% and specificity was 77%. Areas under the curves (AUC) (standard error) were 0.95 (0.01) and 0.88 (0.02) for the PHQ-9 and HADS-D, and 0.91 (0.02) for PHQ-9 using the categorical algorithm. Statistically significant differences between AUCs of the PHQ-9 and the HADS-D favoured the former. Severity ratings compared across measures indicated inconsistency between recommended bandings: the PHQ-9 categorised a larger proportion of participants with mild and moderate depression. CONCLUSION: This is the first large-scale investigation of the accuracy of these commonly used measures within a primary care CHD population. Our results suggest that although both scales have acceptable abilities and can be used as case identification instruments for depression in patients with CHD, the PHQ-9 appeared diagnostically superior. Importantly, optimal cut-off points for depression identification in this population appear to differ from standard values, and severity ratings differ between these measures.

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Figure 1 Receiver operating characteristic curves for PHQ-9, HADS-D, and PHQ-9 categorical algorithm; CIS-R was the criterion standard.
Figure 1 Receiver operating characteristic curves for PHQ-9, HADS-D, and PHQ-9 categorical algorithm; CIS-R was the criterion standard.CC BY · PubMed Central

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Metadata

Authors
Haddad, M., Walters, P., Phillips, R., Tsakok, J., Williams, P., Mann, A., & Tylee, A.
Affiliations
  • City, University of London (GB)
  • King's College London (GB)
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2013-10-10
Volume
8
Issue
10
Pages
e78493
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0078493
PMC
PMC3795055
OpenAlex
W2159522765
Cited by
109
References
49
Citations by year
2026: 3 · 2025: 11 · 2024: 9 · 2023: 9 · 2022: 8 · 2021: 10 · 2020: 17 · 2019: 16 · 2018: 4 · 2017: 5 · 2016: 6 · 2015: 7 · 2014: 4
FWCI
3.85
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, other-oa)
  • City Research Online (City University London) (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
Funders
  • National Institute for Health and Care Research (RP-PG-0606-1048, MET-08-08-101)
  • Programme Grants for Applied Research
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • 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
Keywords
depression, coronary artery disease, PHQ-9, Hospital Anxiety and Depression Scale, case finding, diagnostic accuracy, cut-off values, depression severity, primary care, comorbidities
MeSH terms
Aged, Aged, 80 and over, Coronary Disease, Cross-Sectional Studies, Depressive Disorder, Female, United Kingdom, Humans, Male, Middle Aged, Primary Health Care, Psychometrics, Surveys and Questionnaires

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