Which instruments to support diagnosis of depression have sufficient accuracy? A systematic review
Abstract
BACKGROUND: Instruments are frequently used in case finding, diagnosis and severity grading of major depression, but the evidence supporting their utility is weak. AIM: To systematically review the specificity and sensitivity of instruments used to diagnose and grade the severity of depression. METHODS: MEDLINE, PsycInfo, Embase and the Cochrane Library databases were searched until April 2014. Fifty studies fulfilled the inclusion criteria. Risk of bias was assessed with QUADAS. The average sensitivity and specificity of each instrument was estimated with hierarchical summary receiver operating characteristics analyses and the confidence in the estimates was evaluated using GRADE. Minimum acceptable sensitivity/specificity, with structured interview as the reference, was 80%/80% for structured interviews and 80%/70% for case-finding instruments. The minimum acceptable standard for severity measures was a correlation of 0.7 with DSM-IV classification. RESULTS: Twenty instruments were investigated. The average sensitivity/specificity was 85%/92% for the Structured Clinical Interview for DSM-IV-Axis-I Disorders (SCID-I), 95%/84% for the Mini International Neuropsychiatric Interview (MINI), < 70%/85% for the Primary Care Evaluation of Mental Disorders (PRIME-MD), 88%/78% for the Patient Health Questionnaire-9 (PHQ-9) with a cut-off score of 10, 69%/95% for PHQ-9 as a diagnostic algorithm and 70%/83% for the Hospital Anxiety and Depression Scale (HADS) with a cut-off score of 7. The confidence in the estimates for the other instruments was very low. CONCLUSIONS: Only the SCID-I, MINI and PHQ-9 with a cut-off score of 10 fulfilled the minimum criteria for sensitivity and specificity. The use of the PRIME-MD and HADS is not supported by current evidence.
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The validity of the HDRS has been extensively criticized.
“and its validity has been extensively criticized (42, 43).”
From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [43]
Only diagnosis made with either the Structured Clinical Interview for Diagnostic and Statistical Manual or the Mini-International Neuropsychiatric Interview will be included.
“In order to ensure quality, only diagnosis made with either a stuctured clinical interview for diagnositic and statistical manual (SCID)63 or Mini-International Neuropsychiatric Interview64 will be included, as a recent systematic review has highlighted that only these two tools meet sensitivity and specificity criteria.65”
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Kotiaho, S., Korniloff, K., Vanhala, M., Kautiainen, H., Koponen, H., Ahonen, T., & Mäntyselkä, P. (2019) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2019.1584240 · Cited by 8 · see citing works
A Review of Studies Using Machine Learning to Detect Voice Biomarkers for Depression
Donaghy, P., Ennis, E., Mulvenna, M. D., Bond, R., Kennedy, N. C., McTear, M., O’Connell, H., Blaylock, N., & Brueckner, R. (2024) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-024-00454-2 · Cited by 8 · see citing works
Ho, Y., Gau, S. S., Wu, Y.-S., Chen, C.-H., Wang, J.-K., Lee, H., Chung, K., Chiu, Y.-H., Goh, K. K., Lu, M., et al. (2024) · BJPsych Open · doi:10.1192/bjo.2024.35 · Cited by 8 · see citing works
- Authors
- Pettersson, A., Boström, K. B., Gustavsson, P., & Ekselius, L.
- Affiliations
- Karolinska Institutet (SE)
- Lund University (SE)
- Uppsala University (SE)
- Corresponding author
- Pettersson, Agneta
- Venue
- Nordic Journal of Psychiatry
- Publisher
- Informa UK Limited
- Published
- 2015-03-03
- Volume
- 69
- Issue
- 7
- Pages
- 497-508
- ISSN
- 0029-1455 (ISSN-L)
- 0803-9488
- 1502-4725
- OpenAlex
- W1995398953
- Cited by
- 187
- References
- 96
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 21 · 2023: 13 · 2022: 20 · 2021: 23 · 2020: 26 · 2019: 20 · 2018: 14 · 2017: 12 · 2016: 8 · 2015: 3
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nordic Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- NIH Clinical Center
- 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 diagnosis, diagnostic accuracy, sensitivity and specificity, major depressive disorder, depression severity assessment, structured interviews, SCID-I, MINI, PHQ-9, PRIME-MD, Hospital Anxiety and Depression Scale, case finding, DSM-IV classification
- MeSH terms
- Depression, Major Depressive Disorder, Humans, Primary Health Care, Surveys and Questionnaires, ROC Curve, Diagnostic and Statistical Manual of Mental Disorders
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