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Measuring depression severity in general practice: discriminatory performance of the PHQ-9, HADS-D, and BDI-II
Open accessAbstract
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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Citations
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910
Hamilton, M. (1960) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.23.1.56 · Cited by 32,817
The validity of the Hospital Anxiety and Depression Scale
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(01)00296-3 · Cited by 9,779
Beck, A. T., Steer, R. A., & Brown, G. (2011) · PsycTESTS Dataset · doi:10.1037/t00742-000 · Cited by 7,535
Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients
Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996) · Journal of Personality Assessment · doi:10.1207/s15327752jpa6703_13 · Cited by 5,965
Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2010) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2010.03.006 · Cited by 4,057
Herrmann, C. (1997) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(96)00216-4 · Cited by 2,885
Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008) · PLoS Medicine · doi:10.1371/journal.pmed.0050045 · Cited by 2,442
Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis
Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010) · JAMA · doi:10.1001/jama.2009.1943 · Cited by 2,009
Smithson, M. J. (2000) · SAGE Publications Ltd eBooks · doi:10.4135/9781446218525 · Cited by 1,871
Diagnostic tests 4: likelihood ratios
Deeks, J. J., & Altman, D. G. (2004) · BMJ · doi:10.1136/bmj.329.7458.168 · Cited by 1,600
Gilbody, S., Richards, D., Brealey, S., & Hewitt, C. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0333-y · Cited by 1,290
LOWE, B. (2004) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00237-9 · Cited by 1,060
Anderson, I. M., Ferrier, I. N., Baldwin, R., Cowen, P. J., Howard, L. M., Lewis, G., Matthews, K., McAllister-Williams, H., Peveler, R. C., Scott, J. L., et al. (2008) · Journal of Psychopharmacology · doi:10.1177/0269881107088441 · Cited by 909
Handbook of Psychiatric Measures
Rush, A. J., First, M. B., & Blacker, D. (2000) · Medical Entomology and Zoology · Cited by 846
Normative data for the HADS from a large non-clinical sample
Crawford, J. R., Henry, J. D., Crombie, C., & Taylor, E. P. (2001) · British Journal of Clinical Psychology · doi:10.1348/014466501163904 · Cited by 815
Self-citationPsychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care
Cameron, I. M., Crawford, J. R., Lawton, K., & Reid, I. C. (2008) · British Journal of General Practice · doi:10.3399/bjgp08x263794 · Cited by 590
Self-citationDiagnostic accuracy of the mood module of the patient health questionnaire: a systematic review
Wittkampf, K. A., Naeije, L., Schene, A. H., Huyser, J., & van Weert, H. C. (2007) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2007.06.004 · Cited by 493
Murphy, J. M. (1987) · Archives of General Psychiatry · doi:10.1001/archpsyc.1987.01800180068011 · Cited by 367
Comparison of two self-rating scales to detect depression: HADS and PHQ-9
Hansson, M., Chotai, J., Nordstöm, A., & Bodlund, O. (2009) · British Journal of General Practice · doi:10.3399/bjgp09x454070 · Cited by 246
Kendrick, T., Dowrick, C., McBride, A., Howe, A., Clarke, P., Maisey, S., Moore, M., & Smith, P. W. (2009) · BMJ · doi:10.1136/bmj.b750 · Cited by 231
Dowrick, C., Leydon, G. M., McBride, A., Howe, A., Burgess, H., Clarke, P., Maisey, S., & Kendrick, T. (2009) · BMJ · doi:10.1136/bmj.b663 · Cited by 213
Reporting of precision of estimates for diagnostic accuracy: a review
Harper, R. A., & Reeves, B. C. (1999) · BMJ · doi:10.1136/bmj.318.7194.1322 · Cited by 147
Potts, M. K., Daniels, M. L., Burnam, M. A., & Wells, K. B. (1990) · Journal of Psychiatric Research · doi:10.1016/0022-3956(90)90005-b · Cited by 146
Wittkampf, K., van Ravesteijn, H., Baas, K., van de Hoogen, H., Schene, A., Bindels, P., Lucassen, P., van de Lisdonk, E., & van Weert, H. (2009) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2009.06.001 · Cited by 126
Identification of depression in diabetes: the efficacy of PHQ-9 and HADS-D
Reddy, P., Philpot, B., Ford, D., & Dunbar, J. A. (2010) · British Journal of General Practice · doi:10.3399/bjgp10x502128 · Cited by 90
GP treatment decisions for patients with depression: an observational study.
Kendrick, T., King, F., Albertella, L., & Smith, P. W. F. (2005) · Europe PMC (PubMed Central) · Cited by 87
Mitchell, C. A., Dwyer, R., Thomas, T. H., & Mathers, N. J. (2011) · British Journal of General Practice · doi:10.3399/bjgp11x572472 · Cited by 83
Questionnaire severity measures for depression: a threat to the doctor–patient relationship?
Leydon, G., Dowrick, C. F., McBride, A., Burgess, H. J., Howe, A. C., Clarke, P., Maisey, S., & Kendrick, T. (2011) · British Journal of General Practice · doi:10.3399/bjgp11x556236 · Cited by 50
‘Over-the-counter’ genetic testing: what does it really mean for primary care?
Rafi, I., Qureshi, N., Lucassen, A., Modell, M., Elmslie, F., Kai, J., Kirk, M., Starey, N., Goff, S., Brennan, P., et al. (2009) · British Journal of General Practice · doi:10.3399/bjgp09x395021 · Cited by 14
Time and the General Practitioner
Hull, F. M., & Hull, F. S. (1984) · PubMed Central · Cited by 7
General practice at the cutting edge of information technology, or failing to keep pace?
Delaney, B. C. (2010) · British Journal of General Practice · doi:10.3399/bjgp10x483869 · Cited by 6
Research works printed but not linked: 2
- Kendrick, 2005, GP treatment decisions for patients with depression, Br J Gen Pract, 55, 280
- Spitzer RL Williams JBW Gibbon M First MB (1990) User's guide for the Structured Clinical Interview for DSM-III-R (American Psychiatric Press, Washington DC, US).
Cited by
Sorted by citations
Quittner, A. L., Goldbeck, L., Abbott, J., Duff, A., Lambrecht, P., Solé, A., Tibosch, M. M., Bergsten Brucefors, A., Yüksel, H., Catastini, P., et al. (2014) · Thorax · doi:10.1136/thoraxjnl-2014-205983 · Cited by 524
Zhang, Y., Liang, W., Zuo-ming, C., Zhang, H., Zhang, J.-H., Weng, X., Yang, S.-C., Zhang, L., Shen, L.-J., & Zhang, Y. (2013) · Asia-Pacific Psychiatry · doi:10.1111/appy.12103 · Cited by 456
Neacsiu, A. D., Eberle, J. W., Kramer, R., Wiesmann, T., & Linehan, M. M. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.05.005 · Cited by 394
A Pervasive Approach to EEG‐Based Depression Detection
Cai, H., Han, J., Chen, Y.-F., Sha, X., Wang, Z., Hu, B., Yang, J., Feng, L., Ding, Z., Chen, Y., et al. (2018) · Complexity · doi:10.1155/2018/5238028 · Cited by 312
SELF-REPORT AND CLINICIAN-RATED MEASURES OF DEPRESSION SEVERITY: CAN ONE REPLACE THE OTHER?
Uher, R., Perlis, R. H., Placentino, A., Dernovšek, M. Z., Henigsberg, N., Mors, O. N., Maier, W., McGuffin, P., & FARMER, A. E. (2012) · Depression and Anxiety · doi:10.1002/da.21993 · Cited by 264
Metadata
- Authors
- Cameron, I. M., Cardy, A., Crawford, J. R., du Toit, S. W., Hay, S., Lawton, K., Mitchell, K., Sharma, S., Shivaprasad, S., Winning, S., & Reid, I. C.
- Affiliations
- University of Aberdeen (GB)
- Corresponding author
- Cameron, Isobel M
- Venue
- British Journal of General Practice
- Published
- 2011-07
- Volume
- 61
- Issue
- 588
- Pages
- e419-e426
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC3123505
- OpenAlex
- W2170351571
- Cited by
- 109
- References
- 36
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 7 · 2023: 10 · 2022: 5 · 2021: 8 · 2020: 8 · 2019: 13 · 2018: 8 · 2017: 5 · 2016: 5 · 2015: 6 · 2014: 11 · 2013: 7 · 2012: 6
- FWCI
- 10.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- depression severity, PHQ-9, Beck Depression Inventory-II, primary care, Quality and Outcomes Framework, depression screening, sensitivity and specificity, likelihood ratios
- MeSH terms
- Adult, Depressive Disorder, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, ROC Curve, Scotland, Sensitivity and Specificity, Observer Variation, General Practice
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