Examining the optimal cutoff values of HADS, PHQ‐9 and GAD‐7 as screening instruments for depression and anxiety in irritable bowel syndrome

Abstract

Background: Self-rating scales are frequently used to screen for anxiety and depression in patients with irritable bowel syndrome (IBS). Different cutoff values are recommended in literature, and guidelines have suggested the use of other screening instruments over time. The aim of this study was to assess the correlation between the most commonly used psychological screening instruments for anxiety and depression in IBS and to compare custom cutoff scores for these instruments. Methods: Irritable bowel syndrome patients (n = 192) completed several questionnaires including the Hospital Anxiety and Depression Scale (HADS, HADS-A and HADS-D subscale), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Agreement at different cutoff points, for depressive and anxiety disorder, was assessed by use of the Gwet AC1 coefficient.Key Results: Hospital Anxiety and Depression Scale (HADS)-D and PHQ-9 scores, and HADS-A and GAD-7 scores showed high correlations (r s = 0.735 and r s = 0.805, respectively). For depressive disorder, a Gwet AC1 value of 0.829 was found when recommended cutoff points from literature were compared (PHQ-9 cutoff ≥10, HADS-D cutoff ≥8). For anxiety disorder, a Gwet AC1 value of 0.806 was found when recommended cutoff points from literature were compared (GAD-7 cutoff ≥10, HADS-A cutoff ≥8). Even higher agreements were found when higher HADS cutoff values were chosen, with impact on sensitivity and specificity. Conclusions & Inferences:Custom cutoff values deem the HADS subscales (HADS-D and HADS-A) concordant to PHQ-9 and GAD-7 scores. The choice of a cutoff value has substantial impact on sensitivity/specificity and is dependent on patient population, setting, and the purpose of use.

The Interplay Between Stress and Fullness in Patients With Functional Dyspepsia and Healthy Controls: An Exploratory Experience Sampling Method Study

“…A strong correlation was found for mean daily stress during the week as determined using ESM and both GAD-7 total scores and HADS-D scores (Pearson r of 0.906 and 0.717, respectively) in patients with FD (Table 2). When using cutoff values of 8 for HADS-D and 10 for GAD-7 to screen for depressive and anxiety disorder in a group of patients with a functional GI disorder (30), 5 of 35 patients with FD scored positive for a possible depressive disorder and 5 of 35 patients with FD scored positive for a possible anxiety disorder.…”

Hypnotherapy for irritable bowel syndrome: patient expectations and perceptions

“…There is no single generally accepted cut-off score for the Hospital Anxiety Depression (HAD), although Zigmond and Snaith suggested 7/8 for possible and 10/11 for probable anxiety or depression and we have always chosen to use a value of 10 or above in our previous studies. Some authors have suggested slightly lower cut-off values, 24 but these have not been universally accepted. Consequently, to allow comparison with our previous work, we have continued to use a cut-off of 10 in this study.…”

Group education on the low FODMAP diet improves gastrointestinal symptoms but neither anxiety or depression in irritable bowel syndrome

“…By contrast, our study population consisted of referrals form tertiary care, where a higher prevalence of psychological co‐morbidities can exist 32 . Comparing our results with a larger and more recent study that included primary and secondary/tertiary care patients with IBS, the prevalence of depression was 20% and anxiety was 26% when using a HADS cut‐off ≥8 33 . In another tertiary care setting, anxiety was 45% and depression was 26% in IBS patients when using a HADS cut‐off ≥8 11 .…”

“…32 Comparing our results with a larger and more recent study that included primary and secondary/tertiary care patients with IBS, the prevalence of depression was 20% and anxiety was 26% when using a HADS cut-off ≥8. 33 In another tertiary care setting, anxiety was 45% and depression was 26% in IBS patients when using a HADS cut-off ≥8. 11 Considering the rates observed in the present study, we can say our tertiary care population is similar to others, although it does not represent the general IBS population.…”