‘Optimal’ cutoff selection in studies of depression screening tool accuracy using the PHQ‐9, EPDS, or HADS‐D: A meta‐research study

Brehaut, Eliana; Neupane, Dipika; Levis, Brooke; Wu, Yin; Sun, Ying; Ioannidis, John P. A.; Markham, Sarah; Cuijpers, Pim; Patten, Scott B.; Benedetti, Andrea; Thombs, Brett D.

doi:10.1002/mpr.1956

Cited by 4 publications

(1 citation statement)

References 53 publications

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“…Best cutoff points for the study population and by gender were calculated with the Youden Index for both HSCL-10 and HSCL-5. Youden Index is defined as “Sensitivity + Specificity −1,” it is a value that indicates the validity of the instrument for a specific cutoff point ( 46 ). Sensitivity and specificity were assessed as measures of internal validity; positive and negative predictive values were also calculated.…”

Section: Methodsmentioning

confidence: 99%

Measuring depression in Primary Health Care in Spain: Psychometric properties and diagnostic accuracy of HSCL-5 and HSCL-10

et al. 2023

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BackgroundDepression has a high prevalence among European countries. Several instruments have been designed to assess its symptoms in different populations. The Hopkins Symptom Checklist 25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use. There are short versions of this scale that could be useful in Primary Care (PC) settings, but their psychometric properties are unknown.AimTo assess in PC patients the psychometric properties and diagnostic accuracy of the Spanish version of the HSCL-10 and the HSCL-5 consisting of 10 and 5 items, respectively.MethodsA multicenter, cross-sectional study was carried out at six PC centers in Spain. The HSCL-25 was administered to outpatients aged 45–75 who also participated in the structured Composite International Diagnostic Interview (CIDI). HSCL-10 and HSCL-5 were assessed and compared to HSCL-25 regarding total score correlation, internal consistency, and criterion validity against the gold-standard CIDI. This is a methodological study from a secondary data analysis and the primary data has been previously published.ResultsOut of 790 patients, 767 completed the HSCL-25 and 736 the CIDI interview (96.0%). Cronbach’s Alpha was 0.84 for HSCL-10 and 0.77 for HSCL-5. The known-group method and confirmatory factor analysis were acceptable for the establishment of construct validity. Sensitivity was 79.7% (CI95%, 67.7–88.0%) for HSCL-10, and 78.0% (CI95%, 65.9–86.6%) for HSCL-5, whereas specificity was 83% (CI95%, 80.0–85.7%) for HSCL-10, and 72.8% (CI95%, 69.3–76.0%) for HSCL-5. Area under the curve against CIDI was 0.88 (CI95%, 0.84–0.92%) for HSCL-10, and 0.85 (CI95%, 0.81–0.89%) for HSCL-5. Optimum cutoff point calculated with Youden Index was 1.90 for the HSCL-10 and 1.80 for the HSCL-5.ConclusionHSCL-10 and HSCL-5 are reliable and valid tools to detect depression symptoms and can be used in PC settings.

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Section: Methodsmentioning

confidence: 99%

Measuring depression in Primary Health Care in Spain: Psychometric properties and diagnostic accuracy of HSCL-5 and HSCL-10

et al. 2023

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Data-Driven Cutoff Selection for the Patient Health Questionnaire-9 Depression Screening Tool

Levis,

Bhandari,

Neupane

et al. 2024

JAMA Netw Open

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ImportanceTest accuracy studies often use small datasets to simultaneously select an optimal cutoff score that maximizes test accuracy and generate accuracy estimates.ObjectiveTo evaluate the degree to which using data-driven methods to simultaneously select an optimal Patient Health Questionnaire-9 (PHQ-9) cutoff score and estimate accuracy yields (1) optimal cutoff scores that differ from the population-level optimal cutoff score and (2) biased accuracy estimates.Design, Setting, and ParticipantsThis study used cross-sectional data from an existing individual participant data meta-analysis (IPDMA) database on PHQ-9 screening accuracy to represent a hypothetical population. Studies in the IPDMA database compared participant PHQ-9 scores with a major depression classification. From the IPDMA population, 1000 studies of 100, 200, 500, and 1000 participants each were resampled.Main Outcomes and MeasuresFor the full IPDMA population and each simulated study, an optimal cutoff score was selected by maximizing the Youden index. Accuracy estimates for optimal cutoff scores in simulated studies were compared with accuracy in the full population.ResultsThe IPDMA database included 100 primary studies with 44 503 participants (4541 [10%] cases of major depression). The population-level optimal cutoff score was 8 or higher. Optimal cutoff scores in simulated studies ranged from 2 or higher to 21 or higher in samples of 100 participants and 5 or higher to 11 or higher in samples of 1000 participants. The percentage of simulated studies that identified the true optimal cutoff score of 8 or higher was 17% for samples of 100 participants and 33% for samples of 1000 participants. Compared with estimates for a cutoff score of 8 or higher in the population, sensitivity was overestimated by 6.4 (95% CI, 5.7-7.1) percentage points in samples of 100 participants, 4.9 (95% CI, 4.3-5.5) percentage points in samples of 200 participants, 2.2 (95% CI, 1.8-2.6) percentage points in samples of 500 participants, and 1.8 (95% CI, 1.5-2.1) percentage points in samples of 1000 participants. Specificity was within 1 percentage point across sample sizes.Conclusions and RelevanceThis study of cross-sectional data found that optimal cutoff scores and accuracy estimates differed substantially from population values when data-driven methods were used to simultaneously identify an optimal cutoff score and estimate accuracy. Users of diagnostic accuracy evidence should evaluate studies of accuracy with caution and ensure that cutoff score recommendations are based on adequately powered research or well-conducted meta-analyses.

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The screening accuracy of the Edinburgh Postnatal Depression Scale (EPDS) to detect perinatal depression with and without the self-harm item in pregnant and postpartum women

Stefana,

Mirabella,

Gigantesco

et al. 2024

Journal of Psychosomatic Obstetrics & Gynecology

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‘Optimal’ cutoff selection in studies of depression screening tool accuracy using the PHQ‐9, EPDS, or HADS‐D: A meta‐research study

Cited by 4 publications

References 53 publications

Measuring depression in Primary Health Care in Spain: Psychometric properties and diagnostic accuracy of HSCL-5 and HSCL-10

Measuring depression in Primary Health Care in Spain: Psychometric properties and diagnostic accuracy of HSCL-5 and HSCL-10

Data-Driven Cutoff Selection for the Patient Health Questionnaire-9 Depression Screening Tool

The screening accuracy of the Edinburgh Postnatal Depression Scale (EPDS) to detect perinatal depression with and without the self-harm item in pregnant and postpartum women

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