uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Which instruments to support diagnosis of depression have sufficient accuracy? A systematic review
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
2015 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 7, 497-508 p.Article, review/survey (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2015. Vol. 69, no 7, 497-508 p.
Keyword [en]
Depressive disorder; Diagnosis; Evidence; Interview; Meta-analysis; Questionnaires; Psychiatric status rating scales; Psychological standards; Standards
National Category
URN: urn:nbn:se:uu:diva-279468DOI: 10.3109/08039488.2015.1008568ISI: 000369972000002PubMedID: 25736983OAI: oai:DiVA.org:uu-279468DiVA: diva2:908145
Available from: 2016-03-01 Created: 2016-03-01 Last updated: 2016-05-27Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Ekselius, Lisa
By organisation
Psychiatry, University Hospital
In the same journal
Nordic Journal of Psychiatry

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 58 hits
ReferencesLink to record
Permanent link

Direct link