Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.
Department of Psychiatry, McGill University, Montréal, QC, Canada.
BMJ. 2021 May 10;373:n972. doi: 10.1136/bmj.n972.
To evaluate the accuracy of the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) to screen for major depression among people with physical health problems.
Systematic review and individual participant data meta-analysis.
Medline, Medline In-Process and Other Non-Indexed Citations, PsycInfo, and Web of Science (from inception to 25 October 2018).
Eligible datasets included HADS-D scores and major depression status based on a validated diagnostic interview. Primary study data and study level data extracted from primary reports were combined. For HADS-D cut-off thresholds of 5-15, a bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, in studies that used semi-structured diagnostic interviews (eg, Structured Clinical Interview for ), fully structured interviews (eg, Composite International Diagnostic Interview), and the Mini International Neuropsychiatric Interview. One stage meta-regression was used to examine whether accuracy was associated with reference standard categories and the characteristics of participants. Sensitivity analyses were done to assess whether including published results from studies that did not provide raw data influenced the results.
Individual participant data were obtained from 101 of 168 eligible studies (60%; 25 574 participants (72% of eligible participants), 2549 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of seven or higher for semi-structured interviews, fully structured interviews, and the Mini International Neuropsychiatric Interview. Among studies with a semi-structured interview (57 studies, 10 664 participants, 1048 with major depression), sensitivity and specificity were 0.82 (95% confidence interval 0.76 to 0.87) and 0.78 (0.74 to 0.81) for a cut-off value of seven or higher, 0.74 (0.68 to 0.79) and 0.84 (0.81 to 0.87) for a cut-off value of eight or higher, and 0.44 (0.38 to 0.51) and 0.95 (0.93 to 0.96) for a cut-off value of 11 or higher. Accuracy was similar across reference standards and subgroups and when published results from studies that did not contribute data were included.
When screening for major depression, a HADS-D cut-off value of seven or higher maximised combined sensitivity and specificity. A cut-off value of eight or higher generated similar combined sensitivity and specificity but was less sensitive and more specific. To identify medically ill patients with depression with the HADS-D, lower cut-off values could be used to avoid false negatives and higher cut-off values to reduce false positives and identify people with higher symptom levels.
PROSPERO CRD42015016761.
评估医院焦虑和抑郁量表（HADS-D）的抑郁分量表筛查有躯体健康问题人群中重度抑郁症的准确性。
系统评价和个体参与者数据荟萃分析。
Medline、Medline 正在处理的记录和其他非索引引文、PsycInfo 和 Web of Science（从创建到 2018 年 10 月 25 日）。
合格的数据集包括 HADS-D 评分和基于验证性诊断访谈的重度抑郁症状态。从主要报告中提取主要研究数据和研究水平数据，并将其合并。对于 HADS-D 截断值为 5-15，使用双变量随机效应荟萃分析分别估计使用半结构化诊断访谈（如结构性临床访谈）、完全结构化访谈（如复合国际诊断访谈）和迷你国际神经精神访谈的研究中的汇总敏感性和特异性。单阶段荟萃回归用于检查准确性是否与参考标准类别和参与者特征相关。进行敏感性分析以评估是否包括未提供原始数据的研究的已发表结果是否会影响结果。
从 168 项符合条件的研究中获得了 101 项（60%；25574 名参与者（符合条件参与者的 72%），2549 名患有重度抑郁症）的个体参与者数据。在半结构化访谈、完全结构化访谈和迷你国际神经精神访谈中，截断值为 7 或更高时，联合敏感性和特异性达到最大值。在使用半结构化访谈的研究中（57 项研究，10664 名参与者，1048 名患有重度抑郁症），截断值为 7 或更高时，敏感性和特异性分别为 0.82（95%置信区间 0.76 至 0.87）和 0.78（0.74 至 0.81），截断值为 8 或更高时，敏感性和特异性分别为 0.74（0.68 至 0.79）和 0.84（0.81 至 0.87），截断值为 11 或更高时，敏感性和特异性分别为 0.44（0.38 至 0.51）和 0.95（0.93 至 0.96）。准确性在参考标准和亚组之间相似，并且当包括未提供数据的研究的已发表结果时，准确性也相似。
在筛查重度抑郁症时，HADS-D 截断值为 7 或更高可最大限度地提高联合敏感性和特异性。截断值为 8 或更高可产生相似的联合敏感性和特异性，但敏感性较低，特异性较高。要使用 HADS-D 识别患有抑郁症的有躯体健康问题的患者，可以使用较低的截断值以避免漏诊，使用较高的截断值以减少假阳性并识别症状水平较高的患者。
PROSPERO CRD42015016761。
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