Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses.
BACKGROUND
The aim of this study was to compare the validity of the Hospital Anxiety and Depression Scale (HADS), the WHO (five) Well Being Index (WBI-5), the Patient Health Questionnaire (PHQ), and physicians' recognition of depressive disorders, and to recommend specific cut-off points for clinical decision making.


METHODS
A total of 501 outpatients completed each of the three depression screening questionnaires and received the Structured Clinical Interview for DSM-IV (SCID) as the criterion standard. In addition, treating physicians were asked to give their psychiatric diagnoses. Criterion validity and Receiver Operating Characteristics (ROC) were determined. Areas under the curves (AUCs) were compared statistically.


RESULTS
All depression scales showed excellent internal consistencies (Cronbach's alpha: 0.85-0.90). For 'major depressive disorder', the operating characteristics of the PHQ were significantly superior to both the HADS and the WBI-5. For 'any depressive disorder', the PHQ showed again the best operating characteristics but the overall difference did not reach statistical significance at the 5% level. Cut-off points that can be recommended for the screening of 'major depressive disorder' had sensitivities of 98% (PHQ), 94% (WBI-5), and 85% (HADS). Corresponding specificities were 80% (PHQ), 78% (WBI-5), and 76% (HADS). In contrast, physicians' recognition of 'major depressive disorder' was poor (sensitivity, 40%; specificity, 87%).


CONCLUSIONS
Our sample may not be representative of medical outpatients, but sensitivity and specificity are independent of disorder prevalence.


CONCLUSIONS
All three questionnaires performed well in depression screening, but significant differences in criterion validity existed. These results may be helpful in the selection of questionnaires and cut-off points.
Löwe
Bernd
B
Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Medical Hospital, Bergheimer Strasse 58, D-69115, Heidelberg, Germany. bernd_loewe@med.uni-heidelberg.de
Spitzer
Robert L
RL
Gräfe
Kerstin
K
Kroenke
Kurt
K
Quenter
Andrea
A
Zipfel
Stephan
S
Buchholz
Christine
C
Witte
Steffen
S
Herzog
Wolfgang
W
D000293:Adolescent; D000328:Adult; D003866:Depressive Disorder / Q000175:diagnosis*; D019937:Diagnostic Techniques and Procedures / Q000592:standards*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011320:Primary Health Care; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires