Which instruments to support diagnosis of depression have sufficient accuracy? A systematic review.
BACKGROUND
Instruments are frequently used in case finding, diagnosis and severity grading of major depression, but the evidence supporting their utility is weak.


OBJECTIVE
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.
a Agneta Pettersson, M.Sc., Department of Learning , Informatics, Medical Education and Ethics, Karolinska Institutet, and Swedish Council on Health Technology Assessment , Stockholm , Sweden.
Agneta
A
Pettersson
b Kristina Bengtsson Boström, M.D., Ph.D., Research & Development Centre Skaraborg Primary Care, Skövde, and Department of Clinical Sciences/Endocrinology , Lund University , Malmö , Sweden.
Kristina Bengtsson
KB
Boström
c Petter Gustavsson, Ph.D., Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.
Petter
P
Gustavsson
d Ekselius Lisa, M.D., Ph.D., Department of Neuroscience , Uppsala University , Uppsala , Sweden.
Lisa
L
Ekselius
D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D012372:ROC Curve; D011795:Surveys and Questionnaires / Q000592:standards*
Depressive disorder; Diagnosis; Evidence; Interview; Meta-analysis; Psychiatric status rating scales; Psychological standards; Questionnaires; Standards