Document Detail

Measuring depression severity in general practice: discriminatory performance of the PHQ-9, HADS-D, and BDI-II.
MedLine Citation:
PMID:  21722450     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The UK Quality and Outcomes Framework (QOF) rewards practices for measuring symptom severity in patients with depression, but the endorsed scales have not been comprehensively validated for this purpose.
AIM: To assess the discriminatory performance of the QOF depression severity measures.
DESIGN AND SETTING: Psychometric assessment in nine Scottish general practices.
METHOD: Adult primary care patients diagnosed with depression were invited to participate. The HADS-D, PHQ-9, and BDI-II were assessed against the HRSD-17 interview. Discriminatory performance was determined relative to the HRSD-17 cut-offs for symptoms of at least moderate severity, as per criteria set by the American Psychiatric Association (APA) and NICE. Receiver operating characteristic curves were plotted and area under the curve (AUC), sensitivity, specificity, and likelihood ratios (LRs) calculated.
RESULTS: A total of 267 were recruited per protocol, mean age = 49.8 years (standard deviation [SD] = 14.1), 70% female, mean HRSD-17=12.6 (SD = 7.62, range = 0-34). For APA criteria, AUCs were: HADS-D = 0.84; PHQ-9 = 0.90; and BDI-II = 0.86. Optimal sensitivity and specificity were reached where HADS-D ≥9 (74%, 76%); PHQ-9 ≥12 (77%, 79%), and BDI-II ≥23 (74%, 75%). For NICE criteria: HADS-D AUC = 0.89; PHQ-9 AUC = 0.93; and BDI-II AUC = 0.90. Optimal sensitivity and specificity were reached where HADS-D ≥10 (82%, 75%), PHQ-9 ≥15 (89%, 83%), and BDI-II ≥28 (83%, 80%). LRs did not provide evidence of sufficient accuracy for clinical use.
CONCLUSION: As selecting treatment according to depression severity is informed by an evidence base derived from trials using HRSD-17, and none of the measures tested aligned adequately with that tool, they are inappropriate for use.
Isobel M Cameron; Amanda Cardy; John R Crawford; Schalk W du Toit; Steven Hay; Kenneth Lawton; Kenneth Mitchell; Sumit Sharma; Shilpa Shivaprasad; Sally Winning; Ian C Reid
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The British journal of general practice : the journal of the Royal College of General Practitioners     Volume:  61     ISSN:  1478-5242     ISO Abbreviation:  Br J Gen Pract     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-04     Completed Date:  2012-05-16     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  9005323     Medline TA:  Br J Gen Pract     Country:  England    
Other Details:
Languages:  eng     Pagination:  e419-26     Citation Subset:  IM    
Applied Health Sciences (Mental Health), University of Aberdeen, Royal Cornhill Hospital, Aberdeen, UK.
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MeSH Terms
Depressive Disorder / diagnosis*
General Practice*
Middle Aged
Observer Variation
Psychiatric Status Rating Scales / standards*
ROC Curve
Sensitivity and Specificity

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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