Measuring depression severity in general practice

discriminatory performance of the PHQ-9, HADS-D, and BDI-II

Isobel Mary 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

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

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.
Original languageEnglish
Pages (from-to)e419-e426
Number of pages8
JournalThe British Journal of General Practice
Volume61
Issue number588
DOIs
Publication statusPublished - 1 Jul 2011

Fingerprint

General Practice
Area Under Curve
Depression
Sensitivity and Specificity
Reward
Psychometrics
ROC Curve
Psychiatry
Primary Health Care
4-amino-4'-hydroxylaminodiphenylsulfone
Interviews
Therapeutics

Keywords

  • depression
  • primary care
  • sensitivity
  • severity
  • specificity

Cite this

Measuring depression severity in general practice : discriminatory performance of the PHQ-9, HADS-D, and BDI-II. / Cameron, Isobel Mary; Cardy, Amanda; Crawford, John R; du Toit, Schalk W; Hay, Steven; Lawton, Kenneth; Mitchell, Kenneth; Sharma, Sumit; Shivaprasad, Shilpa; Winning, Sally; Reid, Ian C.

In: The British Journal of General Practice, Vol. 61, No. 588, 01.07.2011, p. e419-e426.

Research output: Contribution to journalArticle

Cameron, Isobel Mary ; Cardy, Amanda ; Crawford, John R ; du Toit, Schalk W ; Hay, Steven ; Lawton, Kenneth ; Mitchell, Kenneth ; Sharma, Sumit ; Shivaprasad, Shilpa ; Winning, Sally ; Reid, Ian C. / Measuring depression severity in general practice : discriminatory performance of the PHQ-9, HADS-D, and BDI-II. In: The British Journal of General Practice. 2011 ; Vol. 61, No. 588. pp. e419-e426.
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abstract = "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.",
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T1 - Measuring depression severity in general practice

T2 - discriminatory performance of the PHQ-9, HADS-D, and BDI-II

AU - Cameron, Isobel Mary

AU - Cardy, Amanda

AU - Crawford, John R

AU - du Toit, Schalk W

AU - Hay, Steven

AU - Lawton, Kenneth

AU - Mitchell, Kenneth

AU - Sharma, Sumit

AU - Shivaprasad, Shilpa

AU - Winning, Sally

AU - Reid, Ian C

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N2 - 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.

AB - 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.

KW - depression

KW - primary care

KW - sensitivity

KW - severity

KW - specificity

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SP - e419-e426

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JF - The British Journal of General Practice

SN - 0960-1643

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