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Abstract：
Validated diagnostic interviews are required to classify depression status and estimate prevalence of disorder, but screening tools are often used instead. We used individual participant data meta-analysis to compare prevalence based on standard Hospital Anxiety and Depression Scale - depression subscale (HADS-D) cutoffs of ≥8 and ≥11 versus Structured Clinical Interview for DSM (SCID) major depression and determined if an alternative HADS-D cutoff could more accurately estimate prevalence.
We searched Medline, Medline In-Process & Other Non-Indexed Citations via Ovid, PsycINFO, and Web of Science (inception-July 11, 2016) for studies comparing HADS-D scores to SCID major depression status. Pooled prevalence and pooled differences in prevalence for HADS-D cutoffs versus SCID major depression were estimated.
6005 participants (689 SCID major depression cases) from 41 primary studies were included. Pooled prevalence was 24.5% (95% Confidence Interval (CI): 20.5%, 29.0%) for HADS-D ≥8, 10.7% (95% CI: 8.3%, 13.8%) for HADS-D ≥11, and 11.6% (95% CI: 9.2%, 14.6%) for SCID major depression. HADS-D ≥11 was closest to SCID major depression prevalence, but the 95% prediction interval for the difference that could be expected for HADS-D ≥11 versus SCID in a new study was -21.1% to 19.5%.
HADS-D ≥8 substantially overestimates depression prevalence. Of all possible cutoff thresholds, HADS-D ≥11 was closest to the SCID, but there was substantial heterogeneity in the difference between HADS-D ≥11 and SCID-based estimates. HADS-D should not be used as a substitute for a validated diagnostic interview.
We searched Medline, Medline In-Process & Other Non-Indexed Citations via Ovid, PsycINFO, and Web of Science (inception-July 11, 2016) for studies comparing HADS-D scores to SCID major depression status. Pooled prevalence and pooled differences in prevalence for HADS-D cutoffs versus SCID major depression were estimated.
6005 participants (689 SCID major depression cases) from 41 primary studies were included. Pooled prevalence was 24.5% (95% Confidence Interval (CI): 20.5%, 29.0%) for HADS-D ≥8, 10.7% (95% CI: 8.3%, 13.8%) for HADS-D ≥11, and 11.6% (95% CI: 9.2%, 14.6%) for SCID major depression. HADS-D ≥11 was closest to SCID major depression prevalence, but the 95% prediction interval for the difference that could be expected for HADS-D ≥11 versus SCID in a new study was -21.1% to 19.5%.
HADS-D ≥8 substantially overestimates depression prevalence. Of all possible cutoff thresholds, HADS-D ≥11 was closest to the SCID, but there was substantial heterogeneity in the difference between HADS-D ≥11 and SCID-based estimates. HADS-D should not be used as a substitute for a validated diagnostic interview.
摘要：
需要经过验证的诊断性访谈来对抑郁状态进行分类并估计疾病的患病率。但经常使用筛选工具来代替。我们使用个体参与者数据荟萃分析来比较基于标准医院焦虑和抑郁量表-抑郁子量表(HADS-D)分界值≥8和≥11与DSM(SCID)重度抑郁症的结构化临床访谈的患病率，并确定替代HADS-D分界值是否可以更准确地估计患病率。
我们搜索了Medline,Medline通过Ovid进行的过程中和其他非索引引文，PsycINFO,和WebofScience（2016年7月11日开始）进行比较HADS-D评分与SCID重度抑郁状态的研究。估计了HADS-D截止值与SCID重度抑郁症的合并患病率和合并患病率差异。
纳入了来自41项主要研究的6005名参与者（689例SCID重度抑郁症病例）。合并患病率为24.5%（95%置信区间（CI）：20.5%，29.0%）对于HADS-D≥8，10.7%（95%CI：8.3%，HADS-D≥11的13.8%）和11.6%（95%CI：9.2%，14.6%)为SCID重度抑郁症。HADS-D≥11与SCID重度抑郁症患病率最接近，但在一项新研究中,HADS-D≥11与SCID的预期差异的95%预测区间为-21.1%~19.5%.
HADS-D≥8大大高估了抑郁症的患病率。在所有可能的截止阈值中，HADS-D≥11与SCID最接近，但HADS-D≥11与基于SCID的估计值之间的差异存在显著异质性.HADS-D不应被用作经验证的诊断性访谈的替代品。
我们搜索了Medline,Medline通过Ovid进行的过程中和其他非索引引文，PsycINFO,和WebofScience（2016年7月11日开始）进行比较HADS-D评分与SCID重度抑郁状态的研究。估计了HADS-D截止值与SCID重度抑郁症的合并患病率和合并患病率差异。
纳入了来自41项主要研究的6005名参与者（689例SCID重度抑郁症病例）。合并患病率为24.5%（95%置信区间（CI）：20.5%，29.0%）对于HADS-D≥8，10.7%（95%CI：8.3%，HADS-D≥11的13.8%）和11.6%（95%CI：9.2%，14.6%)为SCID重度抑郁症。HADS-D≥11与SCID重度抑郁症患病率最接近，但在一项新研究中,HADS-D≥11与SCID的预期差异的95%预测区间为-21.1%~19.5%.
HADS-D≥8大大高估了抑郁症的患病率。在所有可能的截止阈值中，HADS-D≥11与SCID最接近，但HADS-D≥11与基于SCID的估计值之间的差异存在显著异质性.HADS-D不应被用作经验证的诊断性访谈的替代品。
