Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses

Bernd Löwe, Robert L. Spitzer, Kerstin Gräfe, Kurt Kroenke, Andrea Quenter, Stephan Zipfel, Christine Buchholz, Steffen Witte, Wolfgang Herzog

Research output: Contribution to journalArticle

662 Citations (Scopus)

Abstract

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 α: 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%). Limitations: 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.

Original languageEnglish (US)
Pages (from-to)131-140
Number of pages10
JournalJournal of Affective Disorders
Volume78
Issue number2
DOIs
StatePublished - Feb 2004

Fingerprint

Depressive Disorder
Diagnostic and Statistical Manual of Mental Disorders
Physicians
Depression
Major Depressive Disorder
Anxiety
Health
Outpatients
Surveys and Questionnaires
Mental Disorders
ROC Curve
Area Under Curve
Interviews
Sensitivity and Specificity

Keywords

  • Depressive disorder
  • Diagnosis
  • Primary health care
  • Questionnaires
  • Screening
  • Sensitivity and specificity

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Behavioral Neuroscience
  • Biological Psychiatry
  • Neurology
  • Psychology(all)

Cite this

Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses. / Löwe, Bernd; Spitzer, Robert L.; Gräfe, Kerstin; Kroenke, Kurt; Quenter, Andrea; Zipfel, Stephan; Buchholz, Christine; Witte, Steffen; Herzog, Wolfgang.

In: Journal of Affective Disorders, Vol. 78, No. 2, 02.2004, p. 131-140.

Research output: Contribution to journalArticle

Löwe, Bernd ; Spitzer, Robert L. ; Gräfe, Kerstin ; Kroenke, Kurt ; Quenter, Andrea ; Zipfel, Stephan ; Buchholz, Christine ; Witte, Steffen ; Herzog, Wolfgang. / Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses. In: Journal of Affective Disorders. 2004 ; Vol. 78, No. 2. pp. 131-140.
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AU - Löwe, Bernd

AU - Spitzer, Robert L.

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AU - Kroenke, Kurt

AU - Quenter, Andrea

AU - Zipfel, Stephan

AU - Buchholz, Christine

AU - Witte, Steffen

AU - Herzog, Wolfgang

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AB - 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 α: 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%). Limitations: 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.

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