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加拿大蒙特利尔犹太总医院Brett D Thombs团队研究了医院焦虑抑郁量表（HADS-D）抑郁子量表筛查重度抑郁症的准确性。2021年5月10日，该研究发表在《英国医学杂志》上。

为了评价医院焦虑抑郁量表（HADS-D）的抑郁子量表在躯体健康问题人群中筛查重度抑郁症的准确性，研究组在Medline、科学引文索引等大型数据库中检索从建库到2018年10月25日，关于HADS-D评分和基于有效诊断访谈的重度抑郁状态的相关文献，并进行系统回顾和个体参与者数据的荟萃分析。对于HADS-D临界值为5-15的患者，在使用半结构化诊断访谈、完全结构化访谈和迷你国际神经精神访谈的研究中，采用双变量随机效应荟萃分析分别评估联合敏感性和特异性。

个体参与者数据来自168项合格研究中的101项，共25574名参与者，其中2549名患有抑郁症。对于半结构式访谈、全结构式访谈和迷你国际神经精神访谈，在临界值为7或更高时，联合敏感性和特异性达到最大。在采用半结构式访谈的研究中（57项研究，10664名参与者，1048名患有抑郁症），临界值为7及以上时，敏感性和特异性分别为0.82和0.78；临界值为8及以上时分别为0.74和0.84；临界值为11及以上时分别为0.44和0.95。

研究结果表明，在筛查重度抑郁症时，HADS-D临界值为7及以上可使联合敏感性和特异性最大化。临界值为8或更高可产生相似的联合敏感性和特异性，但敏感性较低，特异性更强。为了用HADS-D识别医学患病的抑郁症患者，可以使用较低的临界值来避免假阴性，而为了识别较高的症状水平，可以使用较高的临界值来减少假阳性。

附：英文原文

Title: Accuracy of the Hospital Anxiety and Depression Scale Depression subscale (HADS-D) to screen for major depression: systematic review and individual participant data meta-analysis

Author: Yin Wu, Brooke Levis, Ying Sun, Chen He, Ankur Krishnan, Dipika Neupane, Parash Mani Bhandari, Zelalem Negeri, Andrea Benedetti, Brett D Thombs

Issue&Volume: 2021/05/10

Abstract:

Objective To evaluate the accuracy of the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) to screen for major depression among people with physical health problems.

Design Systematic review and individual participant data meta-analysis.

Data sources Medline, Medline In-Process and Other Non-Indexed Citations, PsycInfo, and Web of Science (from inception to 25 October 2018).

Review methods Eligible datasets included HADS-D scores and major depression status based on a validated diagnostic interview. Primary study data and study level data extracted from primary reports were combined. For HADS-D cut-off thresholds of 5-15, a bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, in studies that used semi-structured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders), fully structured interviews (eg, Composite International Diagnostic Interview), and the Mini International Neuropsychiatric Interview. One stage meta-regression was used to examine whether accuracy was associated with reference standard categories and the characteristics of participants. Sensitivity analyses were done to assess whether including published results from studies that did not provide raw data influenced the results.

Results Individual participant data were obtained from 101 of 168 eligible studies (60%; 25574 participants (72% of eligible participants), 2549 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of seven or higher for semi-structured interviews, fully structured interviews, and the Mini International Neuropsychiatric Interview. Among studies with a semi-structured interview (57 studies, 10664 participants, 1048 with major depression), sensitivity and specificity were 0.82 (95% confidence interval 0.76 to 0.87) and 0.78 (0.74 to 0.81) for a cut-off value of seven or higher, 0.74 (0.68 to 0.79) and 0.84 (0.81 to 0.87) for a cut-off value of eight or higher, and 0.44 (0.38 to 0.51) and 0.95 (0.93 to 0.96) for a cut-off value of 11 or higher. Accuracy was similar across reference standards and subgroups and when published results from studies that did not contribute data were included.

Conclusions When screening for major depression, a HADS-D cut-off value of seven or higher maximised combined sensitivity and specificity. A cut-off value of eight or higher generated similar combined sensitivity and specificity but was less sensitive and more specific. To identify medically ill patients with depression with the HADS-D, lower cut-off values could be used to avoid false negatives and higher cut-off values to reduce false positives and identify people with higher symptom levels.

DOI: 10.1136/bmj.n972

Source: https://www.bmj.com/content/373/bmj.n972

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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