Comparison of the accuracy of the 7-item HADS depression subscale and 14-item total HADS for screening for major depression: A systematic review and individual participant data meta-analysis

Wu, Yin and Levis, Brooke and Daray, Federico M. and Ioannidis, John P. A. and Patten, Scott B. and Cuijpers, Pim and Ziegelstein, Roy C. and Gilbody, Simon and Fischer, Felix H. and Fan, Suiqiong and Sun, Ying and He, Chen and Krishnan, Ankur and Neupane, Dipika and Bhandari, Parash Mani and Negeri, Zelalem and Riehm, Kira E. and Rice, Danielle B. and Azar, Marleine and Yan, Xin Wei and Imran, Mahrukh and Chiovitti, Matthew J. and Boruff, Jill T. and McMillan, Dean and Kloda, Lorie A. and Markham, Sarah and Henry, Melissa and Ismail, Zahinoor and Loiselle, Carmen G. and Mitchell, Nicholas D. and Al-Adawi, Samir and Beck, Kevin R. and Beraldi, Anna and Bernstein, Charles N. and Boye, Birgitte and Buel-Drabe, Natalie and Bunevicius, Adomas and Can, Ceyhun and Carter, Gregory and Chen, Chih-Ken and Cheung, Gary and Clover, Kerrie and Conroy, Ronan M. and Costa-Requena, Gema and Cukor, Daniel and Dabscheck, Eli and De Souza, Jennifer and Downing, Marina and Feinstein, Anthony and Ferentinos, Panagiotis P. and Flint, Alastair J. and Gallagher, Pamela and Gandy, Milena and Grassi, Luigi and Haerter, Martin and Hernando, Asuncion and Jackson, Melinda L. and Jenewein, Josef and Jette, Nathalie and Juliao, Miguel and Kjaergaard, Marie and Kohler, Sebastian and Konig, Hans-Helmut and Krishna, Lalit K. R. and Lee, Yu and Loebner, Margrit and Loosman, Wim L. and Love, Anthony W. and Loewe, Bernd and Malt, Ulrik F. and Marrie, Ruth Ann and Massardo, Loreto and Matsuoka, Yutaka and Mehnert, Anja and Michopoulos, Ioannis and Misery, Laurent and Nelson, Christian J. and Ng, Chong Guan and O'Donnell, Meaghan L. and O'Rourke, Suzanne J. and Ozturk, Ahmet and Pabst, Alexander and Pasco, Julie A. and Peceliuniene, Jurate and Pintor, Luis and Ponsford, Jennie L. and Pulido, Federico and Quinn, Terence J. and Reme, Silje E. and Reuter, Katrin and Riedel-Heller, Steffi G. and Rooney, Alasdair G. and Sanchez-Gonzalez, Roberto and Saracino, Rebecca M. and Schellekens, Melanie P. J. and Scherer, Martin and Schwarzbold, Marcelo L. and Cankorur, Vesile Senturk and Sharpe, Louise and Sharpe, Michael and Simard, Sebastien and Singer, Susanne and Stafford, Lesley and Stone, Jon and Strobe, Natalie A. and Sultan, Serge and Teixeira, Antonio L. and Tiringer, Istvan and Turner, Alyna and Walker, Jane and Walterfang, Mark and Wang, Liang-Jen and Weyerer, Siegfried B. and White, Jennifer and Wiese, Birgitt and Williams, Lana J. and Wong, Lai-Yi and Benedetti, Andrea and Thombsi, Brett D. (2023) Comparison of the accuracy of the 7-item HADS depression subscale and 14-item total HADS for screening for major depression: A systematic review and individual participant data meta-analysis. Psychological Assessment, 35 (2). pp. 95-114. ISSN 1040-3590, DOI

Full text not available from this repository.


The seven-item Hospital Anxiety and Depression Scale Depression subscale (HADS-D) and the total score of the 14-item HADS (HADS-T) are both used for major depression screening. Compared to the HADS-D, the HADS-T includes anxiety items and requires more time to complete. We compared the screening accuracy of the HADS-D and HADS-T for major depression detection. We conducted an individual participant data meta-analysis and fit bivariate random effects models to assess diagnostic accuracy among participants with both HADS-D and HADS-T scores. We identified optimal cutoffs, estimated sensitivity and specificity with 95% confidence intervals, and compared screening accuracy across paired cutoffs via two-stage and individual-level models. We used a 0.05 equivalence margin to assess equivalency in sensitivity and specificity. 20,700 participants (2,285 major depression cases) from 98 studies were included. Cutoffs of >= 7 for the HADS-D (sensitivity 0.79 0.75, 0.83], specificity 0.78 0.75, 0.80]) and >= 15 for the HADS-T (sensitivity 0.79 0.76, 0.82], specificity 0.81 0.78, 0.83]) minimized the distance to the top-left corner of the receiver operating characteristic curve. Across all sets of paired cutoffs evaluated, differences of sensitivity between HADS-T and HADS-D ranged from -0.05 to 0.01 (0.00 at paired optimal cutoffs), and differences of specificity were within 0.03 for all cutoffs (0.02-0.03). The pattern was similar among outpatients, although the HADS-T was slightly (not nonequivalently) more specific among inpatients. The accuracy of HADS-T was equivalent to the HADS-D for detecting major depression. In most settings, the shorter HADS-D would be preferred. Public Significance Statement The present study suggests that the accuracy of 14-item Hospital Anxiety and Depression Scale (HADS-D) and the seven-item HADS Depression subscale (HADS-D) are equivalent for detecting major depression. Using the seven-item HADS-D for depression screening instead of the full 14-item HADS-T has minimal influence on performance of the measure but would reduce patient and participant burden in most clinical and research settings.

Item Type: Article
Funders: Canadian Institutes of Health Research (CIHR) (KRS-140045), Canadian Institutes of Health Research (CIHR) (PCG-155468), Canadian Institutes of Health Research (CIHR) (THC-135234)
Uncontrolled Keywords: HADS-D; HADS-T; Individual participant data meta-analysis; Depression screening; Diagnostic accuracy
Subjects: R Medicine
R Medicine > RZ Other systems of medicine
Divisions: Faculty of Medicine > Psychological Medicine Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 26 Jun 2023 06:36
Last Modified: 26 Jun 2023 06:36

Actions (login required)

View Item View Item