Depression prevalence using the HADS-D compared to SCID major depression classification: An individual participant data meta-analysis

Eliana Brehaut, Dipika Neupane, Brooke Levis, Yin Wu, Ying Sun, Ankur Krishnan, Chen He, Parash Mani Bhandari, Zelalem Negeri, Kira E. Riehm, Danielle B. Rice, Marleine Azar, Xin Wei Yan, Mahrukh Imran, Matthew J. Chiovitti, Nazanin Saadat, Pim Cuijpers, John P.A. Ioannidis, Sarah Markham, Scott B. PattenRoy C. Ziegelstein, Melissa Henry, Zahinoor Ismail, Carmen G. Loiselle, Nicholas D. Mitchell, Marcello Tonelli, Jill T. Boruff, Lorie A. Kloda, Anna Beraldi, Anna P.B.M. Braeken, Gregory Carter, Kerrie Clover, Ronán M. Conroy, Daniel Cukor, Carlos E. da Rocha e Silva, Jennifer De Souza, Marina G. Downing, Anthony Feinstein, Panagiotis P. Ferentinos, Felix H. Fischer, Alastair J. Flint, Maiko Fujimori, Pamela Gallagher, Simone Goebel, Nathalie Jetté, Miguel Julião, Monika Keller, Marie Kjærgaard, Anthony W. Love, Bernd Löwe, Rocio Martin-Santos, Ioannis Michopoulos, Ricard Navines, Suzanne J. O'Rourke, Ahmet Öztürk, Luis Pintor, Jennie L. Ponsford, Alasdair G. Rooney, Roberto Sánchez-González, Marcelo L. Schwarzbold, Michael Sharpe, Sébastien Simard, Susanne Singer, Jon Stone, Ka Yee Tung, Alyna Turner, Jane Walker, Mark Walterfang, Jennifer White, Andrea Benedetti, Brett D. Thombs

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objectives: 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. Methods: 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. Results: 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%. Conclusions: 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.

Original languageEnglish
Article number110256
JournalJournal of Psychosomatic Research
StatePublished - Dec 2020


  • Depression
  • Hospital Anxiety and Depression Scale
  • Individual participant data
  • Meta-analysis
  • Screening tools


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