Which instruments to support diagnosis of depression have sufficient accuracy? A systematic
review
Sammanfattning
Background: Instruments are frequently used in case finding, diagnosis and severity grading of
major depression, but the evidence supporting their utility is weak. Aim: To systematically review the
specificity and sensitivity of instruments used to diagnose and grade the severity of depression.
Methods: MEDLINE, PsycInfo, Embase and the Cochrane Library databases were searched until April
2014. Fifty studies fulfilled the inclusion criteria. Risk of bias was assessed with QUADAS. The
average sensitivity and specificity of each instrument was estimated with hierarchical summary
receiver operating characteristics analyses and the confidence in the estimates was evaluated using
GRADE. Minimum acceptable sensitivity/specificity, with structured interview as the reference, was
80%/80% for structured interviews and 80%/70% for case-finding instruments. The minimum
acceptable standard for severity measures was a correlation of 0.7 with DSM-IV classification.
Results: Twenty instruments were investigated. The average sensitivity/specificity was 85%/92% for
the Structured Clinical Interview for DSM-IV-Axis-I Disorders (SCID-I), 95%/84% for the Mini
International Neuropsychiatric Interview (MINI), < 70%/85% for the Primary Care Evaluation of Mental
Disorders (PRIME-MD), 88%/78% for the Patient Health Questionnaire-9 (PHQ-9) with a cut-off score of
10, 69%/95% for PHQ-9 as a diagnostic algorithm and 70%/83% for the Hospital Anxiety and
Depression Scale (HADS) with a cut-off score of 7. The confidence in the estimates for the other
instruments was very low. Conclusions: Only the SCID-I, MINI and PHQ-9 with a cut-off score of 10
fulfilled the minimum criteria for sensitivity and specificity. The use of the PRIME-MD and HADS is
not supported by current evidence.