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

Yin Wu, Brooke Levis, Federico M Daray, John P A Ioannidis, Scott B Patten, Pim Cuijpers, Roy C Ziegelstein, Simon Gilbody, Felix H Fischer, Suiqiong Fan, Ying Sun, Chen He, Ankur Krishnan, Dipika Neupane, Parash Mani Bhandari, Zelalem Negeri, Kira E Riehm, Danielle B Rice, Marleine Azar, Xin Wei YanMahrukh Imran, Matthew J Chiovitti, Jill T Boruff, Dean McMillan, Lorie A Kloda, Sarah Markham, Melissa Henry, Zahinoor Ismail, Carmen G Loiselle, Nicholas D Mitchell, Samir Al-Adawi, Kevin R Beck, Anna Beraldi, Charles N Bernstein, Birgitte Boye, Natalie Büel-Drabe, Adomas Bunevicius, Ceyhun Can, Gregory Carter, Chih-Ken Chen, Gary Cheung, Kerrie Clover, Ronán M Conroy, Gema Costa-Requena, Daniel Cukor, Eli Dabscheck, Jennifer De Souza, Marina Downing, Anthony Feinstein, Panagiotis P Ferentinos, Alastair J Flint, Pamela Gallagher, Milena Gandy, Luigi Grassi, Martin Härter, Asuncion Hernando, Melinda L Jackson, Josef Jenewein, Nathalie Jetté, Miguel Julião, Marie Kjærgaard, Sebastian Köhler, Hans-Helmut König, Lalit K R Krishna, Yu Lee, Margrit Löbner, Wim L Loosman, Anthony W Love, Bernd Löwe, Ulrik F Malt, Ruth Ann Marrie, Loreto Massardo, Yutaka Matsuoka, Anja Mehnert, Ioannis Michopoulos, Laurent Misery, Christian J Nelson, Chong Guan Ng, Meaghan L O'Donnell, Suzanne J O'Rourke, Ahmet Öztürk, Alexander Pabst, Julie A Pasco, Jurate Peceliuniene, Luis Pintor, Jennie L Ponsford, Federico Pulido, Terence J Quinn, Silje E Reme, Katrin Reuter, Steffi G Riedel-Heller, Alasdair G Rooney, Roberto Sánchez-González, Rebecca M Saracino, Melanie P J Schellekens, Martin Scherer, Andrea Benedetti, Brett D Thombs, Et Al

Research output: Contribution to journalArticlepeer-review


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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Original languageEnglish
Pages (from-to)95-114
Number of pages20
JournalPsychological Assessment
Issue number2
Publication statusPublished - Feb 2023


  • Humans
  • Depressive Disorder, Major/diagnosis
  • Depression/diagnosis
  • Psychiatric Status Rating Scales
  • Sensitivity and Specificity
  • Anxiety/diagnosis
  • Mass Screening

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