. 2021 Sep:137:137-147.

doi: 10.1016/j.jclinepi.2021.03.031. Epub 2021 Apr 8.

Data-driven methods distort optimal cutoffs and accuracy estimates of depression screening tools: a simulation study using individual participant data

Parash Mani Bhandari¹, Brooke Levis², Dipika Neupane¹, Scott B Patten³, Ian Shrier⁴, Brett D Thombs⁵, Andrea Benedetti⁶; Depression Screening Data (DEPRESSD) EPDS Group

Collaborators, Affiliations

Collaborators

Depression Screening Data (DEPRESSD) EPDS Group:
Ying Sun⁷, Chen He⁷, Danielle B Rice⁷, Ankur Krishnan⁷, Yin Wu⁷, Marleine Azar⁷, Tatiana A Sanchez⁷, Matthew J Chiovitti⁷, Nazanin Saadat⁷, Kira E Riehm⁷, Mahrukh Imran⁷, Zelalem Negeri⁷, Jill T Boruff⁸, Pim Cuijpers⁹, Simon Gilbody¹⁰, John P A Ioannidis¹¹, Lorie A Kloda¹², Roy C Ziegelstein¹³, Liane Comeau¹⁴, Nicholas D Mitchell¹⁵, Marcello Tonelli¹⁶, Simone N Vigod¹⁷, Franca Aceti¹⁸, Rubén Alvarado¹⁹, Cosme Alvarado-Esquivel²⁰, Muideen O Bakare²¹, Jacqueline Barnes²², Amar D Bavle²³, Cheryl Tatano Beck²⁴, Carola Bindt²⁵, Philip M Boyce²⁶, Adomas Bunevicius²⁷, Tiago Castro E Couto²⁸, Linda H Chaudron²⁹, Humberto Correa³⁰, Felipe Pinheiro de Figueiredo³¹, Valsamma Eapen³², Nicolas Favez³³, Ethel Felice³⁴, Michelle Fernandes³⁵, Barbara Figueiredo³⁶, Jane R W Fisher³⁷, Lluïsa Garcia-Esteve³⁸, Lisa Giardinelli³⁹, Nadine Helle²⁵, Louise M Howard⁴⁰, Dina Sami Khalifa⁴¹, Jane Kohlhoff⁴², Zoltán Kozinszky⁴³, Laima Kusminskas⁴⁴, Lorenzo Lelli³⁹, Angeliki A Leonardou⁴⁵, Michael Maes⁴⁶, Valentina Meuti¹⁸, Sandra Nakić Radoš⁴⁷, Purificación Navarro García⁴⁸, Daisuke Nishi⁴⁹, Daniel Okitundu Luwa E-Andjafono⁵⁰, Susan J Pawlby⁴⁰, Chantal Quispel⁵¹, Emma Robertson-Blackmore⁵², Tamsen J Rochat⁵³, Heather J Rowe³⁷, Deborah J Sharp⁵⁴, Bonnie W M Siu⁵⁵, Alkistis Skalkidou⁵⁶, Alan Stein⁵⁷, Robert C Stewart⁵⁸, Kuan-Pin Su⁵⁹, Inger Sundström-Poromaa⁵⁶, Meri Tadinac⁶⁰, S Darius Tandon⁶¹, Iva Tendais³⁶, Pavaani Thiagayson⁶², Annamária Töreki⁶³, Anna Torres-Giménez⁴⁸, Thach D Tran³⁷, Kylee Trevillion⁴⁰, Katherine Turner⁶⁴, Johann M Vega-Dienstmaier⁶⁵, Karen Wynter⁶⁶, Kimberly A Yonkers⁶⁷

Affiliations

¹ Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
² Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK.
³ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
⁴ Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, Montréal, Québec, Canada.
⁵ Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada; Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada. Electronic address: brett.thombs@mcgill.ca.
⁶ Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada. Electronic address: andrea.benedetti@mcgill.ca.
⁷ Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.
⁸ Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada.
⁹ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands.
¹⁰ Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK.
¹¹ Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, California, USA.
¹² Library, Concordia University, Montréal, Québec, Canada.
¹³ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹⁴ International Union for Health Promotion and Health Education, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada.
¹⁵ Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
¹⁶ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁷ Women's College Hospital and Research Institute, University of Toronto, Toronto, Ontario, Canada.
¹⁸ Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
¹⁹ School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
²⁰ Laboratorio de Investigación Biomédica, Facultad de Medicina y Nutrición, Avenida Universidad, Dgo, Mexico.
²¹ Child and Adolescent Unit, Federal Neuropsychiatric Hospital, Enugu, Nigeria.
²² Department of Psychological Sciences, Birkbeck, University of London, UK.
²³ Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India.
²⁴ University of Connecticut School of Nursing, Mansfield, Connecticut, USA.
²⁵ Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany.
²⁶ Discipline of Psychiatry, Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.
²⁷ Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.
²⁸ Federal University of Uberlândia, Brazil.
²⁹ University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
³⁰ Medicine Faculty - Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brazil.
³¹ Department of Neurosciences and Behavior, Ribeirão Preto Medical School, Brazil.
³² University of New South Wales and Ingham Institute South West Sydney LHD, Australia.
³³ Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
³⁴ Department of Psychiatry, Mount Carmel Hospital, Attard, Malta.
³⁵ Faculty of Medicine, Department of Paediatrics, University of Southampton, Southampton and Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
³⁶ School of Psychology, University of Minho, Portugal.
³⁷ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
³⁸ Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.
³⁹ Psychiatry Unit, Department of Health Sciences, University of Florence, Firenze, Italy.
⁴⁰ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁴¹ Ahfad University for Women, Omdurman, Sudan.
⁴² University of New South Wales, Kensington, Australia.
⁴³ Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden.
⁴⁴ Private Practice, Hamburg, Germany.
⁴⁵ First Department of Psychiatry, Women's Mental Health Clinic, Athens University Medical School, Athens, Greece.
⁴⁶ Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁴⁷ Department of Psychology, Catholic University of Croatia, Zagreb, Croatia.
⁴⁸ Perinatal Mental Health Unit CLINIC-BCN. Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.
⁴⁹ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Japan.
⁵⁰ Unité de Neuropsychologie, Département de Neurologie, Centre Neuro-psycho-pathologique, Faculté de Médecine, Université de Kinshasa, République Démocratique du Congo.
⁵¹ Department of Obstetrics and Gynaecology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands.
⁵² Halifax Health, Graduate Medical Education, Daytona Beach, FL. USA.
⁵³ MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, South Africa.
⁵⁴ Centre for Academic Primary Care, Bristol Medical School, University of Bristol, UK.
⁵⁵ Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.
⁵⁶ Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
⁵⁷ University of Oxford, Oxford, UK.
⁵⁸ Department of Mental Health, College of Medicine, University of Malawi, Malawi.
⁵⁹ College of Medicine, China Medical University, Taichung, Taiwan.
⁶⁰ Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Croatia.
⁶¹ Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁶² Institute of Mental Health, Singapore.
⁶³ Department of Emergency, University of Szeged, Hungary.
⁶⁴ Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy.
⁶⁵ Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia. Lima, Perú.
⁶⁶ School of Nursing & Midwifery, Deakin University, Melbourne, Australia.
⁶⁷ Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.

PMID: 33838273
DOI: 10.1016/j.jclinepi.2021.03.031

Data-driven methods distort optimal cutoffs and accuracy estimates of depression screening tools: a simulation study using individual participant data

Parash Mani Bhandari et al. J Clin Epidemiol. 2021 Sep.

. 2021 Sep:137:137-147.

doi: 10.1016/j.jclinepi.2021.03.031. Epub 2021 Apr 8.

Authors

Parash Mani Bhandari¹, Brooke Levis², Dipika Neupane¹, Scott B Patten³, Ian Shrier⁴, Brett D Thombs⁵, Andrea Benedetti⁶; Depression Screening Data (DEPRESSD) EPDS Group

Collaborators

Depression Screening Data (DEPRESSD) EPDS Group:
Ying Sun⁷, Chen He⁷, Danielle B Rice⁷, Ankur Krishnan⁷, Yin Wu⁷, Marleine Azar⁷, Tatiana A Sanchez⁷, Matthew J Chiovitti⁷, Nazanin Saadat⁷, Kira E Riehm⁷, Mahrukh Imran⁷, Zelalem Negeri⁷, Jill T Boruff⁸, Pim Cuijpers⁹, Simon Gilbody¹⁰, John P A Ioannidis¹¹, Lorie A Kloda¹², Roy C Ziegelstein¹³, Liane Comeau¹⁴, Nicholas D Mitchell¹⁵, Marcello Tonelli¹⁶, Simone N Vigod¹⁷, Franca Aceti¹⁸, Rubén Alvarado¹⁹, Cosme Alvarado-Esquivel²⁰, Muideen O Bakare²¹, Jacqueline Barnes²², Amar D Bavle²³, Cheryl Tatano Beck²⁴, Carola Bindt²⁵, Philip M Boyce²⁶, Adomas Bunevicius²⁷, Tiago Castro E Couto²⁸, Linda H Chaudron²⁹, Humberto Correa³⁰, Felipe Pinheiro de Figueiredo³¹, Valsamma Eapen³², Nicolas Favez³³, Ethel Felice³⁴, Michelle Fernandes³⁵, Barbara Figueiredo³⁶, Jane R W Fisher³⁷, Lluïsa Garcia-Esteve³⁸, Lisa Giardinelli³⁹, Nadine Helle²⁵, Louise M Howard⁴⁰, Dina Sami Khalifa⁴¹, Jane Kohlhoff⁴², Zoltán Kozinszky⁴³, Laima Kusminskas⁴⁴, Lorenzo Lelli³⁹, Angeliki A Leonardou⁴⁵, Michael Maes⁴⁶, Valentina Meuti¹⁸, Sandra Nakić Radoš⁴⁷, Purificación Navarro García⁴⁸, Daisuke Nishi⁴⁹, Daniel Okitundu Luwa E-Andjafono⁵⁰, Susan J Pawlby⁴⁰, Chantal Quispel⁵¹, Emma Robertson-Blackmore⁵², Tamsen J Rochat⁵³, Heather J Rowe³⁷, Deborah J Sharp⁵⁴, Bonnie W M Siu⁵⁵, Alkistis Skalkidou⁵⁶, Alan Stein⁵⁷, Robert C Stewart⁵⁸, Kuan-Pin Su⁵⁹, Inger Sundström-Poromaa⁵⁶, Meri Tadinac⁶⁰, S Darius Tandon⁶¹, Iva Tendais³⁶, Pavaani Thiagayson⁶², Annamária Töreki⁶³, Anna Torres-Giménez⁴⁸, Thach D Tran³⁷, Kylee Trevillion⁴⁰, Katherine Turner⁶⁴, Johann M Vega-Dienstmaier⁶⁵, Karen Wynter⁶⁶, Kimberly A Yonkers⁶⁷

Affiliations

¹ Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
² Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK.
³ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
⁴ Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, Montréal, Québec, Canada.
⁵ Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada; Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada. Electronic address: brett.thombs@mcgill.ca.
⁶ Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada. Electronic address: andrea.benedetti@mcgill.ca.
⁷ Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.
⁸ Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada.
⁹ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands.
¹⁰ Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK.
¹¹ Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, California, USA.
¹² Library, Concordia University, Montréal, Québec, Canada.
¹³ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹⁴ International Union for Health Promotion and Health Education, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada.
¹⁵ Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
¹⁶ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁷ Women's College Hospital and Research Institute, University of Toronto, Toronto, Ontario, Canada.
¹⁸ Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
¹⁹ School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
²⁰ Laboratorio de Investigación Biomédica, Facultad de Medicina y Nutrición, Avenida Universidad, Dgo, Mexico.
²¹ Child and Adolescent Unit, Federal Neuropsychiatric Hospital, Enugu, Nigeria.
²² Department of Psychological Sciences, Birkbeck, University of London, UK.
²³ Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India.
²⁴ University of Connecticut School of Nursing, Mansfield, Connecticut, USA.
²⁵ Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany.
²⁶ Discipline of Psychiatry, Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.
²⁷ Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.
²⁸ Federal University of Uberlândia, Brazil.
²⁹ University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
³⁰ Medicine Faculty - Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brazil.
³¹ Department of Neurosciences and Behavior, Ribeirão Preto Medical School, Brazil.
³² University of New South Wales and Ingham Institute South West Sydney LHD, Australia.
³³ Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
³⁴ Department of Psychiatry, Mount Carmel Hospital, Attard, Malta.
³⁵ Faculty of Medicine, Department of Paediatrics, University of Southampton, Southampton and Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
³⁶ School of Psychology, University of Minho, Portugal.
³⁷ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
³⁸ Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.
³⁹ Psychiatry Unit, Department of Health Sciences, University of Florence, Firenze, Italy.
⁴⁰ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁴¹ Ahfad University for Women, Omdurman, Sudan.
⁴² University of New South Wales, Kensington, Australia.
⁴³ Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden.
⁴⁴ Private Practice, Hamburg, Germany.
⁴⁵ First Department of Psychiatry, Women's Mental Health Clinic, Athens University Medical School, Athens, Greece.
⁴⁶ Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁴⁷ Department of Psychology, Catholic University of Croatia, Zagreb, Croatia.
⁴⁸ Perinatal Mental Health Unit CLINIC-BCN. Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.
⁴⁹ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Japan.
⁵⁰ Unité de Neuropsychologie, Département de Neurologie, Centre Neuro-psycho-pathologique, Faculté de Médecine, Université de Kinshasa, République Démocratique du Congo.
⁵¹ Department of Obstetrics and Gynaecology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands.
⁵² Halifax Health, Graduate Medical Education, Daytona Beach, FL. USA.
⁵³ MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, South Africa.
⁵⁴ Centre for Academic Primary Care, Bristol Medical School, University of Bristol, UK.
⁵⁵ Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.
⁵⁶ Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
⁵⁷ University of Oxford, Oxford, UK.
⁵⁸ Department of Mental Health, College of Medicine, University of Malawi, Malawi.
⁵⁹ College of Medicine, China Medical University, Taichung, Taiwan.
⁶⁰ Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Croatia.
⁶¹ Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁶² Institute of Mental Health, Singapore.
⁶³ Department of Emergency, University of Szeged, Hungary.
⁶⁴ Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy.
⁶⁵ Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia. Lima, Perú.
⁶⁶ School of Nursing & Midwifery, Deakin University, Melbourne, Australia.
⁶⁷ Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.

PMID: 33838273
DOI: 10.1016/j.jclinepi.2021.03.031

Abstract

Objective: To evaluate, across multiple sample sizes, the degree that data-driven methods result in (1) optimal cutoffs different from population optimal cutoff and (2) bias in accuracy estimates.

Study design and setting: A total of 1,000 samples of sample size 100, 200, 500 and 1,000 each were randomly drawn to simulate studies of different sample sizes from a database (n = 13,255) synthesized to assess Edinburgh Postnatal Depression Scale (EPDS) screening accuracy. Optimal cutoffs were selected by maximizing Youden's J (sensitivity+specificity-1). Optimal cutoffs and accuracy estimates in simulated samples were compared to population values.

Results: Optimal cutoffs in simulated samples ranged from ≥ 5 to ≥ 17 for n = 100, ≥ 6 to ≥ 16 for n = 200, ≥ 6 to ≥ 14 for n = 500, and ≥ 8 to ≥ 13 for n = 1,000. Percentage of simulated samples identifying the population optimal cutoff (≥ 11) was 30% for n = 100, 35% for n = 200, 53% for n = 500, and 71% for n = 1,000. Mean overestimation of sensitivity and underestimation of specificity were 6.5 percentage point (pp) and -1.3 pp for n = 100, 4.2 pp and -1.1 pp for n = 200, 1.8 pp and -1.0 pp for n = 500, and 1.4 pp and -1.0 pp for n = 1,000.

Conclusions: Small accuracy studies may identify inaccurate optimal cutoff and overstate accuracy estimates with data-driven methods.

Keywords: Accuracy estimates; Bias; Cherry-picking; Data-driven methods; Depression; Optimal cutoff.

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Data-driven methods distort optimal cutoffs and accuracy estimates of depression screening tools: a simulation study using individual participant data

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Data-driven methods distort optimal cutoffs and accuracy estimates of depression screening tools: a simulation study using individual participant data

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