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. 2021 Dec;33(12):e14161.
doi: 10.1111/nmo.14161. Epub 2021 May 3.

Examining the optimal cutoff values of HADS, PHQ-9 and GAD-7 as screening instruments for depression and anxiety in irritable bowel syndrome

Johanna T W Snijkers  1   2 , Wendy van den Oever  1   2 , Zsa Zsa R M Weerts  1   2 , Lisa Vork  1   2 , Zlatan Mujagic  1   2 , Carsten Leue  3   4 , Martine A M Hesselink  1   2 , Joanna W Kruimel  1   2 , Jean W M Muris  5 , Roel M M Bogie  1   6 , Ad A M Masclee  1   2 , Daisy M A E Jonkers  1   2 , Daniel Keszthelyi  1   2
Affiliations

Examining the optimal cutoff values of HADS, PHQ-9 and GAD-7 as screening instruments for depression and anxiety in irritable bowel syndrome

Johanna T W Snijkers et al. Neurogastroenterol Motil. 2021 Dec.

Abstract

Background: Self-rating scales are frequently used to screen for anxiety and depression in patients with irritable bowel syndrome (IBS). Different cutoff values are recommended in literature, and guidelines have suggested the use of other screening instruments over time. The aim of this study was to assess the correlation between the most commonly used psychological screening instruments for anxiety and depression in IBS and to compare custom cutoff scores for these instruments.

Methods: Irritable bowel syndrome patients (n = 192) completed several questionnaires including the Hospital Anxiety and Depression Scale (HADS, HADS-A and HADS-D subscale), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Agreement at different cutoff points, for depressive and anxiety disorder, was assessed by use of the Gwet AC1 coefficient.

Key results: Hospital Anxiety and Depression Scale (HADS)-D and PHQ-9 scores, and HADS-A and GAD-7 scores showed high correlations (rs = 0.735 and rs = 0.805, respectively). For depressive disorder, a Gwet AC1 value of 0.829 was found when recommended cutoff points from literature were compared (PHQ-9 cutoff ≥10, HADS-D cutoff ≥8). For anxiety disorder, a Gwet AC1 value of 0.806 was found when recommended cutoff points from literature were compared (GAD-7 cutoff ≥10, HADS-A cutoff ≥8). Even higher agreements were found when higher HADS cutoff values were chosen, with impact on sensitivity and specificity.

Conclusions & inferences: Custom cutoff values deem the HADS subscales (HADS-D and HADS-A) concordant to PHQ-9 and GAD-7 scores. The choice of a cutoff value has substantial impact on sensitivity/specificity and is dependent on patient population, setting, and the purpose of use.

Keywords: GAD-7; PHQ-9; anxiety disorders; depressive disorder; irritable bowel syndrome; psychological tests.

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Conflict of interest statement

DK and AAMM have received research funding from Allergan and Grünenthal on IBS topics, and from ZonMw (Dutch Governmental fund). DK an AAMM have received an unrestricted research grant from Will Pharma S.A., which also supported ZZRM to attend a scientific meeting. DK has received research funding from UEG (United Europe Gastroenterology) and the Dutch Gastroenterology Foundation (Maag‐Lever‐Darm Stichting, MLDS). DMAEJ and DK have received research funding from EU Horizon 2020. AAMM has given scientific advice to Bayer (topic: IBS), to Kyowa Kirin (topic: constipation) and to Takeda (topic: gastroparesis). AAMM has received funding from Pentax Europe GmBH and from the Dutch Cancer Society related to endoscopy and to colorectal polyps. Part of the work of DMAEJ is financed by Grant Top Knowledge Institute (Well on Wheat) and the Carbokinietics program as part of the NWO‐CCC Partnership program. RMMB has received an unrestricted educational grant of Pentax Medical Europe bv. The other authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Flowchart participant selection
See this image and copyright information in PMC

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