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Review
. 2023 Sep;32(3):e1956.
doi: 10.1002/mpr.1956. Epub 2022 Dec 3.

'Optimal' cutoff selection in studies of depression screening tool accuracy using the PHQ-9, EPDS, or HADS-D: A meta-research study

Eliana Brehaut  1 , Dipika Neupane  1   2 , Brooke Levis  1   3 , Yin Wu  1   4 , Ying Sun  1 , John P A Ioannidis  5 , Sarah Markham  6 , Pim Cuijpers  7 , Scott B Patten  8 , Andrea Benedetti  2   9   10 , Brett D Thombs  1   2   4   9   11   12
Affiliations
Review

'Optimal' cutoff selection in studies of depression screening tool accuracy using the PHQ-9, EPDS, or HADS-D: A meta-research study

Eliana Brehaut et al. Int J Methods Psychiatr Res. 2023 Sep.

Abstract

Objectives: Optimal cutoff thresholds are selected to separate 'positive' from 'negative' screening results. We evaluated how depression screening tool studies select optimal cutoffs.

Methods: We included studies from previously conducted meta-analyses of Patient Health Questionnaire-9, Edinburgh Postnatal Depression Scale, or Hospital Anxiety and Depression Scale-Depression accuracy. Outcomes included whether an optimal cutoff was selected, method used, recommendations made, and reporting guideline and protocol citation.

Results: Of 212 included studies, 172 (81%) attempted to identify an optimal cutoff, and 147 of these 172 (85%) reported one or more methods. Methods were heterogeneous with Youden's J (N = 35, 23%) most common. Only 23 of 147 (16%) studies described a rationale for their method. Rationales focused on balancing sensitivity and specificity without describing why desirable. 131 of 172 studies (76%) identified an optimal cutoff other than the standard; most did not make use recommendations (N = 56; 43%) or recommended using a non-standard cutoff (N = 53; 40%). Only 4 studies cited a reporting guideline, and 4 described a protocol with optimal cutoff selection methods, but none used the protocol method in the published study.

Conclusions: Research is needed to guide how selection of cutoffs for depression screening tools can be standardized and reflect clinical considerations.

Keywords: edinburgh postnatal depression scale; hospital anxiety and depression scale; major depression; optimal cutoff selection; patient health questionnaire-9; screening.

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Conflict of interest statement

All authors completed the ICJME uniform disclosure form and declared no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years. All authors declare no other relationships or activities that could appear to have influenced the submitted work.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study selection process
See this image and copyright information in PMC

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