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‘Optimal’ cutoff selection in studies of depression screening tool accuracy using the PHQ‐9, EPDS, or HADS‐D: A meta‐research study
‘Optimal’ cutoff selection in studies of depression screening tool accuracy using the PHQ‐9, EPDS, or HADS‐D: A meta‐research study
Eliana Brehaut
(Lady Davis Institute for Medical Research Jewish General Hospital Montréal Québec Canada)
Dipika Neupane
(Lady Davis Institute for Medical Research Jewish General Hospital Montréal Québec Canada)
Brooke Levis
(Lady Davis Institute for Medical Research Jewish General Hospital Montréal Québec Canada)
Yin Wu
(Lady Davis Institute for Medical Research Jewish General Hospital Montréal Québec Canada)
Ying Sun
(Lady Davis Institute for Medical Research Jewish General Hospital Montréal Québec Canada)
John P. A. Ioannidis
(Department of Medicine Department of Epidemiology and Population Health Department of Biomedical Data Science Department of Statistics and Meta‐Research Innovation Center at Stanford (METRICS) Stanford University Stanford California USA)
Sarah Markham
(Department of Biostatistics and Health Informatics King's College London London UK)
Pim Cuijpers
(Department of Clinical, Neuro and Developmental Psychology Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam The Netherlands)
Scott B. Patten
(Department of Community Health Sciences University of Calgary Calgary Alberta Canada)
Andrea Benedetti
(Department of Epidemiology, Biostatistics and Occupational Health McGill University Montréal Québec Canada)
Brett D. Thombs
(Lady Davis Institute for Medical Research Jewish General Hospital Montréal Québec Canada)
Journal: International Journal of Methods in Psychiatric Research
•
• Wiley
• ISSN: 1557-0657
Abstract
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.
Eliana Brehaut, Dipika Neupane, Brooke Levis, et al. (2023). "‘Optimal’ cutoff selection in studies of depression screening tool accuracy using the PHQ‐9, EPDS, or HADS‐D: A meta‐research study". International Journal of Methods in Psychiatric Research. https://doi.org/10.1002/mpr.1956