TY - JOUR T1 - Measuring depression severity in general practice: discriminatory performance of the PHQ-9, HADS-D, and BDI-II JF - British Journal of General Practice JO - Br J Gen Pract SP - e419 LP - e426 DO - 10.3399/bjgp11X583209 VL - 61 IS - 588 AU - Isobel M Cameron AU - Amanda Cardy AU - John R Crawford AU - Schalk W du Toit AU - Steven Hay AU - Kenneth Lawton AU - Kenneth Mitchell AU - Sumit Sharma AU - Shilpa Shivaprasad AU - Sally Winning AU - Ian C Reid Y1 - 2011/07/01 UR - http://bjgp.org/content/61/588/e419.abstract N2 - Background The UK Quality and Outcomes Framework (QOF) rewards practices for measuring symptom severity in patients with depression, but the endorsed scales have not been comprehensively validated for this purpose.Aim To assess the discriminatory performance of the QOF depression severity measures.Design and setting Psychometric assessment in nine Scottish general practices.Method Adult primary care patients diagnosed with depression were invited to participate. The HADS-D, PHQ-9, and BDI-II were assessed against the HRSD-17 interview. Discriminatory performance was determined relative to the HRSD-17 cut-offs for symptoms of at least moderate severity, as per criteria set by the American Psychiatric Association (APA) and NICE. Receiver operating characteristic curves were plotted and area under the curve (AUC), sensitivity, specificity, and likelihood ratios (LRs) calculated.Results A total of 267 were recruited per protocol, mean age = 49.8 years (standard deviation [SD] = 14.1), 70% female, mean HRSD-17=12.6 (SD = 7.62, range = 0–34). For APA criteria, AUCs were: HADS-D = 0.84; PHQ-9 = 0.90; and BDI-II = 0.86. Optimal sensitivity and specificity were reached where HADS-D ≥9 (74%, 76%); PHQ-9 ≥12 (77%, 79%), and BDI-II ≥23 (74%, 75%). For NICE criteria: HADS-D AUC = 0.89; PHQ-9 AUC = 0.93; and BDI-II AUC = 0.90. Optimal sensitivity and specificity were reached where HADS-D ≥10 (82%, 75%), PHQ-9 ≥15 (89%, 83%), and BDI-II ≥28 (83%, 80%). LRs did not provide evidence of sufficient accuracy for clinical use.Conclusion As selecting treatment according to depression severity is informed by an evidence base derived from trials using HRSD-17, and none of the measures tested aligned adequately with that tool, they are inappropriate for use. ER -