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Open AccessArticle

Accuracy of Self-Reported Items for the Screening of Depression in the General Population

Department of Psychological Medicine, Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK
CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain
Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, 08950 Barcelona, Spain
Health Services and Policy Research Group, University of Exeter Medical School, Exeter EX4 2LU, UK
Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), 08002 Barcelona, Spain
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(21), 7955;
Received: 31 August 2020 / Revised: 2 October 2020 / Accepted: 27 October 2020 / Published: 29 October 2020
(This article belongs to the Special Issue Assessment of Health-Related Quality of Life (HRQoL) in Public Health)
Introduction: Though self-reported items (SRD, self-reported depression) are commonly used in health surveys and cohort studies, their metric properties as a depression indicator remain unclear. The aims were to evaluate the measurement properties of SRD using the Patient Health Questionnaire-8 (PHQ-8) as reference and to identify factors related to the agreement between both indicators. Methods: Data from the European Health Interview Survey in Spain in 2014/2015 (n = 22,065) were analyzed. Two indicators of depression were considered: SRD based on two items yes/no (positive: both yes), and the PHQ-8 (positive ≥ 10). Socioeconomic factors and use of health services were considered as independent variables. The prevalence of depression, sensitivity, specificity, global agreement, and positive and negative predictive values (PPV and NPV) of SRDs were evaluated using the PHQ-8 as a reference. Logistic regression models were fitted to determine factors associated with the agreement between indicators. Results: The prevalence of depression was lower when assessed with PHQ-8 (5.9%) than with SRD (7.7%). SRD sensitivity and PPV were moderate–low (52.9% and 40.4%, respectively) whereas global agreement, specificity, and NPV were high (92.7%, 95.1%, and 97.0%, respectively). Positive agreement was associated with marital status, country of birth, employment status, and social class. Negative agreement was related to all independent variables except country of birth. Conclusions: SRD items tend to overestimate the current prevalence of depression. While its use in health surveys and cohorts may be appropriate as a quick assessment of possible depression, due to their low sensitivity, its use in clinical contexts is questionable. View Full-Text
Keywords: depression; metric properties; sensitivity and specificity; health surveys depression; metric properties; sensitivity and specificity; health surveys
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Arias-de la Torre, J.; Vilagut, G.; Serrano-Blanco, A.; Martín, V.; Molina, A.J.; Valderas, J.M.; Alonso, J. Accuracy of Self-Reported Items for the Screening of Depression in the General Population. Int. J. Environ. Res. Public Health 2020, 17, 7955.

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