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

Authors
  • Snijkers, Johanna T W1, 2
  • van den Oever, Wendy1, 2
  • Weerts, Zsa Zsa R M1, 2
  • Vork, Lisa1, 2
  • Mujagic, Zlatan1, 2
  • Leue, Carsten3, 4
  • Hesselink, Martine A M1, 2
  • Kruimel, Joanna W1, 2
  • Muris, Jean W M5
  • Bogie, Roel M M1, 6
  • Masclee, Ad A M1, 2
  • Jonkers, Daisy M A E1, 2
  • Keszthelyi, Daniel1, 2
  • 1 Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands. , (Netherlands)
  • 2 NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. , (Netherlands)
  • 3 Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, The Netherlands. , (Netherlands)
  • 4 MHeNS, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands. , (Netherlands)
  • 5 Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. , (Netherlands)
  • 6 GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands. , (Netherlands)
Type
Published Article
Journal
Neurogastroenterology & Motility
Publisher
Wiley (Blackwell Publishing)
Publication Date
Dec 01, 2021
Volume
33
Issue
12
Identifiers
DOI: 10.1111/nmo.14161
PMID: 33938601
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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. © 2021 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.

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