Concordance between symptom screening and diagnostic procedure: the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview I

Abstract

The definition of case is a core issue in psychiatric epidemiology. Psychiatric symptom screening scales have been extensively used in population studies for many decades. Structured diagnostic interviews have become available during recent years to give exact diagnoses through carefully undertaken procedures. The aim of this article was to assess how well the Hopkins Symptom Checklist-25 (HSCL-25) predicted cases by the Composite International Diagnostic Interview (CIDI), and find the optimal cut-offs on the HSCL-25 for each diagnosis and gender. Characteristics of concordant and discordant cases were explored. In a Norwegian two-stage survey mental health problems were measured by the HSCL-25 and the CIDI. Only 46% of the present CIDI diagnoses were predicted by the HSCL-25. Comorbidity between CIDI diagnoses was found more than four times as often in the concordant cases (case agreed upon by both instruments) than in the discordant CIDI cases. Concordant cases had more depression and panic/generalized anxiety disorders. Neither the anxiety nor the depression subscales improved the prediction of anxiety or depression. The receiver operating characteristic (ROC) curves confirmed that the HSCL-25 gave best information about depression. Except for phobia it predicted best for men. Optimal HSCL-25 cut-off was 1.67 for men and 1.75 for women. Of the discordant HSCL-25 cases, one-third reported no symptoms in the CIDI, one-third reported symptoms in the CIDI anxiety module, and the rest had symptoms spread across the modules. With the exception of depression, the HSCL-25 was insufficient to select individuals for further investigation of diagnosis. The two instruments to a large extent identified different cases. Either the HSCL-25 is a very imperfect indicator of the chosen CIDI diagnoses, or the dimensions of mental illness measured by each of the instruments are different and clearly only partly overlapping.

Depressive symptoms and insulin resistance in young adult males: results from the Northern Finland 1966 birth cohort

“…10 Thirdly, HSCL-25 has proven to be an acceptable screening scale for obtaining information on symptoms of depression in the normal population. 15 In conclusion, we found a significant association between IR and concomitant severe depressive symptoms in young men without earlier diagnosed diabetes. In addition, in men with the highest mean scores of the HSCL-25 depression subscale, the strength of the association increased in line with tightening the definition of IR.…”

“…Information on depressive symptoms was obtained through Hopkins' Symptom Checklist-25 (HSCL-25), [12][13][14][15][16] which was included in the above mentioned postal questionnaires. HSCL-25 is a 25-item shortened version of an originally 90-item questionnaire designed by Degoratis et al 12 A depression subscale consists of 13 items.…”

“…In this study, mean scores of X1.55, X1.75 and X2.01 in the HSCL-25 depression subscale were used to assess the severity of current depressive symptoms. [13][14][15][16] The data concerning IR and depressive symptoms was available from 2616 men, of which seven subjects with earlier diagnosed diabetes were excluded, leaving 2609 male cohort members for our analyses. Information on diabetes was obtained through postal questionnaires during the 31-year follow-up survey by posing the following question: 'Have you ever had diabetes verified or treated by a doctor (yes/no)?…”

Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study

“…Thirdly, the HSCL-25 has proved to be an acceptable screening scale in obtaining information on symptoms of depression in normal populations and also in this database. 26,53 In conclusion, obesity in adolescence might be associated with later depression among female subjects, abdominal obesity among male subjects may be closely related to concomitant depression, and being overweight/obese both in adolescence and adulthood may be a risk for depression among female subjects. In clinical practice, it is important to take into account the growing rates of obesity among children and adolescents.…”

Widespread Hyperalgesia in Adolescents With Symptoms of Irritable Bowel Syndrome: Results From a Large Population-Based Study

“…HSCL is a screening tool for detecting negative mood symptoms, suited for epidemiological research, also among adolescents, and has been validated against clinical diagnostic depression and anxiety tools. 12,13,32,45,46 Subjects with a mean score of 1.85 or higher were classified as having psychological distress. This cut-off has previously been shown to have a sensitivity of 89 % and specificity of 98 % with respect to detecting anxiety or depression compared to the more extensive 25-item HSCL version.…”