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Genetic analyses benefit from using less heterogeneous phenotypes: an illustration with the hospital anxiety and depression scale (HADS).

ABSTRACT: Phenotypic heterogeneity of depression has been cited as one of the causes of the limited success to detect genetic variants in genome-wide studies. The 7-item Hospital Anxiety and Depression Scale (HADS-D) was developed to detect depression in individuals with physical health problems. An initial psychometric analysis showed that a short version ("HADS-4") is less heterogeneous and hence more reliable than the full scale, and correlates equally strong with a DSM-oriented depression scale. We compared the HADS-D and the HADS-4 to assess the benefits of using less heterogeneous phenotype measures in genetic analyses. We compared HADS-D and HADS-4 in three separate analyses: (1) twin- and family-based heritability estimation, (2) SNP-based heritability estimation using the software GCTA, and (3) a genome-wide association study (GWAS). The twin study resulted in heritability estimates between 18% and 25%, with additive genetic variance being the largest component. There was also evidence for assortative mating and a dominance component of genetic variance, with HADS-4 having slightly lower estimates of assortment. Importantly, when estimating heritability from SNPs, the HADS-D did not show a significant genetic variance component, while for the HADS-4, a statistically significant amount of heritability was estimated. Moreover, the HADS-4 had substantially more SNPs with small P-values in the GWAS analysis than did the HADS-D. Our results underline the benefits of using more homogeneous phenotypes in psychiatric genetic analyses. Homogeneity can be increased by focusing on core symptoms of disorders, thus reducing the noise in aggregate phenotypes caused by substantially different symptom profiles.

SUBMITTER: Laurin CA

PROVIDER: S-EPMC4406831 | biostudies-literature | 2015 May

REPOSITORIES: biostudies-literature

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Genetic analyses benefit from using less heterogeneous phenotypes: an illustration with the hospital anxiety and depression scale (HADS).

Laurin Charles A CA Hottenga Jouke-Jan JJ Willemsen Gonneke G Boomsma Dorret I DI Lubke Gitta H GH

Genetic epidemiology 20150401 4

Phenotypic heterogeneity of depression has been cited as one of the causes of the limited success to detect genetic variants in genome-wide studies. The 7-item Hospital Anxiety and Depression Scale (HADS-D) was developed to detect depression in individuals with physical health problems. An initial psychometric analysis showed that a short version ("HADS-4") is less heterogeneous and hence more reliable than the full scale, and correlates equally strong with a DSM-oriented depression scale. We co ...[more]

PMID: 25832296

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Project description:The Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) has been recommended for depression screening in medically ill patients. Many existing HADS-D studies have used exploratory methods to select optimal cut-offs. Often, these studies report results from a small range of cut-off thresholds; cut-offs with more favourable accuracy results are more likely to be reported than others with worse accuracy estimates. When published data are combined in meta-analyses, selective reporting may generate biased summary estimates. Individual patient data (IPD) meta-analyses can address this problem by estimating accuracy with data from all studies for all relevant cut-off scores. In addition, a predictive algorithm can be generated to estimate the probability that a patient has depression based on a HADS-D score and clinical characteristics rather than dichotomous screening classification alone. The primary objectives of our IPD meta-analyses are to determine the diagnostic accuracy of the HADS-D to detect major depression among adults across all potentially relevant cut-off scores and to generate a predictive algorithm for individual patients. We are already aware of over 100 eligible studies, and more may be identified with our comprehensive search.Data sources will include MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO and Web of Science. Eligible studies will have datasets where patients are assessed for major depression based on a validated structured or semistructured clinical interview and complete the HADS-D within 2 weeks (before or after). Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects meta-analysis will be conducted for the full range of plausible cut-off values, and a predictive algorithm for individual patients will be generated.The findings of this study will be of interest to stakeholders involved in research, clinical practice and policy.

Project description:ObjectiveTo evaluate the accuracy of the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) to screen for major depression among people with physical health problems.DesignSystematic review and individual participant data meta-analysis.Data sourcesMedline, Medline In-Process and Other Non-Indexed Citations, PsycInfo, and Web of Science (from inception to 25 October 2018).Review methodsEligible datasets included HADS-D scores and major depression status based on a validated diagnostic interview. Primary study data and study level data extracted from primary reports were combined. For HADS-D cut-off thresholds of 5-15, a bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, in studies that used semi-structured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders), fully structured interviews (eg, Composite International Diagnostic Interview), and the Mini International Neuropsychiatric Interview. One stage meta-regression was used to examine whether accuracy was associated with reference standard categories and the characteristics of participants. Sensitivity analyses were done to assess whether including published results from studies that did not provide raw data influenced the results.ResultsIndividual participant data were obtained from 101 of 168 eligible studies (60%; 25 574 participants (72% of eligible participants), 2549 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of seven or higher for semi-structured interviews, fully structured interviews, and the Mini International Neuropsychiatric Interview. Among studies with a semi-structured interview (57 studies, 10 664 participants, 1048 with major depression), sensitivity and specificity were 0.82 (95% confidence interval 0.76 to 0.87) and 0.78 (0.74 to 0.81) for a cut-off value of seven or higher, 0.74 (0.68 to 0.79) and 0.84 (0.81 to 0.87) for a cut-off value of eight or higher, and 0.44 (0.38 to 0.51) and 0.95 (0.93 to 0.96) for a cut-off value of 11 or higher. Accuracy was similar across reference standards and subgroups and when published results from studies that did not contribute data were included.ConclusionsWhen screening for major depression, a HADS-D cut-off value of seven or higher maximised combined sensitivity and specificity. A cut-off value of eight or higher generated similar combined sensitivity and specificity but was less sensitive and more specific. To identify medically ill patients with depression with the HADS-D, lower cut-off values could be used to avoid false negatives and higher cut-off values to reduce false positives and identify people with higher symptom levels.Trial registrationPROSPERO CRD42015016761.

Dataset Information

Genetic analyses benefit from using less heterogeneous phenotypes: an illustration with the hospital anxiety and depression scale (HADS).

Publications

Genetic analyses benefit from using less heterogeneous phenotypes: an illustration with the hospital anxiety and depression scale (HADS).

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