Sensitivity and Specificity of Anxiety and Depression Scales in Patients with Depressive Syndrome in Affective Disorders and Schizophrenia

Abstract

Background. Screening diagnostics of the risk of depression in healthy controls and various mental illnesses for the purpose of timely seeking specialized help requires the elaboration of critical values of indicators as well as calculation of sensitivity and specificity.

Objectives. The study had its purpose to reveal the critical values of the scales for assessing anxiety, depression, and quality of life in patients with affective disorders and schizophrenia.

Study Participants. 277 individuals participated in the study, including 162 adults without mental illness (control group), 47 patients with affective disorders and depressive syndrome, and 68 patients with schizophrenia.

Methods. For data collecting the following standardized methods were used: The Beck Anxiety and Depression Inventories BAI and BDI-II (Beck et al., 1988; Beck et al., 1996), Center for Epidemiological Studies Depression Scale (Radloff, 1977), SCL-90R (Derogatis, 1983), the Satisfaction With Life Scale, the Scale for Positive and Negative Experiences (Diener et al., 1985; Diener, 2010), the Quality of Life and Satisfaction Questionnaire (Stevanovic, 2011). Data processing methods included descriptive statistics, ROC analysis, calculation of sensitivity and specificity, assessment of reliability and consistency, methods for comparing groups, and correlation analysis.

Results. When assessing the differential abilities of anxiety and depression scales, while comparing patients with depressive syndrome in affective disorders and respondents in the control group, the area under the curve in the ROC analysis was significant and amounted to 0.79–0.87. The maximum values were found for the Beck Depression Inventory, Center for Epidemiological Studies Depression Scale, and the depression subscale of the SCL-90R. The depression subscale of the SCL-90R questionnaire is only slightly inferior in psychodiagnostic capabilities to the Beck Depression Inventory and Center for Epidemiological Studies Depression Scale; however, its cutoff values can be recommended at 11 points and 23 points. The 18 items selected from all the inventories implemented in the study form a scale that allows to distinguish between patients with depressive syndrome in schizophrenia and in affective disorders (Cronbach's alpha 0.91 for affective disorders and 0.93 — for schizophrenia). At a cutoff value of 1.59 points, the sensitivity for distinguishing patients with affective disorders and schizophrenia is 72.3%, and the specificity is 78.1%. A content analysis of the items indicates that patients with affective disorders are more likely to report negative obsessive thoughts, criticism and self-rejection, somatic complaints, and difficulty concentrating.

Conclusions. The clinical cutoff for mild depression on the Beck Depression Inventory is 13 points, and for moderate depression — 19 points. The clinical cutoff point for mild depression on the Center for Epidemiological Studies Depression Scale is 17 points, and for moderate depression — 28 points.

References

Beck, A.T., Epstein, N., Brown, G., Steer, R.A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893-897. https://doi.org/10.1037/0022-006X.56.6.893

Beck, A.T., Steer, R.A., Brown, G. (1996). Beck Depression Inventory — II (BDI-II). San Antonio: Harcourt Assessment Press.

Brambila-Tapia, A., Saldaña-Cruz, A., Meléndez-Monreal, K., Esparza-Guerrero, Y., Martínez-Hernández, A., Rosales-Torres, B., Ríos-González, B. (2023). Association of personal, behavioral and positive psychological variables with somatization and number of diseases in mexican general population: the influence of gender. Psychology, Health Medicine, 28(4), 995-1003. https://doi.org/10.1080/13548506.2021.1985150

Derogatis, L.R. (1983). SCL-90-R: Administration, scoring and procedures: Manual II. Baltimore: Clinical Psychometric Research Publ.

Diener, E., Emmons, R.A., Larsen, R.J., Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, (49), 71–75.

Diener, E., Ryan, K. (2009). Subjective well-being: a general overview. South African Journal of Psychology, (39), 391–406.

Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D., Oishi, S., Biswas-Diener, R. (2010). New well-being measures: short scales to assess flourishing and positive and negative feelings. Social Indicators Research, (97), 143–156.

Eaton, W.W., Smith, C., Ybarra, M., Muntaner, C., Tien, A. (2004). Center for Epidemiologic Studies Depression Scale — Revised (CESD-R). Open Journal of Obstetrics and Gynecology, 5(4), 363–377.

Endicott, J., Nee, J., Harrison, W., Blumenthal, R. (1993). Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacology Bulletin, 29(2), 321–326.

Ettman, C.K., Cohen, G.H., Abdalla, S.M., Sampson, L., Trinquart, L., Castrucci, B.C., Bork, R.H., Clark, M.A., Wilson, I., Vivier, P.M., Galea, S., less, S. (2022). persistent depressive symptoms during covid-19: a national, population-representative, longitudinal study of U.S. adults. The Lancet Regional Health — Americas, (5), 100091. URL: https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00087-9/fulltext (access date: 27.05.2021).

Goodwin, R.D., Dierker, L.C., Wu, M., Galea, S., Hoven, C.W., Weinberger, A.H. (2022). Trends in U.S. depression prevalence from 2015 to 2020: the widening treatment gap. American Journal of Preventive Medicine, (63), 726–733. https://doi.org/10.1016/j.amepre.2022.05.014

Grace, A.A. (2016). Dysregulation of the dopamine system in the pathophysiology of schizophrenia and depression. Nature Reviews Neuroscience, 17(8), 524–532. https://doi.org/10.1038/nrn.2016.57

Hasin, D.S., Sarvet, A.L., Meyers, J.L., et al. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75(4), 336–346. https://doi.org/10.1001/jamapsychiatry.2017.4602

Hinz, A., Brähler, E. (2011). Normative values for the hospital anxiety and depression scale (hads) in the general German population. Journal of Psychosomatic Research, 71(2), 74–78. https://doi.org/10.1016/j.jpsychores.2011.01.005

Ilić, I., Milić, I., Arandelović, M. (2010). Assessment quality of life: current approaches. Acta Medica Medianae, 49(4), 52–60.

Krynicki, C.R., Upthegrove, R., Deakin, J.F.W., Barnes, T.R.E. (2018). The relationship between negative symptoms and depression in schizophrenia: a systematic review. Acta Psychiatrica Scandinavica, 137(5), 380–390. https://doi.org/10.1111/acps.12873

Monroe, S.M., Harkness, K.L. (2022). Major depression and its recurrences: life course matters. Annual Review of Clinical Psychology, (18), 329–357. https://doi.org/10.1146/annurev-clinpsy-072220-021440

Osin, E.N., Leontiev, D.A. (2020). Brief Russian-language scales for subjective well-being assessment: Psychometric properties and comparative analysis. Monitoring obshchestvennogo mneniia: Ekonomicheskie i sotsial'nye peremeny = Monitoring of Public Opinion: Economic and Social Changes, (1), 117–142. (In Russ.)

Radloff, L.S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306

Rasskazova, E.I. (2012). The assessment of quality of life and satisfaction: Psychometric characteristics of the Russian version. Psikhologiia. Zhurnal Vysshei shkoly ekonomiki = Psychology. Journal of the Higher School of Economics, 9(4), 81–90. (In Russ.)

Rasskazova, E.I., Lebedeva, A.A. (2020). E. Diener's Scale of Positive and Negative Experience: Validation of the Russian version. Psikhologiia. Zhurnal Vysshei shkoly ekonomiki = Psychology. Journal of the Higher School of Economics, 17(2), 250–263. (In Russ.). https://doi.org/10.17323/1813-8918-2020-2-250-263

Riendeau, R.P., Sullivan, J.L., Meterko, M., Stolzmann, K., Williamson, A.K., Miller, C.J., Kim, B., Bauer, M.S. (2018). Factor structure of the Q-LES-Q short form in an enrolled mental health clinic population. Quality of Life Research, 27(11), 2953–2964. https://doi.org/10.1007/s11136-018-1963-8

Shorey, S., Ng, E.D., Wong, C.H.J. (2022). Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta-analysis. British Journal of Clinical Psychology, 61(2), 287–305. https://doi.org/10.1111/bjc.12333

Sirgy, M.J., Michalos, A.C., Ferris, A.L., Easterlin, R.A., Patrick, D., Pavot, W. (2006). The quality of life (QOL) research movement: past, present and future. Social Indicators Research, (76), 343–466.

Stevanovic, D. (2011). Quality of Life Enjoyment and Satisfaction Questionnaire-short form for quality of life assessments in clinical practice: A psychometric study. Journal of Psychiatric and Mental Health Nursing, 18(8), 744–750. https://doi.org/10.1111/j.1365-2850.2011.01735.x

Syropyatov, O.G., Dzeruzhinskaya, N.A., Astapov, Yu.N., Ivantsova, G.V. (2003). Early diagnosis and treatment of depression in general medical practice. Kiev: Gelarium-test Publ. (In Russ.)

Tarabrina, N.V. (2001). Workshop on the psychology of post-traumatic stress. Saint Petersburg: Piter Publ. (In Russ.)

Tellegen, A., Ben-Porath, Y.S., McNulty, J.L., Arbisi, P.A., Graham, J.R., Kaemmer, B. (2008). The MMPI-2 restructured clinical scales: development, validation, and interpretation. Minneapolis; University of Minnesota Press.

Tkhostov, A.Sh., Rasskazova, E.I., Lachinina, E.P., Chernov, N.V. (2025). Psychometric characteristics of depressive symptom assessment scales in normal and mental disorders. Psychology Issues = Voprosy psikhologii, 71(1), 82–96. (In Russ.)

Upthegrove, R., Birchwood, M., Ross, K., Brunett, K., McCollum, R., Jones, L. (2010). The evolution of depression and suicidality in first episode psychosis. Acta Psychiatrica Scandinavica, 122(3), 211–218. https://doi.org/10.1111/j.1600-0447.2009.01506.x

Upthegrove, R., Marwaha, S., Birchwood, M. (2017). Depression and schizophrenia: cause, consequence, or trans-diagnostic issue? Schizophrenia Bulletin, 43(2), 240–244. https://doi.org/10.1093/schbul/sbw097

Villarroel, M.A., Terlizzi, E.P. (2020). Symptoms of depression among adults: United States, 2019 (NCHS Data Brief, No. 379). Hyattsville: National Center for Health Statistics Publ.

World Health Organization. (2016). Depression. URL: http://www.who.int/mediacentre/factsheets/fs369/en/ (access date: 29.08.2016).

Zigmond, A.S., Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, (67), 361–370.