Measuring depression in Primary Health Care in Spain: Psychometric properties and diagnostic accuracy of HSCL-5 and HSCL-10

Front Med (Lausanne). 2023 Jan 9:9:1014340. doi: 10.3389/fmed.2022.1014340. eCollection 2022.

Abstract

Background: Depression has a high prevalence among European countries. Several instruments have been designed to assess its symptoms in different populations. The Hopkins Symptom Checklist 25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use. There are short versions of this scale that could be useful in Primary Care (PC) settings, but their psychometric properties are unknown.

Aim: To assess in PC patients the psychometric properties and diagnostic accuracy of the Spanish version of the HSCL-10 and the HSCL-5 consisting of 10 and 5 items, respectively.

Methods: A multicenter, cross-sectional study was carried out at six PC centers in Spain. The HSCL-25 was administered to outpatients aged 45-75 who also participated in the structured Composite International Diagnostic Interview (CIDI). HSCL-10 and HSCL-5 were assessed and compared to HSCL-25 regarding total score correlation, internal consistency, and criterion validity against the gold-standard CIDI. This is a methodological study from a secondary data analysis and the primary data has been previously published.

Results: Out of 790 patients, 767 completed the HSCL-25 and 736 the CIDI interview (96.0%). Cronbach's Alpha was 0.84 for HSCL-10 and 0.77 for HSCL-5. The known-group method and confirmatory factor analysis were acceptable for the establishment of construct validity. Sensitivity was 79.7% (CI95%, 67.7-88.0%) for HSCL-10, and 78.0% (CI95%, 65.9-86.6%) for HSCL-5, whereas specificity was 83% (CI95%, 80.0-85.7%) for HSCL-10, and 72.8% (CI95%, 69.3-76.0%) for HSCL-5. Area under the curve against CIDI was 0.88 (CI95%, 0.84-0.92%) for HSCL-10, and 0.85 (CI95%, 0.81-0.89%) for HSCL-5. Optimum cutoff point calculated with Youden Index was 1.90 for the HSCL-10 and 1.80 for the HSCL-5.

Conclusion: HSCL-10 and HSCL-5 are reliable and valid tools to detect depression symptoms and can be used in PC settings.

Keywords: Hopkins Symptom Checklist; Primary Health Care (MeSH); depression; diagnostic accuracy; patient reported outcome measures (MeSH); psychometric properties.

Grants and funding

This study was supported by the Carlos III Health Institute, the Spanish Ministry of Economy and Competitiveness via a health research grant (PI15/00114, PI15/00565, PI15/00762, PI15/01072, PI15/00896, PI15/01412, PI15/01151, PI15/00519, and PI15/01133) through the Research Network in Preventive Activities and Health Promotion in Primary Care (redIAPP), (RD12/0005/0001, RD16/0007/0001, RD16/0007/0002, RD16/0007/0003, RD16/0007/0004, RD16/00 07/0005, RD16/0007/0006, RD16/0007/0008, RD16/0007/0009, RD16/0007/0010, RD16/0007/0012, RD16/0007/0013, and RD16/0007/0015), the European Union ERDF funds, (European Regional DevelopmentFund) and the Health Department (SLT002/16/00112) of the Generalitat de Catalunya. This study received a predoctoral grant from the University Institute of Research in Primary Care IDIAP Jordi Gol (Spain) and another grant from the Autonomous University of Barcelona (UAB)–Novartis for research in Family and Community Medicine (reference: 7Z19/019), both in 2019. The study obtained funding from the Spanish Society of Family Medicine (semFYC) as it was awarded a predoctoral grant, “Isabel Fernández.” The project also received a research grant from the Carlos III Institute of Health, Ministry of Science and Innovation (Spain) co-funded with European Union—NextGenerationEU funds, through the Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), with reference RD21/0022. This study received funding from Novartis. The funder was not involved in the study design, collection, analysis, interpretation of data, and the writing of this article or the decision to submit it for publication.