The Ability of the Hopkins Symptom Checklist-5 to Identify Generalized Anxiety Disorder and Major Depressive Disorder in the General Population

Abstract

Background: The Hopkins Symptom Checklist (HSCL) is a widely used measure of anxiety and depression symptoms. The short form HSCL-5 is especially suitable for large population-based studies, but its ability to detect mental disorders in the general population remains unknown. The aim of the study was to assess how well the HSCL-5 identified cases of generalized anxiety disorder (GAD) and major depressive disorder (MDD) measured by the Composite International Diagnostic Interview (CIDI) 5.0 and to find the optimal sex-specific cut-off levels of the HSCL-5. Methods: Participants from the population-based Trøndelag Health Study (HUNT) in Norway were recruited for the current study. Between April and September 2020, 1343 participants (64% women) aged 20–65 years completed the CIDI, followed by the HSCL-5. The overall agreement between the HSCL-5 and GAD or MDD measured by CIDI was examined with Receiver Operator Characteristics (ROC) analysis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) for different cut-off levels were assessed. Results: The area under the curve for GAD or MDD was 0.90 (CI 95% = 0.85–0.95) for women and 0.85 (CI 95% = 0.68–1.00) for men. For women, a cut-off level of ≥1.80 had the best balance between sensitivity (85%) and specificity (84%), while the corresponding numbers were ≥2.00, 73%, and 93% for men. The global PPV was 21%, while the NPV was 99%. Conclusions: The HSCL-5 has high sensitivity and specificity for identifying cases of GAD or MDD. In the current study, the positive predictive value of HSCL-5 was low.