Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury

Objective: To evaluate the validity and utility of the Hamilton Rating Scale for Depression (HAM-D),Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) as screeningtools for depression after severe traumatic brain injury (TBI).Methods: Forty-six consecutive survivors of severe TBI were evaluated at a median of 15 monthsafter injury. Receiver operating characteristic (ROC) analysis was performed using HAM-D, BDI, andHADS as predictors, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) asgold standard.Results: The area under the curve (AUC) for HAM-D was 0.89, and the optimal cutoff point was 7(sensitivity 92.9%, specificity 78.1%); for the BDI, the AUC was 0.946 and the optimal cutoff pointwas 14 (sensitivity 92.3%, specificity 96.7%); for the HADS, the AUC was 0.947 and the optimal cutoffpoint was 9 (sensitivity 100%, specificity 80.7%); and for the HADS depression subscale, the AUCwas 0.937 and the optimal cutoff point was 6 (sensitivity 92.9%, specificity 83.9%). There were nostatistically significant differences among the AUCs.Conclusion: Our findings support a high validity and utility for the HAM-D, BDI, and HADS asscreening tools for depression in patients with severe TBI, without major changes in standard cutoffpoints.Keywords: Traumatic brain injury; depression; ROC curve; screening