Comparison of algorithm-based versus single-item diagnostic measures of anxiety and depression disorders in the GLAD and COPING cohorts
Molly R Davies,
Joshua E. J. Buckman,
Brett N Adey,
John R Bradley,
Susannah C. B. Curzons,
Katrina A S Davis,
Kimberley A Goldsmith,
Colette R Hirsch,
Matthew H Hotopf,
Ian R Jones,
Andrew M McIntosh,
Alicia J Peel,
Henry C Rogers,
Daniel J Smith,
Abigail ter Kuile,
Katherine N Thompson,
James T. R. Walters,
Thalia C. Eley
Posted 08 Jan 2021
medRxiv DOI: 10.1101/2021.01.08.21249434
Posted 08 Jan 2021
Background: Understanding and improving outcomes for people with anxiety or depression often requires large studies. To increase participation and reduce costs, such research is typically unable to utilise "gold-standard" methods to ascertain diagnoses, instead relying on remote, self-report measures. Aims: To assess the comparability of remote diagnostic methods for anxiety and depression disorders commonly used in research. Method: Participants from the UK-based GLAD and COPING NBR cohorts (N = 58,400) completed an online questionnaire between 2018-2020. Responses to detailed symptom reports were compared to DSM-5 criteria to generate algorithm-based diagnoses of major depressive disorder (MDD), generalised anxiety disorder (GAD), specific phobia, social anxiety disorder, panic disorder, and agoraphobia. Participants also self-reported any prior diagnoses from health professionals, termed single-item diagnoses. "Any anxiety" included participants with at least one anxiety disorder. Agreement was assessed by calculating accuracy, Cohen's kappa, McNemar's chi-squared, sensitivity, and specificity. Results: Agreement between diagnoses was moderate for MDD, any anxiety, and GAD, but varied by cohort. Agreement was slight to fair for the phobic disorders. Many participants with single-item GAD did not receive an algorithm-based diagnosis. In contrast, algorithm-based diagnoses of the phobic disorders were more common than single-item diagnoses. Conclusions: Agreement for MDD, any anxiety, and GAD was higher for cases in the case-enriched GLAD cohort and for controls in the general population COPING NBR cohort. For anxiety disorders, single-item diagnoses classified most participants as having GAD, whereas algorithm-based diagnoses distributed participants more evenly across the anxiety disorders. Further validation against gold standard measures is required.
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