Diagnosis of depressed young people--criterion validity of WHO-5 and HSCL-6 in Denmark and Norway

Fam Pract. 2015 Jun;32(3):359-63. doi: 10.1093/fampra/cmv011. Epub 2015 Mar 23.


Background: According to the World Health Organization, depression ranks as a major contributor to the global burden of disease. A large proportion of adult depressions had their first appearance in adolescence. Brief and reliable rating scales are needed for early detection.

Objective: The aim of this study is to validate the WHO-5 and the HSCL-6 for detection of depression among adolescents.

Methods: The project is a GP multicentre study conducted in Denmark and Norway. A total of 294 adolescents (14-16 years) responded by answering a paper- or web-based questionnaire and later completed a Composite International Diagnostic Interview, which was used as the gold standard. Depression was defined by ICD-10 criteria. Criterion validity was examined, the likelihood ratios measured and cut-offs for depression were calculated using the Youden index.

Results: The prevalence of depression was 11.8% in our sample. The optimal cut-off point was 11 for the WHO-5 test and 9 for the HSCL-6 test. There were no gender differences. For the WHO-5 and the HSCL-6, respectively, the sensitivity was 0.88 [95% confidence interval (CI): 0.74-0.96] and 0.85 (95% CI: 0.70-0.94), the specificity was 0.80 (95% CI: 0.75-0.85) and 0.79 (95% CI: 0.74-0.84) and the likelihood ratio was 4.5 and 3.8 (P = 0.39). We observed no statistically significant diagnostic differences with respect to nationality or administration procedure.

Conclusions: The WHO-5 and the HSCL-6 may both serve as valid case finding instruments for depression in young people in primary care.

Keywords: Adolescent; brief psychiatric rating scale; depression; mass screening; primary health care; sensitivity and specificity..

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Brief Psychiatric Rating Scale / standards
  • Brief Psychiatric Rating Scale / statistics & numerical data
  • Denmark / epidemiology
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / epidemiology
  • Female
  • General Practice / methods*
  • General Practice / statistics & numerical data
  • Humans
  • International Classification of Diseases
  • Interview, Psychological / methods
  • Interview, Psychological / standards
  • Male
  • Mass Screening / methods
  • Multicenter Studies as Topic
  • Norway / epidemiology
  • Psychometrics
  • ROC Curve
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Sex Distribution
  • World Health Organization