Gender differences in responses to the Hopkins Symptom Checklist-25, a scale to assess depression in Primary Care

Maria Rodriguez Barragan, Maria Isabel Fernández San Martín, Ana Clavería Fontán, Eva Peguero Rodríguez, Patrice Nabbe, Jean Yves Le Reste

Keywords: Primary Health Care; Family Practice; General Practitioners; Depression; Depressive Disorder; Questionnaires; Psychometrics; Validation Studies

Background:

As a collaborative project of the Family Practice Depression and Multimorbidity Group of European General Practice Research Network, the Hopkins Symptom Checklist 25 (HSCL-25) scale was identified as a valid, reproducible, effective and easy to use instrument. Depression manifests itself differently by gender; nevertheless, the assessment instruments are the same regardless to gender.

Research questions:

Are there differences in the psychometric properties of the HSCL-25 depending on the gender?

Method:

Multicentre cross-sectional study. HSCL-25 was self-administered to outpatients aged from 45 to 75 in six Spanish Primary Care Centres. All patients also conducted the structured Composite International Diagnostic Interview (CIDI). Difference between male and female were assessed regarding responsiveness (discrimination index for the items); total score mean; construct validity (Pearson’s correlation with PHQ-9); criterion validity against CIDI (area under curve and optimal cut-off point, sensitivity and specificity); and reliability (Cronbach’s Alpha).

Results:

767 patients out of 790 (97.1%) complimented HSCL-. Mean age was 58.4 years (± 8.2), 54.4% were women. 736 participated in the CIDI. Item “Sleep disturbance” discriminated better among males, whereas “Losing sexual interest” and “Worrying too much” discriminated better among females. Total score mean was 1.42 (SD 0.64) for males and 1.57 (SD 0.76) for females (p<0.001). Pearson’s correlation was 0.78 (CI95% 0.73-0.82) for males and 0.76 (CI95%, 0.71–0.79) for females. AUC against CIDI was 0.96 (CI95% 0.93-0.99) for males and 0.83 (CI95% 0.87-0.89) for females. Sensitivity was 87.5% (CI95% 61.7-98.4) for males and 88.4% (CI95% 74.9-96.1) for females, whereas specificity was 86.8% (CI95% 82.6-90.3) for males and 67.3% (CI95% 62.2-72.1) for females. Cronbach’s Alpha was 0.90 for males and 0.92 for females.

Conclusions:

Sensitivity and reliability of the HSCL-25 are the same between gender. Some items perform differently according to gender. Specificity is far lower for women demanding more investigation to see if the cut-off should be differentiated by gender.

Points for discussion:

Should gender be taken into account when interpreting depression scale scores?

Should different cut-off points be considered according to gender?

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