Comparison of symptom-based versus self-reported diagnostic measures of anxiety and depression disorders in the GLAD and COPING cohorts

Molly R. Davies, Joshua E.J. Buckman, Brett N. Adey, Chérie Armour, John R. Bradley, Susannah C.B. Curzons, Helena L. Davies, Katrina A.S. Davis, Kimberley A. Goldsmith, Colette R. Hirsch, Matthew Hotopf, Christopher Hübel, Ian R. Jones, Gursharan Kalsi, Georgina Krebs, Yuhao Lin, Ian Marsh, Monika McAtarsney-Kovacs, Andrew M. McIntosh, Jessica MundyDina Monssen, Alicia J. Peel, Henry C. Rogers, Megan Skelton, Daniel J. Smith, Abigail ter Kuile, Katherine N. Thompson, David Veale, James T.R. Walters, Roland Zahn, Gerome Breen, Thalia C. Eley*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background
Understanding and improving outcomes for people with anxiety or depression often requires large sample sizes. 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
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 and 2020. Responses to detailed symptom reports were compared to DSM-5 criteria to generate symptom-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 self-reported 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 self-reported GAD did not receive a symptom-based diagnosis. In contrast, symptom-based diagnoses of the phobic disorders were more common than self-reported 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, self-reported diagnoses classified most participants as having GAD, whereas symptom-based diagnoses distributed participants more evenly across the anxiety disorders. Further validation against gold standard measures is required.
Original languageEnglish
Article number102491
JournalJournal of Anxiety Disorders
Volume85
Early online date26 Oct 2021
DOIs
Publication statusPublished - Jan 2022

Keywords

  • Anxiety disorders
  • Major depression
  • Measurement
  • Online surveys
  • Phobias
  • Self-report

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