Screening for anxiety and depression: reassessing the utility of the Zung scales - PubMed (original) (raw)

Screening for anxiety and depression: reassessing the utility of the Zung scales

Debra A Dunstan et al. BMC Psychiatry. 2017.

Abstract

Background: While the gold standard for the diagnosis of mental disorders remains the structured clinical interview, self-report measures continue to play an important role in screening and measuring progress, as well as being frequently employed in research studies. Two widely-used self-report measures in the area of depression and anxiety are Zung's Self-Rating Depression Scale (SDS) and Self Rating Anxiety Scale (SAS). However, considerable confusion exists in their application, with clinical cut-offs often applied incorrectly. This study re-examines the credentials of the Zung scales by comparing them with the Depression Anxiety Stress Scale (DASS) in terms of their ability to predict clinical diagnoses of anxiety and depression made using the Patient Health Questionnaire (PHQ).

Method: A total sample of 376 adults, of whom 87 reported being in receipt of psychological treatment, completed the two-page version of the PHQ relating to depression and anxiety, together with the SDS, the SAS and the DASS.

Results: Overall, although the respective DASS scales emerged as marginally stronger predictors of PHQ diagnoses of anxiety and depression, the Zung indices performed more than acceptably in comparison. The DASS also had an advantage in discriminative ability. Using the current recommended cut-offs for all scales, the DASS has the edge on specificity, while the Zung scales are superior in terms of sensitivity. There are grounds to consider making the Zung cut-offs more conservative, and doing this would produce comparable numbers of 'Misses' and 'False Positives' to those obtained with the DASS.

Conclusions: Given these promising results, further research is justified to assess the Zung scales ability against full clinical diagnoses and to further explore optimum cut-off levels.

Keywords: Depression anxiety stress scale (DASS); Depression/anxiety screening; Zung self-rating anxiety scales (SAS); Zung self-rating depression scales (SDS).

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Conflict of interest statement

Authors’ information

Debra Dunstan Ph.D., M.Psych.(Clinical), M.Litt., B.Sc., Grad. Dip Phty., MAPS CClin., is a registered Clinical Psychologist and Physiotherapist; Associate Professor and Director of the Clinical Psychology Program; and, Deputy Head of School of Behavioural Cognitive and Social Sciences at the University of New England, Australia.

Ned Scott M.Psych.(Clinical), B.Psych.(Hons) is a registered Psychologist, Unit Coordinator and Clinical Supervisor within the Clinical Psychology Program of the School of Behavioural Cognitive and Social Sciences at the University of New England, Australia.

Anna Todd M.Psych.(Clinical), M.Sc.(Forensic Psychology), B.Sc.Psych.(Hons) is a registered Psychologist. She completed her Clinical Masters degree in Psychology at the University of New England, Australia in 2010.

The study was approved by the University of New England Human Research Ethics Committee (Approval No: HE09/203). Participants gave their written informed consent to their involvement prior to any data collection.

Not required as the manuscript does not contain individuals’ data.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Fig. 1

Venn diagram illustrating overlap between diagnoses of depressive disorder on the PHQ (area a – pink ellipse), and positive screens on the DASS depression subscale (area b –green shaded ellipse) and the SDS with a revised cut-off: index scores of 55 and above (area c – clear ellipse). Figure produced using the eulerAPE software developed by Micallef and Rodgers [31]

Fig. 2

Fig. 2

Venn diagram illustrating overlap between diagnoses of an anxiety disorder on the PHQ (area a – pink ellipse), and positive screens on the DASS anxiety subscale (area b –green shaded ellipse) and the SAS with a revised cut-off: index scores of 50 and above (area c – clear ellipse). Figure produced using the eulerAPE software developed by Micallef and Rodgers [31]

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