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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Screening and case finding for depression in offender populations: a systematic review of diagnostic properties

CE Hewitt, AE Perry, B Adams, and SM Gilbody.

Review published: 2011.

Link to full article: [Journal publisher]

CRD summary

The review concluded that a number of different tools had been identified which could perhaps serve as a benchmark for the identification of depression in offender populations; further research was recommended (particularly validating newer instruments in offender populations). These conclusions were appropriately cautious.

Authors' objectives

To assess the diagnostic accuracy of brief psychometric instruments to identify depression in offender populations and to compare accuracy between instruments.


Five unspecified electronic databases on criminal justice, psychology and health were searched from inception to March 2009, with no language restrictions. An example search strategy for MEDLINE was reported in full. Bibliographies of retrieved articles were screened for additional studies.

Study selection

Prospective studies that assessed the performance of any brief psychometric instrument (self-report or administered by a lay person) to identify depression in offender populations were eligible for inclusion. Studies had to use a standardised diagnostic interview as the reference standard. Psychometric instruments had to report on the presence or absence of depressive symptoms and syndromes which examined depression and other mood symptoms (such as anxiety).

Most included studies were conducted in the USA, with others from the UK, Australia, Canada and Denmark. Most studies were conducted in adult populations; two were exclusively in children and/or adolescents. The proportion of male participants ranged from 44 to 90%; both all male and all female studies were included in the review. Instruments assessed included both general depression questionnaires and specific measures that had been developed for use in offender populations. Most instruments were self completed; definitions of depression varied. The most frequently assessed instruments were the General Health Questionnaire (GHQ), the Referral Decision Scale (RDS) and Co-occurring Disorders Screening Instruments (CODSI); completion times ranged from two to 20 minutes (where reported). Most (69%) of the included studies used the Diagnostic and Statistical Manual of Mental Disorders (DSM) classifications as the reference standard to define depression; other reference standards used were the International Statistical Classification of Disease and Related Health Problems (ICD) and Research Diagnostic Criteria (RDC).

Two authors independently assessed studies for inclusion; any disagreements were resolved by consensus or by referral to a third party.

Assessment of study quality

The methodological quality of included studies was independently assessed by two reviewers, using the authors published adaptation of Quality Assessment of Diagnostic Accuracy Studies (QUADAS) for reviews of diagnostic instruments.

Data extraction

Data were extracted on the numbers of true positive, false negative, false positive, and true positive results (2x2 data), for each study and instrument. These data were used to calculate sensitivity and specificity.

Data were independently extracted by two reviewers.

Methods of synthesis

Studies were combined in a narrative synthesis. Sensitivity and specificity estimates were tabulated, for each instrument, study and cut-off value. Results were plotted in receiver operating characteristic (ROC) space.

Results of the review

Thirteen studies were included in the review (n=5,565 participants). Results of study quality assessment were not reported.

Taking the optimal cut-off (maximising sensitivity and specificity) for each study, reported sensitivities ranged from 45% (Prisoner Intake Screening

Procedure or PISP) to 100% (Mood and Feelings Questionnaire-Short, SMFQ) and reported specificities ranged from 55% (CODSI for any mental disorder) to 98% (Referral Decision Scale, RDS).

The authors stated that the instruments that appeared to perform the best for sensitivity and specificity, irrespective of the cut-off value used, were the RDS, the combined RDS and PISP and the General Health Questionnaire (GHQ-12). However, they noted that this interpretation took no account of study quality or population.

Authors' conclusions

A number of different tools were identified in the review which could perhaps serve as a benchmark for the identification of depression in offender populations.

CRD commentary

The review stated a clear research question and defined inclusion criteria for the index test and reference standard. A number of sources were searched for relevant studies, with no language restrictions, minimising the possibility of missed studies. Measures to minimise error and/or bias were applied throughout the review process.

The authors stated that they assessed the methodological quality of included studies, but did not report the results of this assessment; the authors stated that the potential impact of study quality on the findings of the review could not be assessed. The use of a narrative synthesis was appropriate for the nature of the data presented.

The authors' conclusions were appropriately cautious, given the noted limitations of the review.

Implications of the review for practice and research

Practice: The authors did not specify any recommendations for practice.

Research: The authors stated that instruments should be validated against a gold standard and that the full range of false positives and false negatives should be given. They further stated that relatively new brief instruments (such as the Patient Health Questionnaire 9, PHQ9), which have been widely validated in primary care and hospital settings, should be urgently validated in prison settings.


None declared.

Bibliographic details

Hewitt CE, Perry AE, Adams B, Gilbody SM. Screening and case finding for depression in offender populations: a systematic review of diagnostic properties. Journal of Affective Disorders 2011; 128(1-2): 72-82. [PubMed: 20655597]

Indexing Status

Subject indexing assigned by NLM


Criminals /psychology /statistics & numerical data; Depressive Disorder /diagnosis /epidemiology /psychology; Evaluation Studies as Topic; Humans; Mass Screening /methods; Psychometrics; Questionnaires /standards; Validation Studies as Topic



Database entry date


Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20655597