Generic patient-reported outcome measures (PROMs) may help screen adults for anxiety and depression, with the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) showing particularly strong performance across multiple countries. These study findings were published in Quality of Life Research.

Anxiety and depression are commonly assessed using condition-specific screening questionnaires. However, health systems increasingly use generic PROMs to capture broader information about patients’ health and well-being. 

Researchers conducted a cross-sectional analysis to determine whether mental health components already included in these measures could also help identify individuals with anxiety or depression.

Using data from the EuroQol Data for Assessment of Population Health Needs and Instrument Evaluation (EQ-DAPHNIE) project, researchers selected eligible adults from 15 countries across the Americas, Europe, Asia, and Oceania, with diagnoses for depression and/or anxiety. Mental health items from the EQ-5D-5L, EQ-Health and Wellbeing (EQ-HWB), and Patient-Reported Outcomes Measurement Information System Scale v1.2–Global Health (PROMIS-10) were evaluated against participants’ reported history of anxiety or depression. Researchers also assessed the 2-item Patient Health Questionnaire (PHQ-2) and 2-item Generalized Anxiety Disorder questionnaire (GAD-2) for comparison. The ability of each measure to distinguish participants with vs without a reported diagnostic history was evaluated using area under the receiver operating characteristic curve (AUROC) analyses.

Future research should continue to explore the cross-cultural applicability and implementation of these tools to ensure their widespread utility in addressing the global burden of mental health disorders.

The final analysis included 68,419 study participants (mean age range, 36.3-51.8 years; 45.9%-62.9% women). 

There was substantial international variation in reported mental health diagnoses. In Brazil, 29.6% reported an anxiety diagnosis, the largest proportion among the participating countries, vs 3.7% in Japan. The United States (US) had the greatest prevalence of reported depression (26.7%) and also had the largest proportions of adults with either anxiety or depression (34.1%) and with both diagnoses (20.9%). China had comparatively low rates of depression (3.9%) and either mental health condition (9.7%).

Among the measures evaluated, the anxiety/depression component of the EQ-5D-5L produced the most consistently favorable results. Depending on the country, AUROC values were 0.72 (China) to 0.86 (US and Canada) when identifying anxiety and 0.71 (China) to 0.85 (Spain) when identifying depression. Results were similarly strong when anxiety and depression were considered together, reaching an AUROC of 0.88 (Japan) among adults reporting both diagnoses. China was the principal exception to this overall pattern.

PROMIS-10 findings further supported the potential use of broader health measures for mental health screening. Its emotional problems item distinguished respondents by diagnostic history with AUROC values of 0.74 (China) to 0.82 (United Kingdom [UK]) for anxiety and 0.73 (China) to 0.82 (UK) for depression. When either diagnosis was considered, values ranged from 0.74 (China) to 0.82 (Spain). EQ-HWB mental health items also showed screening potential, although results were less uniform across countries.

The analysis also suggested that commonly used screening thresholds may affect the number of cases detected. Across several measures, using EQ-5D-5L, EQ-HWB, PHQ-2 and GAD-2 scores with a cut off of at least 2 favored sensitivity and reduced the likelihood that respondents with a diagnostic history would screen negative. Greater sensitivity came with a trade-off, however, as specificity was generally moderate at this threshold. The usual PHQ-2 and GAD-2 threshold of at least 3 had substantially lower sensitivity in some analyses, whereas a score of at least 3 appeared to provide the most useful balance for the PROMIS-10 emotional problems and mental health items.

The researchers highlighted that differences in translation, cultural expression of mental health symptoms, and interpretation of response options may contribute to variation between countries.

Study limitations include reliance on self-reported diagnoses, small sample sizes in some diagnostic groups, and the inability of cross-sectional data to track changes in mental health over time.

“Future research should continue to explore the cross-cultural applicability and implementation of these tools to ensure their widespread utility in addressing the global burden of mental health disorders,” the study authors concluded.

This research was supported by the Euro-Qol Research Foundation. Please see the original reference for a full list of disclosures.