Assessing Diagnostic Precision: Adaptations of the Hopkins Symptom Checklist (HSCL-5/10/25) Among Tertiary-Level Students in Norway

[Background] Universities worldwide are witnessing a surge in mental health problems among students, particularly in anxiety and depression. The Hopkins Symptom Checklist (HSCL) is a popular screening tool, but its reliability in identifying mental disorders remains debated. The aim of this study wa...

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Main Authors: Børge Sivertsen, Jens C. Skogen, Anne Reneflot, Marit Knapstad, Otto Robert Frans Smith, Leif Edvard Aarø, Benedicte Kirkøen, Bengt Oscar Lagerstrøm, Ann Kristin Skrindo Knudsen
Format: Article
Language:English
Published: PsychOpen GOLD/ Leibniz Institute for Psychology 2024-12-01
Series:Clinical Psychology in Europe
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Online Access:https://doi.org/10.32872/cpe.13275
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author Børge Sivertsen
Jens C. Skogen
Anne Reneflot
Marit Knapstad
Otto Robert Frans Smith
Leif Edvard Aarø
Benedicte Kirkøen
Bengt Oscar Lagerstrøm
Ann Kristin Skrindo Knudsen
author_facet Børge Sivertsen
Jens C. Skogen
Anne Reneflot
Marit Knapstad
Otto Robert Frans Smith
Leif Edvard Aarø
Benedicte Kirkøen
Bengt Oscar Lagerstrøm
Ann Kristin Skrindo Knudsen
author_sort Børge Sivertsen
collection DOAJ
description [Background] Universities worldwide are witnessing a surge in mental health problems among students, particularly in anxiety and depression. The Hopkins Symptom Checklist (HSCL) is a popular screening tool, but its reliability in identifying mental disorders remains debated. The aim of this study was to evaluate the criterion validity of the HSCL-25, HSCL-10, and HSCL-5 using 30-day prevalence of major depressive episode (MDE) and generalized anxiety disorder (GAD) from a self-administered electronic version of the Composite International Diagnostic Interview, fifth version (CIDI 5.0), as the benchmark. [Method] Data stem from a national survey targeting students in higher education in Norway. In a 2023 follow-up study on mental disorders, 5,568 participants completed both the HSCL-25 and the CIDI. Sex-specific optimal thresholds for all HSCL versions in relation to MDE and GAD (from CIDI) were determined using the Youden Index maximization. [Results] The optimal cut-off values for detecting MDE or GAD with the HSCL-25 were 1.96 for males and 2.20 for females, displaying a good balance between sensitivity and specificity. Similar high and balanced sensitivity and specificity patterns were found for both the HSCL-10 and HSCL-5. However, all HSCL versions overestimated prevalence rates compared to the self-administered CIDI. [Conclusions] All three HSCL versions showed high criterion validity. The data indicate that HSCL may be better as a screening tool than for precise estimation of MDE and GAD prevalence. For improved diagnostic accuracy, future HSCL versions should incorporate functional impairment assessment. This update would bring the HSCL into closer alignment with clinical diagnostic standards.
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spelling doaj-art-e5d2c408ab334018bae1efb81e8dcad52025-08-20T02:26:59ZengPsychOpen GOLD/ Leibniz Institute for PsychologyClinical Psychology in Europe2625-34102024-12-016410.32872/cpe.13275cpe.13275Assessing Diagnostic Precision: Adaptations of the Hopkins Symptom Checklist (HSCL-5/10/25) Among Tertiary-Level Students in NorwayBørge Sivertsen0https://orcid.org/0000-0003-4654-9296Jens C. Skogen1https://orcid.org/0000-0003-0722-5440Anne Reneflot2https://orcid.org/0000-0003-0536-5271Marit Knapstad3https://orcid.org/0000-0003-0958-1596Otto Robert Frans Smith4https://orcid.org/0000-0002-6306-2239Leif Edvard Aarø5https://orcid.org/0000-0001-5027-3611Benedicte Kirkøen6https://orcid.org/0000-0003-2641-5477Bengt Oscar Lagerstrøm7Ann Kristin Skrindo Knudsen8https://orcid.org/0000-0002-1218-798XDepartment of Health Promotion, Norwegian Institute of Public Health, Bergen, NorwayDepartment of Health Promotion, Norwegian Institute of Public Health, Bergen, NorwayDepartment of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, NorwayDepartment of Health Promotion, Norwegian Institute of Public Health, Bergen, NorwayDepartment of Health Promotion, Norwegian Institute of Public Health, Bergen, NorwayDepartment of Health Promotion, Norwegian Institute of Public Health, Bergen, NorwayCentre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, NorwayDepartment for Methodology and Data Collection, Statistics Norway, Oslo, NorwayDepartment of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway[Background] Universities worldwide are witnessing a surge in mental health problems among students, particularly in anxiety and depression. The Hopkins Symptom Checklist (HSCL) is a popular screening tool, but its reliability in identifying mental disorders remains debated. The aim of this study was to evaluate the criterion validity of the HSCL-25, HSCL-10, and HSCL-5 using 30-day prevalence of major depressive episode (MDE) and generalized anxiety disorder (GAD) from a self-administered electronic version of the Composite International Diagnostic Interview, fifth version (CIDI 5.0), as the benchmark. [Method] Data stem from a national survey targeting students in higher education in Norway. In a 2023 follow-up study on mental disorders, 5,568 participants completed both the HSCL-25 and the CIDI. Sex-specific optimal thresholds for all HSCL versions in relation to MDE and GAD (from CIDI) were determined using the Youden Index maximization. [Results] The optimal cut-off values for detecting MDE or GAD with the HSCL-25 were 1.96 for males and 2.20 for females, displaying a good balance between sensitivity and specificity. Similar high and balanced sensitivity and specificity patterns were found for both the HSCL-10 and HSCL-5. However, all HSCL versions overestimated prevalence rates compared to the self-administered CIDI. [Conclusions] All three HSCL versions showed high criterion validity. The data indicate that HSCL may be better as a screening tool than for precise estimation of MDE and GAD prevalence. For improved diagnostic accuracy, future HSCL versions should incorporate functional impairment assessment. This update would bring the HSCL into closer alignment with clinical diagnostic standards.https://doi.org/10.32872/cpe.13275depressionanxietystudentsyoung adultsquestionnairespsychometrics
spellingShingle Børge Sivertsen
Jens C. Skogen
Anne Reneflot
Marit Knapstad
Otto Robert Frans Smith
Leif Edvard Aarø
Benedicte Kirkøen
Bengt Oscar Lagerstrøm
Ann Kristin Skrindo Knudsen
Assessing Diagnostic Precision: Adaptations of the Hopkins Symptom Checklist (HSCL-5/10/25) Among Tertiary-Level Students in Norway
Clinical Psychology in Europe
depression
anxiety
students
young adults
questionnaires
psychometrics
title Assessing Diagnostic Precision: Adaptations of the Hopkins Symptom Checklist (HSCL-5/10/25) Among Tertiary-Level Students in Norway
title_full Assessing Diagnostic Precision: Adaptations of the Hopkins Symptom Checklist (HSCL-5/10/25) Among Tertiary-Level Students in Norway
title_fullStr Assessing Diagnostic Precision: Adaptations of the Hopkins Symptom Checklist (HSCL-5/10/25) Among Tertiary-Level Students in Norway
title_full_unstemmed Assessing Diagnostic Precision: Adaptations of the Hopkins Symptom Checklist (HSCL-5/10/25) Among Tertiary-Level Students in Norway
title_short Assessing Diagnostic Precision: Adaptations of the Hopkins Symptom Checklist (HSCL-5/10/25) Among Tertiary-Level Students in Norway
title_sort assessing diagnostic precision adaptations of the hopkins symptom checklist hscl 5 10 25 among tertiary level students in norway
topic depression
anxiety
students
young adults
questionnaires
psychometrics
url https://doi.org/10.32872/cpe.13275
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