- EQ-5D-5L anxiety/depression dimension showed highest screening accuracy across countries (AUROC 0.76 to 0.88), excluding China.
- PROMIS-10 emotional problems item ranked second in screening performance (AUROC 0.75 to 0.84) across countries.
- Generic PROMs (EQ-5D-5L, EQ-HWB, PROMIS-10) show potential as effective screening tools overall, though performance was lower in China (AUROC 0.65 to 0.75).
Qual Life Res. 2026 Aug 29;35(10):272. doi: 10.1007/s11136-026-04359-w.
ABSTRACT
BACKGROUND: Generic patient-reported outcome measures (PROMs) are increasingly being implemented in health systems for routine outcome measurement. Their ability to screen for anxiety and depression could serve as an added benefit. This study aims to assess the screening ability of selected EQ-5D-5L, EQ-HWB, and PROMIS-10 items for anxiety and depression, using self-reported diagnostic history of these conditions, relative to established PHQ-2 and GAD-2 screeners, in general adult populations across 15 countries.
METHODS: Cross-sectional data from “EuroQol Data for Assessment of Population Health Needs and Instrument Evaluation (EQ-DAPHNIE)” project was used. The following countries were included in the analysis: Argentina, Australia, Brazil, Canada, Chile, China, France, Germany, Japan, Mexico, Netherlands, New Zealand, Spain, the United Kingdom (UK), and the United States (US). A sample size of 4500 was planned per country. Sample quotas for age, sex, income, and urban/rural area were based on census or national data in each country. The performance of specific mental health items of the EQ-5D-5L, EQ-Health and Wellbeing (EQ-HWB), Patient-Reported Outcomes Measurement Information System Scale v1.2 – Global Health (PROMIS-10), Generalized Anxiety Disorder 2-item questionnaire (GAD-2), and Patient Health Questionnaire 2-item version (PHQ-2) were compared to self-reported diagnostic history of anxiety or depression. Performance of EQ-5D-5L, EQ-HWB, PROMIS-10, GAD-2, and PHQ-2 in screening for anxiety and depression was evaluated using area under receiver operating curve (AUROC) analysis RESULTS: A total of 68,419 respondents from 15 countries completed surveys. Brazil had the highest percentage of self-reported anxiety diagnoses (29.6%). The US had the highest depression diagnoses (26.7%), anxiety or depression diagnoses (34.1%), and anxiety and depression diagnoses (20.9%). By contrast, China had the lowest percentage of diagnoses for depression (3.9%) and anxiety or depression (9.7%) and Japan the lowest for anxiety (3.7%) and anxiety and depression (2.1%). Across all countries, except China, the EQ-5D-5L anxiety/depression dimension performed the best in screening for all conditions (AUROC range: 0.76-0.88), followed by the PROMIS-10 emotional problems item (AUROC range: 0.75-0.84). All measures performed considerably lower in China (AUROC range: 0.65-0.75).
CONCLUSION: Generic PROMs, like the EQ-5D-5L, EQ-HWB, and PROMIS-10 have potential added value as effective screening tools for anxiety and depression in the general adult population, as evidenced by their performance across multiple countries.
PMID:42667493 | DOI:10.1007/s11136-026-04359-w
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