Depression Research and Treatment / 2018 / Article / Tab 3

Research Article

Assigning Clinical Significance and Symptom Severity Using the Zung Scales: Levels of Misclassification Arising from Confusion between Index and Raw Scores

Table 3

Articles and evaluation of the use of the Zung Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS).

Reference details Discipline SDS SAS
Used?Cut-offSeverity rangeNotesUsed?Cut-offSeverity rangeNotes


Chagas et al., 2010 [16]Neuroscience25

Friebe et al., 2010 [17]Psychiatry22

Lande et al., 2010 [18]Psychiatry22

Saban et al., 2010 [19]Psychiatry55

Ohira, 2010 [20]Cardiovascular15

Lombardi et al., 2010 [21]Immunology55

Podlipný et al., 2010 [22]Psychiatry22

Ostojic et al., 2010 [23]Rheumatology22“SAS” severity ranges

Sonikian et al., 2010 [24]Nephrology33

Biggs et al., 2010 [25]Psychiatry35

Alimohammadi et al., 2010 [26]Health55

Oishi et al., 2010 [27]Audiology15Cut-off of 48 used (i.e., index of 60)

Bitsika et al., 2010 [28]Counselling15

Sharpley et al., 2010 [29]Oncology15

Klemenc-Ketiš et al., 2010 [30]Mental health15Cut-off of 50 raw score

Tang et al., 2010 [31]Mental health55

Fernandes et al., 2010 [32]Psychometrics11Raw score ranges: up to 36 - no anxiety. 37–39 - possible anxiety: 40+ - high anxiety.

Wang et al., 2010 [33]Urology25cut-off 50 (Chinese)

Pascazio et al., 2010 [34]Nephrology55

Herbert et al., 2010 [35]Psychology33


Ide, 2011 [36]Orthopedic11

Lande et al., 2011 [37]Psychiatry55

Li et al., 2011 [38]Psychology55Short 10-item version of SDS used

Huang et al., 2011 [39]Cardiology44Used index classifications with no indication of conversion

Takayama et al., 2011 [40]Dentistry11Mentions index conversion but uses raw scores correctly

Perugi et al., 2011 [41]Psychiatry44Used index scores with no indication of conversion44Used index scores with no indication of conversion: cut-off of 50. SDS ranges

Ogawa et al., 2011 [42]Gynecology55

Uji et al., 2011 [43]Psychotherapy55Only used 7 statements: “affective subscale”

Davidson et al., 2011 [44]Psychology55

Sharpley et al., 2011 [45]Oncology15SAS cut-off

Wan et al., 2011 [46]Psychiatry55

Weigold and Robitschek, 2011 [47]Psychiatry55

Li et al., 2011 [48]Opthalmology25Chinese cut-off used (50 index)

Liao et al., 2011 [49]Drugs55

Nassiri et al., 2011 [50]Env. science44Divided into normal/low/moderate/high but no indication given of cut-offs or indexing

De Tommaso et al., 2011 [51]Neurology55

Chiaffarino et al., 2011 [52]Gynecology11Raw score ranges: <40, nonanxious; 40–60 anxious symptoms; >60 clinically significant anxiety

Richards et al., 2011 [53]Psychology44Uses Index scores: no mention of conversion44Uses index scores with no mention of conversation. “SAS” ranges


Yu et al., 2012 [54]Cardiology2222“SAS” severity ranges

Lei et al., 2012 [55]Psychiatry25Chinese cut-offs used (53 index)25Chinese cut-off used (50 index)

Mammadova et al., 2012 [56]Psychiatry55Calculating appropriate cut-off for different population

Trento et al., 2012 [57]Endocrinology3333“SAS” severity ratings

Adogwa et al., 2012 [58]Orthopaedics35

Gao et al., 2012 [59]Psychiatry15Use Chinese norm cut-off of 40 (raw score)

Sawa et al., 2012 [60]Psychiatry55

Chang and Koh, 2012 [61]Mental health55

Sapranaviciute et al., 2012 [62]Psychology55

de Pasquale et al., 2012 [63]General medicine3555

Shen et al., 2012 [64]Psychiatry25Chinese cut-off: index 50

Liu et al., 2012 [65]Gastroenterology25Probably used Chinese cut-off

Huang et al., 2012 [66]Gynecology25Chinese cut-off: index 50

Li et al., 2012 [67]Mental health55

Tang et al., 2012 [68]Gastroenterology55

Campbell et al., 2012 [69]Psychiatry55


Adogwa et al., 2013 [70]Spinal35Other ranges used based on quartiles

Balázs et al., 2013 [71]Psychology44“SAS” severity ranges

Li et al., 2014 [72]Oncology15Chinese cut-offs used (42 raw)

Lowery et al., 2013 [73]Psychiatry55Brief instrument used. Score range indicated index scores (25 to 100) but only raw range given (1 to 4 Likert)55Score range indicated index scores (25 to 100) but only raw range given (1 to 4 Likert)

Zhang et al., 2013 [74]Urology25

Guo et al., 2013 [75]Oncology25Chinese version used25Chinese cut-off used

Nardelli et al., 2013 [76]Neurology35

Siennicki-Lantz et al., 2013 [77]Geriatric22SAS “severity rating” applied (i.e., mild depression 45–59)

Liu et al., 2013 [78]Immunology25Chinese cut-off used

Deb, 2013 [79]Pharmacology3333SAS “severity ratings”

Wang et al., 2013 [80]Psychiatry25Chinese version used

Khorvash et al., 2013 [81]Neuroscience44“SAS” severity ratings provided

Quintão et al., 2013 [82]Psychology55

Delibegovic and Sinanovic, 2013 [83]Oncology4444Uses SDS severity ratings

Klemenc-Ketiš and Peterlin, 2013 [84]Psychiatry33

Carli et al., 2013 [85]Public health55“A full description of assessment instruments and interventions was previously published”

Grandi et al., 2013 [86]Gynecology55“Higher scores indicating worst depressive symptoms.” Raw score range given (20 to 80)

Luo et al., 2013 [87]Geriatric55


Akinsulore et al., 2014 [88]Psychology22

Banth and Sharma, 2014 [89]Psychology33

Bhatti et al., 2013 [90]Spinal33“SAS” severity ranges

Kaess et al., 2014 [91]Psychiatry44“SAS” severity ranges

Atteritano et al., 2014 [92]Gynecology33

Lee et al., 2014 [93]Endocrinology55“Severity score was calculated by formula conversion” and link to Zung article

Vlachos et al., 2014 [94]Gastroenterology35

Ding et al., 2014 [95]Psychiatry15Chinese cut-off used (40 raw)

Trento et al., 2014 [96]Endocrinology33“SAS” severity ranges

Fernández‐Matarrubia et al., 2014 [97]Neurology5555

Feng et al., 2014 [98]Public health45Chinese cut-offs used (53 index)45Chinese cut-offs used (50 Index)

Hou et al., 2014 [99]Nephrology25“Each scale consists of 40 items,”- incorrect description of scales provided. Chinese version used: non-Chinese cut-off25“Each scale consists of 40 items,” incorrect description of scales provided. Chinese version used: Chinese cut-off

Khorvash et al., 2014 [100]Neurology55

Liu et al., 2014 [101]Respiratory45Chinese version used45Chinese cut-off used

La Fianza et al., 2014 [102]Radiology1515`


Bobić et al., 2015 [103]Psychiatry15Chinese cut-offs used (42 raw)

Chen et al., 2015 [104]Orthopedic45Chinese cut-offs used (53 index)45Chinese cut-off used (50 index)

Jiang et al., 2015 [105]Rheumatology5555

Rus Makovec et al., 2015 [106]Public health2222SDS severity ranges used

Kourkoveli et al., 2015 [107]Cardiac15

Shi et al., 2015 [108]Psychiatry25Chinese cut-off used (50 index)

Stefanidou et al., 2015 [109]Psychiatry35

Pozzi et al., 2015 [110]Psychiatry55

Yuan et al., 2015 [111]Neurology35Chinese cut-off used (50 index)

Yin et al., 2015 [112]Psychiatry33SAS severity ranges quoted but Chinese cut-offs used (53 index)33“SAS” severity ranges quoted but Chinese cut-off used (50)

Li et al., 2015 [113]Spinal33SDS standard indices applied to raw scores33SDS severity ranges applied to raw scores

Hirao, 2015 [114]Occupational therapy55Mentioned the Japanese version

Lou et al., 2015 [115]Cardiac22Chinese cut-off used (50 index): ranges: 50–59; 60–69; 70+

Yang et al., 2015 [116]Psychiatry25Mentioned the Chinese version but used standard index cut-off (50)

Trento et al., 2015 [117]Endocrinology33“SAS” severity ranges

Notes. Zung analysis classifications; 1: consistent use of raw scores; 2: consistent use of index scores; 3: inconsistent application; 4: unclear whether consistent or not; 5: not utilized.

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