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 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.