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Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis
journal contribution
posted on 2023-05-16, 06:29 authored by Brooke Levis, Andrea Benedetti, Brett D Thombs, Dickens H Akena, Bruce Arroll, Liat Ayalon, Marleine Azar, Hamid R Baradaran, Murray Baron, Charles H Bombardier, Jill Boruff, Peter Butterworth, Gregory Carter, Marcos H Chagas, Juliana CN Chan, Matthew J Chiovitti, Kerrie Clover, Yeates Conwell, Pim Cuijpers, Janneke M de Man-van Ginkel, Jaime Delgadillo, Jesse R Fann, Felix H Fischer, Daniel Fung, Bizu Gelaye, Simon Gilbody, Felicity Goodyear-Smith, Catherine G Greeno, Brian J Hall, John Hambridge, Patricia A Harrison, Martin Harter, Ulrich Hegerl, Leanne Hides, Stevan E Hobfoll, Marie Hudson, Masatoshi Inagaki, John PA Ioannidis, Khalida Ismail, Nathalie Jette, Mohammad E Khamseh, Kim M Kiely, Lorie A Kloda, Yunxin Kwan, Alexander W Levis, Shen-Ing Liu, Manote Lotrakul, Sonia R Loureiro, Bernd Lowe, Laura Marsh, Anthony McGuire, Dean McMillan, Sherina Mohd Sidik, Tiago N Munhoz, Kumiko Muramatsu, Flavia L Osorio, Vikram Patel, Scott B Patten, Brian W Pence, Philippe Persoons, Angelo Picardi, Danielle B Rice, Kira E Riehm, Katrin Reuter, Alasdair G Rooney, Nazanin Saadat, Tatiana A Sanchez, Ina S Santos, Juwita Shaaban, Abbey Sidebottom, Adam Simning, Ian Shrier, Lesley Stafford, Sharon C Sung, Pei Lin Lynnette Tan, Alyna TurnerAlyna Turner, Christina M van der Feltz-Cornelis, Henk C van Weert, Paul A Vohringer, Jennifer White, Mary A Whooley, Kirsty Winkley, Mitsuhiko Yamada, Roy C Ziegelstein, Yuying ZhangAbstract
Objective
To determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression.
Design
Individual participant data meta-analysis.
Data sources
Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-February 2015).
Inclusion criteria
Eligible studies compared PHQ-9 scores with major depression diagnoses from validated diagnostic interviews. Primary study data and study level data extracted from primary reports were synthesized. For PHQ-9 cut-off scores 5-15, bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, among studies that used semistructured diagnostic interviews, which are designed for administration by clinicians; fully structured interviews, which are designed for lay administration; and the Mini International Neuropsychiatric (MINI) diagnostic interviews, a brief fully structured interview. Sensitivity and specificity were examined among participant subgroups and, separately, using meta-regression, considering all subgroup variables in a single model.
Results
Data were obtained for 58 of 72 eligible studies (total n=17 357; major depression cases n=2312). Combined sensitivity and specificity was maximized at a cut-off score of 10 or above among studies using a semistructured interview (29 studies, 6725 participants; sensitivity 0.88, 95% confidence interval 0.83 to 0.92; specificity 0.85, 0.82 to 0.88). Across cut-off scores 5-15, sensitivity with semistructured interviews was 5-22% higher than for fully structured interviews (MINI excluded; 14 studies, 7680 participants) and 2-15% higher than for the MINI (15 studies, 2952 participants). Specificity was similar across diagnostic interviews. The PHQ-9 seems to be similarly sensitive but may be less specific for younger patients than for older patients; a cut-off score of 10 or above can be used regardless of age..
Conclusions
PHQ-9 sensitivity compared with semistructured diagnostic interviews was greater than in previous conventional meta-analyses that combined reference standards. A cut-off score of 10 or above maximized combined sensitivity and specificity overall and for subgroups.
Registration
PROSPERO CRD42014010673.
History
Journal
BMJ: British Medical JournalVolume
365Article number
l1476Pagination
1-1Location
London, Eng.Publisher DOI
ISSN
0959-535XeISSN
1756-1833Language
engPublication classification
C1 Refereed article in a scholarly journalPublisher
BMJ Publishing GroupUsage metrics
Keywords
CIDIDISORDERGeneral & Internal MedicineINTERNATIONAL DIAGNOSTIC INTERVIEWLife Sciences & BiomedicineMedicine, General & InternalMINIPRIMARY-CARERECOMMENDATIONSRELIABILITYScience & TechnologyUTILITYVALIDITYAgedData AccuracyDepressive Disorder, MajorFemaleHumansInterview, PsychologicalMaleMass ScreeningMiddle AgedPatient Health QuestionnairePsychiatric Status Rating ScalesSensitivity and SpecificityDEPRESsion Screening Data (DEPRESSD) CollaborationDepressionClinical ResearchMental HealthBrain DisordersPublic Health and Health Services not elsewhere classifiedClinical Sciences not elsewhere classified
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