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Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis

Version 3 2024-06-19, 17:29
Version 2 2024-06-06, 05:05
Version 1 2023-05-16, 06:29
journal contribution
posted on 2024-06-19, 17:29 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 ButterworthPeter 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 Zhang
Abstract 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 Journal

Volume

365

Article number

l1476

Pagination

1-1

Location

London, Eng.

ISSN

0959-535X

eISSN

1756-1833

Language

eng

Publication classification

C1 Refereed article in a scholarly journal

Publisher

BMJ Publishing Group