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Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis
journal contribution
posted on 2020-06-01, 00:00 authored by Y Wu, B Levis, K E Riehm, N Saadat, A W Levis, M Azar, D B Rice, J Boruff, P Cuijpers, S Gilbody, J P A Ioannidis, L A Kloda, D Mcmillan, S B Patten, I Shrier, R C Ziegelstein, D H Akena, B Arroll, L Ayalon, H R Baradaran, M Baron, C H Bombardier, P Butterworth, G Carter, M H Chagas, J C N Chan, R Cholera, Y Conwell, J M De Man-Van Ginkel, J R Fann, F H Fischer, D Fung, B Gelaye, F Goodyear-Smith, C G Greeno, B J Hall, P A Harrison, M Härter, U Hegerl, L Hides, S E Hobfoll, M Hudson, T Hyphantis, M D Inagaki, N Jetté, M E Khamseh, K M Kiely, Y Kwan, F Lamers, S I Liu, M Lotrakul, S R Loureiro, B Löwe, A Mcguire, S Mohd-Sidik, T N Munhoz, K Muramatsu, F L Osório, V Patel, B W Pence, P Persoons, A Picardi, K Reuter, A G Rooney, I S Santos, J Shaaban, A Sidebottom, A Simning, M D Stafford, S Sung, P L L Tan, Alyna TurnerAlyna Turner, H C Van Weert, J White, M A Whooley, K Winkley, M Yamada, A Benedetti, B D ThombsBackgroundItem 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.MethodsWe conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.Results16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (-0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).ConclusionsPHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
History
Journal
Psychological medicineVolume
50Issue
8Pagination
1368 - 1380Publisher
Cambridge University PressLocation
Cambridge, Eng.Publisher DOI
ISSN
0033-2917eISSN
1469-8978Language
engPublication classification
C1 Refereed article in a scholarly journalCopyright notice
2019, Cambridge University PressUsage metrics
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