Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis. Issue 8 (12th June 2020)

• Record Type: Journal Article
• Authors: Wu, Yin; Levis, Brooke; Riehm, Kira E.; Saadat, Nazanin; Levis, Alexander W.; Azar, Marleine; Rice, Danielle B.; Boruff, Jill; Cuijpers, Pim; Gilbody, Simon; Ioannidis, John P.A.; Kloda, Lorie A.; McMillan, Dean; Patten, Scott B.; Shrier, Ian; Ziegelstein, Roy C.; Akena, Dickens H.; Arroll, Bruce; Ayalon, Liat; Baradaran, Hamid R.; Baron, Murray; Bombardier, Charles H.; Butterworth, Peter; Carter, Gregory; Chagas, Marcos H.; Chan, Juliana C. N.; Cholera, Rushina; Conwell, Yeates; de Man-van Ginkel, Janneke M.; Fann, Jesse R.; Fischer, Felix H.; Fung, Daniel; Gelaye, Bizu; Goodyear-Smith, Felicity; Greeno, Catherine G.; Hall, Brian J.; Harrison, Patricia A.; Härter, Martin; Hegerl, Ulrich; Hides, Leanne; Hobfoll, Stevan E.; Hudson, Marie; Hyphantis, Thomas; Inagaki, Masatoshi; Jetté, Nathalie; Khamseh, Mohammad E.; Kiely, Kim M.; Kwan, Yunxin; Lamers, Femke; Liu, Shen-Ing; Lotrakul, Manote; Loureiro, Sonia R.; Löwe, Bernd; McGuire, Anthony; Mohd-Sidik, Sherina; Munhoz, Tiago N.; Muramatsu, Kumiko; Osório, Flávia L.; Patel, Vikram; Pence, Brian W.; Persoons, Philippe; Picardi, Angelo; Reuter, Katrin; Rooney, Alasdair G.; Santos, Iná S.; Shaaban, Juwita; Sidebottom, Abbey; Simning, Adam; Stafford, Lesley; Sung, Sharon; Tan, Pei Lin Lynnette; Turner, Alyna; van Weert, Henk C.; White, Jennifer; Whooley, Mary A.; Winkley, Kirsty; Yamada, Mitsuhiko; Benedetti, Andrea; Thombs, Brett D.;
• Is Part Of: Psychological medicine. Volume 50:Issue 8(2020)
• Page Start: 1368
• Page End: 1380
• Publication Date: 2020-06-12
• Subjects: Depression, -- diagnostic accuracy, -- individual participant data meta-analysis, -- meta-analysis, -- PHQ-8, -- PHQ-9, -- screening, -- systematic review; Psychiatry -- Periodicals; Medicine and psychology -- Periodicals; Clinical psychology -- Periodicals; 616.89
• DOI: 10.1017/S0033291719001314
• Languages: English
• ISSNs: 0033-2917

Abstract

Abstract: Background: Item 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. Methods: We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy. Results: 16 742 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). Conclusions: PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.