Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression: updated systematic review and individual participant data meta-analysis. (5th October 2021)

• Record Type: Journal Article
• Authors: Negeri, Zelalem F; Levis, Brooke; Sun, Ying; He, Chen; Krishnan, Ankur; Wu, Yin; Bhandari, Parash Mani; Neupane, Dipika; Brehaut, Eliana; Benedetti, Andrea; Thombs, Brett D
• Other Names: author non-byline.; Imran Mahrukh author non-byline.; Rice Danielle B author non-byline.; Riehm Kira E author non-byline.; Azar Marleine author non-byline.; Levis Alexander W author non-byline.; Boruff Jill T author non-byline.; Cuijpers Pim author non-byline.; Gilbody Simon author non-byline.; Ioannidis John P A author non-byline.; Kloda Lorie A author non-byline.; Patten Scott B author non-byline.; Shrier Ian author non-byline.; Ziegelstein Roy C author non-byline.; Markham Sarah author non-byline.; Alamri Sultan H author non-byline.; Amtmann Dagmar author non-byline.; Arroll Bruce author non-byline.; Ayalon Liat author non-byline.; Baradaran Hamid R author non-byline.; Beraldi Anna author non-byline.; Bernstein Charles N author non-byline.; Bhana Arvin author non-byline.; Bombardier Charles H author non-byline.; Buji Ryna Imma author non-byline.; Butterworth Peter author non-byline.; Carter Gregory author non-byline.; Chagas Marcos H author non-byline.; Chan Juliana C N author non-byline.; Chan Lai Fong author non-byline.; Chibanda Dixon author non-byline.; Clover Kerrie author non-byline.; Conway Aaron author non-byline.; Conwell Yeates author non-byline.; Daray Federico M author non-byline.; de Man-van Ginkel Janneke M author non-byline.; Delgadillo Jaime author non-byline.; Diez-Quevedo Crisanto author non-byline.; Fann Jesse R author non-byline.; Fischer Felix H author non-byline.; Field Sally author non-byline.; Fisher Jane R W author non-byline.; Fung Daniel author non-byline.; Garman Emily C author non-byline.; Gelaye Bizu author non-byline.; Gholizadeh Leila author non-byline.; Gibson Lorna J author non-byline.; Goodyear-Smith Felicity author non-byline.; Green Eric P author non-byline.; Greeno Catherine G author non-byline.; Hall Brian J author non-byline.; Hantsoo Liisa author non-byline.; Haroz Emily E author non-byline.; Härter Martin author non-byline.; Hegerl Ulrich author non-byline.; Hides Leanne author non-byline.; Hobfoll Stevan E author non-byline.; Honikman Simone author non-byline.; Hudson Marie author non-byline.; Hyphantis Thomas author non-byline.; Inagaki Masatoshi author non-byline.; Jeon Hong Jin author non-byline.; Jetté Nathalie author non-byline.; Khamseh Mohammad E author non-byline.; Kӧhler Sebastian author non-byline.; Kohrt Brandon A author non-byline.; Kwan Yunxin author non-byline.; Lamers Femke author non-byline.; Lara Maria Asunción author non-byline.; Levin-Aspenson Holly F author non-byline.; Liu Shen-Ing author non-byline.; Lotrakul Manote author non-byline.; Loureiro Sonia R author non-byline.; Löwe Bernd author non-byline.; Luitel Nagendra P author non-byline.; Lund Crick author non-byline.; Marrie Ruth Ann author non-byline.; Marsh Laura author non-byline.; Marx Brian P author non-byline.; McGuire Anthony author non-byline.; Mohd Sidik Sherina author non-byline.; Munhoz Tiago N author non-byline.; Muramatsu Kumiko author non-byline.; Nakku Juliet E M author non-byline.; Navarrete Laura author non-byline.; Osório Flávia L author non-byline.; Pence Brian W author non-byline.; Persoons Philippe author non-byline.; Petersen Inge author non-byline.; Picardi Angelo author non-byline.; Pugh Stephanie L author non-byline.; Quinn Terence J author non-byline.; Rancans Elmars author non-byline.; Rathod Sujit D author non-byline.; Reuter Katrin author non-byline.; Rooney Alasdair G author non-byline.; Rowe Heather J author non-byline.; Santos Iná S author non-byline.; Schram Miranda T author non-byline.; Shaaban Juwita author non-byline.; Shinn Eileen H author non-byline.; Sidebottom Abbey author non-byline.; Simning Adam author non-byline.; Spangenberg Lena author non-byline.; Stafford Lesley author non-byline.; Sung Sharon C author non-byline.; Suzuki Keiko author non-byline.; Tan, Pei Lin Lynnette author non-byline.; Taylor-Rowan Martin author non-byline.; Tran Thach D author non-byline.; Turner Alyna author non-byline.; van der Feltz-Cornelis Christina M author non-byline.; van Heyningen Thandi author non-byline.; van Weert Henk C author non-byline.; Vöhringer Paul A author non-byline.; Wagner Lynne I author non-byline.; Wang Jian Li author non-byline.; Wang Wenzheng author non-byline.; Watson David author non-byline.; White Jennifer author non-byline.; Whooley Mary A author non-byline.; Winkley Kirsty author non-byline.; Wynter Karen author non-byline.; Yamada Mitsuhiko author non-byline.; Zeng Qing Zhi author non-byline.; Zhang Yuying author non-byline.;
• Is Part Of: BMJ. Volume 375(2021)
• Publication Date: 2021-10-05
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj.n2183
• Languages: English
• ISSNs: 0007-1447

Abstract

Abstract: Objective: To update a previous individual participant data meta-analysis and determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9), the most commonly used depression screening tool in general practice, for detecting major depression overall and by study or participant subgroups. Design: Systematic review and individual participant data meta-analysis. Data sources: Medline, Medline In-Process, and Other Non-Indexed Citations via Ovid, PsycINFO, Web of Science searched through 9 May 2018. Review methods: Eligible studies administered the PHQ-9 and classified current major depression status using a validated semistructured diagnostic interview (designed for clinician administration), fully structured interview (designed for lay administration), or the Mini International Neuropsychiatric Interview (MINI; a brief interview designed for lay administration). A bivariate random effects meta-analytic model was used to obtain point and interval estimates of pooled PHQ-9 sensitivity and specificity at cut-off values 5-15, separately, among studies that used semistructured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual), fully structured interviews (eg, Composite International Diagnostic Interview), and the MINI. Meta-regression was used to investigate whether PHQ-9 accuracy correlated with reference standard categories and participant characteristics. Results: Data from 44 503 total participants (27 146 additional from the update) were obtained from 100 of 127 eligible studies (42 additional studies; 79% eligible studies; 86% eligible participants). Among studies with a semistructured interview reference standard, pooled PHQ-9 sensitivity and specificity (95% confidence interval) at the standard cut-off value of ≥10, which maximised combined sensitivity and specificity, were 0.85 (0.79 to 0.89) and 0.85 (0.82 to 0.87), respectively. Specificity was similar across reference standards, but sensitivity in studies with semistructured interviews was 7-24% (median 21%) higher than with fully structured reference standards and 2-14% (median 11%) higher than with the MINI across cut-off values. Across reference standards and cut-off values, specificity was 0-10% (median 3%) higher for men and 0-12 (median 5%) higher for people aged 60 or older. Conclusions: Researchers and clinicians could use results to determine outcomes, such as total number of positive screens and false positive screens, at different PHQ-9 cut-off values for different clinical settings using the knowledge translation tool at www.depressionscreening100.com/phq . Study registration: PROSPERO CRD42014010673.