Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. (9th April 2019)

• Record Type: Journal Article
• Authors: Levis, Brooke; Benedetti, Andrea; Thombs, Brett D
• Other Names: author non-byline.; Riehm Kira E author non-byline.; Saadat Nazanin author non-byline.; Levis Alexander W author non-byline.; Azar Marleine author non-byline.; Rice Danielle B author non-byline.; Chiovitti Matthew J author non-byline.; Sanchez Tatiana A author non-byline.; Boruff Jill 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.; McMillan Dean author non-byline.; Patten Scott B author non-byline.; Shrier Ian author non-byline.; Ziegelstein Roy C author non-byline.; Akena Dickens H author non-byline.; Arroll Bruce author non-byline.; Ayalon Liat author non-byline.; Baradaran Hamid R author non-byline.; Baron Murray author non-byline.; Bombardier Charles H 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.; Clover Kerrie author non-byline.; Conwell Yeates author non-byline.; de Man-van Ginkel Janneke M author non-byline.; Delgadillo Jaime author non-byline.; Fann Jesse R author non-byline.; Fischer Felix H author non-byline.; Fung Daniel author non-byline.; Gelaye Bizu author non-byline.; Goodyear-Smith Felicity author non-byline.; Greeno Catherine G author non-byline.; Hall Brian J author non-byline.; Hambridge John author non-byline.; Harrison Patricia A author non-byline.; Härter Martin author non-byline.; Hegerl Ulrich author non-byline.; Hides Leanne author non-byline.; Hobfoll Stevan E author non-byline.; Hudson Marie author non-byline.; Inagaki Masatoshi author non-byline.; Ismail Khalida author non-byline.; Jetté Nathalie author non-byline.; Khamseh Mohammad E author non-byline.; Kiely Kim M author non-byline.; Kwan Yunxin 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.; Marsh Laura 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.; Osório Flávia L author non-byline.; Patel Vikram author non-byline.; Pence Brian W author non-byline.; Persoons Philippe author non-byline.; Picardi Angelo author non-byline.; Reuter Katrin author non-byline.; Rooney Alasdair G. author non-byline.; Santos Iná S author non-byline.; Shaaban Juwita author non-byline.; Sidebottom Abbey author non-byline.; Simning Adam author non-byline.; Stafford Lesley author non-byline.; Sung Sharon C author non-byline.; Tan Pei Lin Lynnette author non-byline.; Turner Alyna author non-byline.; van der Feltz-Cornelis Christina M author non-byline.; van Weert Henk C author non-byline.; Vöhringer Paul A author non-byline.; White Jennifer author non-byline.; Whooley Mary A author non-byline.; Winkley Kirsty author non-byline.; Yamada Mitsuhiko author non-byline.; Zhang Yuying author non-byline.;
• Is Part Of: BMJ. Volume 365(2019)
• Publication Date: 2019-04-09
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj.l1476
• Languages: English
• ISSNs: 0007-1447

Abstract

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.