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

• Published in: BMJ (Online) Vol. 365; p. l1476
• Main Authors: Levis, Brooke, Benedetti, Andrea, Thombs, Brett D, Riehm, Kira E, Saadat, Nazanin, Levis, Alexander W, Azar, Marleine, Rice, Danielle B, Chiovitti, Matthew J, Sanchez, Tatiana A, 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, Clover, Kerrie, Conwell, Yeates, de Man-van Ginkel, Janneke M, Delgadillo, Jaime, Fann, Jesse R, Fischer, Felix H, Fung, Daniel, Gelaye, Bizu, Goodyear-Smith, Felicity, Greeno, Catherine G, Hall, Brian J, Hambridge, John, Harrison, Patricia A, Härter, Martin, Hegerl, Ulrich, Hides, Leanne, Hobfoll, Stevan E, Hudson, Marie, Inagaki, Masatoshi, Ismail, Khalida, Jetté, Nathalie, Khamseh, Mohammad E, Kiely, Kim M, Kwan, Yunxin, Liu, Shen-Ing, Lotrakul, Manote, Loureiro, Sonia R, Löwe, Bernd, Marsh, Laura, 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 C, Tan, Pei Lin Lynnette, Turner, Alyna, van der Feltz-Cornelis, Christina M, van Weert, Henk C, Vöhringer, Paul A, White, Jennifer, Whooley, Mary A, Winkley, Kirsty, Yamada, Mitsuhiko, Zhang, Yuying
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 09.04.2019; BMJ Publishing Group LTD; BMJ Publishing Group Ltd
• Subjects: Accuracy; Citation management software; Data processing; Health risk assessment; Medical screening; Mental depression; Mental disorders; Mental health; Meta-analysis; Patients; Primary care; Questionnaires; Task forces; Validity
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.l1476

AbstractObjectiveTo determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression.DesignIndividual participant data meta-analysis.Data sourcesMedline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-February 2015).Inclusion criteriaEligible 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.ResultsData 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..ConclusionsPHQ-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.RegistrationPROSPERO CRD42014010673.