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

DEPRESsion Screening Data (DEPRESSD) Collaboration; Dickens Akena; Bruce Arroll; Liat Ayalon; Marleine Azar; Hamid R Baradaran; Murray Baron; Andrea Benedetti; Charles H Bombardier; Jill Boruff; Peter Butterworth; Gregory Carter; Marcos H Chagas; Juliana C N Chan; Matthew J Chiovitti; Kerrie Clover; Yeates Conwell; Pim Cuijpers; Janneke M de Man-van Ginkel; Jaime Delgadillo; Jesse R Fann; Felix H Fischer; Daniel Fung; Bizu Gelaye; Simon Gilbody; Felicity Goodyear-Smith; Catherine G Greeno; Brian J Hall; John Hambridge; Patricia A Harrison; Martin Härter; Ulrich Hegerl; Leanne Hides; Stevan E Hobfoll; Marie Hudson; Masatoshi Inagaki; John P.A.  Ioannidis; Khalida Ismail; Nathalie Jetté; Mohammad E Khamseh; Kim M Kiely; Lorie A Kloda; Yunxin Kwan; Alexander W Levis; Brooke Levis; Shen-Ing Liu; Manote Lotrakul; Sonia R Loureiro; Bernd Löwe; Laura Marsh; Anthony McGuire; Dean McMillan; Sherina Mohd Sidik; Tiago N Munhoz; Kumiko Muramatsu; Flávia L Osório; Vikram Patel; Scott B Patten; Brian W Pence; Philippe Persoons; Angelo Picardi; Danielle B Rice; Kira E Riehm; Katrin Reuter; Alasdair G Rooney; Nazanin Saadat; Tatiana A Sanchez; Iná S Santos; Juwita Shaaban; Abbey Sidebottom; Adam Simning; Ian Shrier; Lesley Stafford; Sharon C Sung; Pei Lin Lynnette Tan; Brett D Thombs; Alyna Turner; Christina Maria Van Der Feltz-Cornelis; Henk C P M van Weert; Paul A Vöhringer; Jennifer White; Mary A Whooley; Kirsty Winkley; Mitsuhiko Yamada; Roy C Ziegelstein; Yuying Zhang

doi:10.1136/bmj.l1476

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

DEPRESsion Screening Data (DEPRESSD) Collaboration, Dickens Akena, Bruce Arroll, Liat Ayalon, Marleine Azar, Hamid R Baradaran, Murray Baron, Andrea Benedetti, Charles H Bombardier, Jill Boruff, Peter Butterworth, Gregory Carter, Marcos H Chagas, Juliana C N Chan, Matthew J Chiovitti, Kerrie Clover, Yeates Conwell, Pim Cuijpers, Janneke M de Man-van Ginkel, Jaime DelgadilloJesse R Fann, Felix H Fischer, Daniel Fung, Bizu Gelaye, Simon Gilbody, Felicity Goodyear-Smith, Catherine G Greeno, Brian J Hall, John Hambridge, Patricia A Harrison, Martin Härter, Ulrich Hegerl, Leanne Hides, Stevan E Hobfoll, Marie Hudson, Masatoshi Inagaki, John P.A. Ioannidis, Khalida Ismail, Nathalie Jetté, Mohammad E Khamseh, Kim M Kiely, Lorie A Kloda, Yunxin Kwan, Alexander W Levis, Brooke Levis, Shen-Ing Liu, Manote Lotrakul, Sonia R Loureiro, Bernd Löwe, Laura Marsh, Anthony McGuire, Dean McMillan, Sherina Mohd Sidik, Tiago N Munhoz, Kumiko Muramatsu, Flávia L Osório, Vikram Patel, Scott B Patten, Brian W Pence, Philippe Persoons, Angelo Picardi, Danielle B Rice, Kira E Riehm, Katrin Reuter, Alasdair G Rooney, Nazanin Saadat, Tatiana A Sanchez, Iná S Santos, Juwita Shaaban, Abbey Sidebottom, Adam Simning, Ian Shrier, Lesley Stafford, Sharon C Sung, Pei Lin Lynnette Tan, Brett D Thombs, Alyna Turner, Christina Maria Van Der Feltz-Cornelis, Henk C P M van Weert, Paul A Vöhringer, Jennifer White, Mary A Whooley, Kirsty Winkley, Mitsuhiko Yamada, Roy C Ziegelstein, Yuying Zhang

The Hull York Medical School

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Article number	l1476
Journal	BMJ
Volume	365
DOIs	https://doi.org/10.1136/bmj.l1476
Publication status	Published - 9 Apr 2019

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10.1136/bmj.l1476

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© 2019, British Medical Journal Publishing Group.
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DEPRESsion Screening Data (DEPRESSD) Collaboration, Akena, D., Arroll, B., Ayalon, L., Azar, M., Baradaran, H. R., Baron, M., Benedetti, A., Bombardier, C. H., Boruff, J., Butterworth, P., Carter, G., Chagas, M. H., Chan, J. C. N., Chiovitti, M. J., Clover, K., Conwell, Y., Cuijpers, P., de Man-van Ginkel, J. M., ... Zhang, Y. (2019). Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ, 365, Article l1476. https://doi.org/10.1136/bmj.l1476

@article{8fa58e61574744d1afe33a7c38f964cd,

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

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.",

author = "{DEPRESsion Screening Data (DEPRESSD) Collaboration} and Brooke Levis and Andrea Benedetti and Thombs, {Brett D} and Dickens Akena and Bruce Arroll and Liat Ayalon and Marleine Azar and Baradaran, {Hamid R} and Murray Baron and Andrea Benedetti and Bombardier, {Charles H} and Jill Boruff and Peter Butterworth and Gregory Carter and Chagas, {Marcos H} and Chan, {Juliana C N} and Chiovitti, {Matthew J} and Kerrie Clover and Yeates Conwell and Pim Cuijpers and {de Man-van Ginkel}, {Janneke M} and Jaime Delgadillo and Fann, {Jesse R} and Fischer, {Felix H} and Daniel Fung and Bizu Gelaye and Simon Gilbody and Felicity Goodyear-Smith and Greeno, {Catherine G} and Hall, {Brian J} and John Hambridge and Harrison, {Patricia A} and Martin H{\"a}rter and Ulrich Hegerl and Leanne Hides and Hobfoll, {Stevan E} and Marie Hudson and Masatoshi Inagaki and Ioannidis, {John P.A.} and Khalida Ismail and Nathalie Jett{\'e} and Khamseh, {Mohammad E} and Kiely, {Kim M} and Kloda, {Lorie A} and Yunxin Kwan and Levis, {Alexander W} and Brooke Levis and Shen-Ing Liu and Manote Lotrakul and Loureiro, {Sonia R} and Bernd L{\"o}we and Laura Marsh and Anthony McGuire and Dean McMillan and {Mohd Sidik}, Sherina and Munhoz, {Tiago N} and Kumiko Muramatsu and Os{\'o}rio, {Fl{\'a}via L} and Vikram Patel and Patten, {Scott B} and Pence, {Brian W} and Philippe Persoons and Angelo Picardi and Rice, {Danielle B} and Riehm, {Kira E} and Katrin Reuter and Rooney, {Alasdair G} and Nazanin Saadat and Sanchez, {Tatiana A} and Santos, {In{\'a} S} and Juwita Shaaban and Abbey Sidebottom and Adam Simning and Ian Shrier and Lesley Stafford and Sung, {Sharon C} and Tan, {Pei Lin Lynnette} and Thombs, {Brett D} and Alyna Turner and {Van Der Feltz-Cornelis}, {Christina Maria} and {van Weert}, {Henk C P M} and V{\"o}hringer, {Paul A} and Jennifer White and Whooley, {Mary A} and Kirsty Winkley and Mitsuhiko Yamada and Ziegelstein, {Roy C} and Yuying Zhang",

note = "{\textcopyright} 2019, British Medical Journal Publishing Group ",

year = "2019",

month = apr,

day = "9",

doi = "10.1136/bmj.l1476",

language = "English",

volume = "365",

journal = "BMJ",

issn = "0959-8138",

publisher = "BMJ",

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DEPRESsion Screening Data (DEPRESSD) Collaboration, Akena, D, Arroll, B, Ayalon, L, Azar, M, Baradaran, HR, Baron, M, Benedetti, A, Bombardier, CH, Boruff, J, Butterworth, P, Carter, G, Chagas, MH, Chan, JCN, Chiovitti, MJ, Clover, K, Conwell, Y, Cuijpers, P, de Man-van Ginkel, JM, Delgadillo, J, Fann, JR, Fischer, FH, Fung, D, Gelaye, B, Gilbody, S, Goodyear-Smith, F, Greeno, CG, Hall, BJ, Hambridge, J, Harrison, PA, Härter, M, Hegerl, U, Hides, L, Hobfoll, SE, Hudson, M, Inagaki, M, Ioannidis, JPA, Ismail, K, Jetté, N, Khamseh, ME, Kiely, KM, Kloda, LA, Kwan, Y, Levis, AW, Levis, B, Liu, S-I, Lotrakul, M, Loureiro, SR, Löwe, B, Marsh, L, McGuire, A, McMillan, D, Mohd Sidik, S, Munhoz, TN, Muramatsu, K, Osório, FL, Patel, V, Patten, SB, Pence, BW, Persoons, P, Picardi, A, Rice, DB, Riehm, KE, Reuter, K, Rooney, AG, Saadat, N, Sanchez, TA, Santos, IS, Shaaban, J, Sidebottom, A, Simning, A, Shrier, I, Stafford, L, Sung, SC, Tan, PLL, Thombs, BD, Turner, A, Van Der Feltz-Cornelis, CM, van Weert, HCPM, Vöhringer, PA, White, J, Whooley, MA, Winkley, K, Yamada, M, Ziegelstein, RC & Zhang, Y 2019, 'Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis', BMJ, vol. 365, l1476. https://doi.org/10.1136/bmj.l1476

TY - JOUR

T1 - Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression

T2 - individual participant data meta-analysis

AU - DEPRESsion Screening Data (DEPRESSD) Collaboration

AU - Levis, Brooke

AU - Benedetti, Andrea

AU - Thombs, Brett D

AU - Akena, Dickens

AU - Arroll, Bruce

AU - Ayalon, Liat

AU - Azar, Marleine

AU - Baradaran, Hamid R

AU - Baron, Murray

AU - Benedetti, Andrea

AU - Bombardier, Charles H

AU - Boruff, Jill

AU - Butterworth, Peter

AU - Carter, Gregory

AU - Chagas, Marcos H

AU - Chan, Juliana C N

AU - Chiovitti, Matthew J

AU - Clover, Kerrie

AU - Conwell, Yeates

AU - Cuijpers, Pim

AU - de Man-van Ginkel, Janneke M

AU - Delgadillo, Jaime

AU - Fann, Jesse R

AU - Fischer, Felix H

AU - Fung, Daniel

AU - Gelaye, Bizu

AU - Gilbody, Simon

AU - Goodyear-Smith, Felicity

AU - Greeno, Catherine G

AU - Hall, Brian J

AU - Hambridge, John

AU - Harrison, Patricia A

AU - Härter, Martin

AU - Hegerl, Ulrich

AU - Hides, Leanne

AU - Hobfoll, Stevan E

AU - Hudson, Marie

AU - Inagaki, Masatoshi

AU - Ioannidis, John P.A.

AU - Ismail, Khalida

AU - Jetté, Nathalie

AU - Khamseh, Mohammad E

AU - Kiely, Kim M

AU - Kloda, Lorie A

AU - Kwan, Yunxin

AU - Levis, Alexander W

AU - Levis, Brooke

AU - Liu, Shen-Ing

AU - Lotrakul, Manote

AU - Loureiro, Sonia R

AU - Löwe, Bernd

AU - Marsh, Laura

AU - McGuire, Anthony

AU - McMillan, Dean

AU - Mohd Sidik, Sherina

AU - Munhoz, Tiago N

AU - Muramatsu, Kumiko

AU - Osório, Flávia L

AU - Patel, Vikram

AU - Patten, Scott B

AU - Pence, Brian W

AU - Persoons, Philippe

AU - Picardi, Angelo

AU - Rice, Danielle B

AU - Riehm, Kira E

AU - Reuter, Katrin

AU - Rooney, Alasdair G

AU - Saadat, Nazanin

AU - Sanchez, Tatiana A

AU - Santos, Iná S

AU - Shaaban, Juwita

AU - Sidebottom, Abbey

AU - Simning, Adam

AU - Shrier, Ian

AU - Stafford, Lesley

AU - Sung, Sharon C

AU - Tan, Pei Lin Lynnette

AU - Thombs, Brett D

AU - Turner, Alyna

AU - Van Der Feltz-Cornelis, Christina Maria

AU - van Weert, Henk C P M

AU - Vöhringer, Paul A

AU - White, Jennifer

AU - Whooley, Mary A

AU - Winkley, Kirsty

AU - Yamada, Mitsuhiko

AU - Ziegelstein, Roy C

AU - Zhang, Yuying

PY - 2019/4/9

Y1 - 2019/4/9

N2 - 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.

AB - 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.

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U2 - 10.1136/bmj.l1476

DO - 10.1136/bmj.l1476

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SN - 0959-8138

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JO - BMJ

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

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