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Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis

Research output: Contribution to journalArticle

Published copy (DOI)


  • Yin Wu
  • Brooke Levis
  • Kira E Riehm
  • Nazanin Saadat
  • Alexander W Levis
  • Marleine Azar
  • Danielle B Rice
  • Jill Boruff
  • Pim Cuijpers
  • John P A Ioannidis
  • Lorie A Kloda
  • Scott B Patten
  • Ian Shrier
  • Roy C Ziegelstein
  • Dickens H Akena
  • Bruce Arroll
  • Liat Ayalon
  • Hamid R Baradaran
  • Murray Baron
  • Charles H Bombardier
  • Peter Butterworth
  • Gregory Carter
  • Marcos H Chagas
  • Juliana C N Chan
  • Rushina Cholera
  • Yeates Conwell
  • Janneke M de Man-van Ginkel
  • Jesse R Fann
  • Felix H Fischer
  • Daniel Fung
  • Bizu Gelaye
  • Felicity Goodyear-Smith
  • Catherine G Greeno
  • Brian J Hall
  • Patricia A Harrison
  • Martin Härter
  • Ulrich Hegerl
  • Leanne Hides
  • Stevan E Hobfoll
  • Marie Hudson
  • Thomas Hyphantis
  • M D Inagaki
  • Nathalie Jetté
  • Mohammad E Khamseh
  • Kim M Kiely
  • Yunxin Kwan
  • Femke Lamers
  • Shen-Ing Liu
  • Manote Lotrakul
  • Sonia R Loureiro
  • Bernd Löwe
  • Anthony McGuire
  • Sherina Mohd-Sidik
  • Tiago N Munhoz
  • Kumiko Muramatsu
  • Flávia L Osório
  • Vikram Patel
  • Brian W Pence
  • Philippe Persoons
  • Angelo Picardi
  • Katrin Reuter
  • Alasdair G Rooney
  • Iná S Santos
  • Juwita Shaaban
  • Abbey Sidebottom
  • Adam Simning
  • M D Stafford
  • Sharon Sung
  • Pei Lin Lynnette Tan
  • Alyna Turner
  • Henk C van Weert
  • Jennifer White
  • Mary A Whooley
  • Kirsty Winkley
  • Mitsuhiko Yamada
  • Andrea Benedetti
  • Brett D Thombs


Publication details

JournalPsychological Medicine
DateAccepted/In press - 14 May 2019
DateE-pub ahead of print (current) - 12 Jul 2019
Number of pages13
Early online date12/07/19
Original languageEnglish


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.

Bibliographical note

© Cambridge University Press 2019. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.

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