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Psychol Med. 2019 Jul 12:1-13. doi: 10.1017/S0033291719001314. [Epub ahead of print]

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

Author information

1
Lady Davis Institute for Medical Research, Jewish General Hospital,Montréal,Québec,Canada.
2
Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University,Montreal,Quebec,Canada.
3
Department of Clinical, Neuro and Developmental Psychology,Amsterdam Public Health Research Institute, Vrije Universiteit,Amsterdam,the Netherlands.
4
Hull York Medical School and the Department of Health Sciences,University of York,Heslington, York,UK.
5
Department of Medicine,Department of Health Research and Policy,Department of Biomedical Data Science,Department of Statistics,Stanford University, Stanford,California,USA.
6
Library, Concordia University,Montréal,Québec,Canada.
7
Department of Community Health Sciences,University of Calgary,Calgary, Alberta,Canada.
8
Department of Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland,USA.
9
Department of Psychiatry,Makerere University College of Health Sciences,Kampala,Uganda.
10
Department of General Practice and Primary Health Care,University of Auckland, Auckland,New Zealand.
11
Louis and Gabi Weisfeld School of Social Work, Bar Ilan University,Ramat Gan,Israel.
12
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences,Tehran,Iran.
13
Department of Rehabilitation Medicine,University of Washington,Seattle,Washington,USA.
14
Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University,Canberra,Australia.
15
Centre for Brain and Mental Health Research, University of Newcastle,New South Wales,Australia.
16
Department of Neurosciences and Behavior,Ribeirão Preto Medical School, University of São Paulo,Ribeirão Preto,Brazil.
17
Department of Medicine and Therapeutics,Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR),China.
18
Department of Pediatrics,University of North Carolina at Chapel Hill School of Medicine,Chapel Hill,North Carolina,USA.
19
Department of Psychiatry,University of Rochester Medical Center,New York,USA.
20
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht,Utrecht,the Netherlands.
21
Department of Psychiatry and Behavioral Sciences,University of Washington,Seattle, Washington,USA.
22
Department of Psychosomatic Medicine,Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin,Germany.
23
Department of Child & Adolescent Psychiatry,Institute of Mental Health,Singapore,Singapore.
24
Department of Epidemiology,Harvard T. H. Chan School of Public Health,Boston, Massachusetts,USA.
25
School of Social Work, University of Pittsburgh,Pittsburgh,Pennsylvania,USA.
26
Global and Community Mental Health Research Group,Department of Psychology, Faculty of Social Sciences,University of Macau, Macau Special Administrative Region,China.
27
City of Minneapolis Health Department,Minneapolis,Minnesota,USA.
28
Department of Medical Psychology,University Medical Center Hamburg-Eppendorf,Hamburg,Germany.
29
Depression Research Center of the German Depression Foundation and Department of Psychiatry,Psychosomatics and Psychotherapy, Goethe University, Frankfurt,Germany.
30
School of Psychology, University of Queensland,Brisbane,Queensland,Australia.
31
STAR-Stress, Anxiety & Resilience Consultants,Chicago,Illinois,USA.
32
Department of Psychiatry,University of Ioannina,Ioannina,Greece.
33
Department of Psychiatry, Faculty of Medicine,Shimane University,Shimane,Japan.
34
School of Psychology, University of New South Wales,Sydney,Australia.
35
Department of Psychological Medicine,Tan Tock Seng Hospital,Singapore,Singapore.
36
Department of Psychiatry,Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute,Amsterdam,the Netherlands.
37
Programme in Health Services & Systems Research, Duke-NUS Medical School,Singapore,Singapore.
38
Department of Psychiatry, Faculty of Medicine,Ramathibodi Hospital, Mahidol University,Bangkok,Thailand.
39
Department of Psychosomatic Medicine and Psychotherapy,University Medical Center Hamburg-Eppendorf,Hamburg,Germany.
40
Department of Nursing,St. Joseph's College,Standish,Maine,USA.
41
Department of Psychiatry,Faculty of Medicine and Health Sciences,Cancer Resource & Education Centre, Universiti Putra Malaysia,Serdang,Selangor,Malaysia.
42
Post-graduate Program in Epidemiology, Federal University of Pelotas,Pelotas,RS,Brazil.
43
Department of Clinical Psychology,Graduate School of Niigata Seiryo University,Niigata,Japan.
44
Department of Global Health and Social Medicine,Harvard Medical School,Boston,Massachusetts,USA.
45
Department of Epidemiology,Gillings School of Global Public Health, The University of North Carolina at Chapel Hill,Chapel Hill,North Carolina,USA.
46
Department of Adult Psychiatry,University Hospitals Leuven,Leuven,Belgium.
47
Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health,Rome,Italy.
48
Department of Psychiatry and Psychotherapy,University Medical Center Freiburg,Freiburg,Germany.
49
Division of Psychiatry,Royal Edinburgh Hospital, University of Edinburg,Edinburgh, Scotland,UK.
50
Department of Family Medicine,School of Medical Sciences, Universiti Sains Malaysia,Kelantan,Malaysia.
51
Allina Health,Minneapolis,Minnesota,USA.
52
Centre for Women's Mental Health, Royal Women's Hospital,Parkville,Melbourne,Australia.
53
School of Medicine and Public Health, University of Newcastle,New South Wales,Newcastle,Australia.
54
Department of General Practice,Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, location AMC,Amsterdam, the Netherlands.
55
Monash University,Melbourne,Australia.
56
Department of Epidemiology and Biostatistics,University of California San Francisco,San Francisco,California,USA.
57
Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London,London,UK.
58
Department of Neuropsychopharmacology,National Institute of Mental Health, National Center of Neurology and Psychiatry,Ogawa-Higashi,Kodaira,Tokyo,Japan.
59
Department of Epidemiology, Biostatistics and Occupational Health,McGill University,Montréal,Québec,Canada.

Abstract

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.

KEYWORDS:

Depression; PHQ-8; PHQ-9; diagnostic accuracy; individual participant data meta-analysis; meta-analysis; screening; systematic review

PMID:
31298180
PMCID:
PMC6954991
[Available on 2021-01-12]
DOI:
10.1017/S0033291719001314
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