Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression: updated systematic review and individual participant data meta-analysis.

Negeri, ZF; Levis, B; Sun, Y; He, C; Krishnan, A; Wu, Y; Bhandari, PM; Neupane, D; Brehaut, E; Benedetti, A; Thombs, BD; Depression Screening Data (DEPRESSD) PHQ Group,

Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression: updated systematic review and individual participant data meta-analysis.

Negeri, ZF Levis, B Sun, Y He, C Krishnan, A Wu, Y Bhandari, PM Neupane, D Brehaut, E Benedetti, A Thombs, BD Depression Screening Data (DEPRESSD) PHQ Group,

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Publisher:: BMJ Publishing Group
Publication Type:: Journal Article
Citation:: BMJ: British Medical Journal, 2021, 375, pp. n2183-n2183
Issue Date:: 2021-10-05

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Field	Value	Language
dc.contributor.author	Negeri, ZF
dc.contributor.author	Levis, B
dc.contributor.author	Sun, Y
dc.contributor.author	He, C
dc.contributor.author	Krishnan, A
dc.contributor.author	Wu, Y
dc.contributor.author	Bhandari, PM
dc.contributor.author	Neupane, D
dc.contributor.author	Brehaut, E
dc.contributor.author	Benedetti, A
dc.contributor.author	Thombs, BD
dc.contributor.author	Depression Screening Data (DEPRESSD) PHQ Group,
dc.date.accessioned	2022-01-21T11:13:20Z
dc.date.available	2022-01-21T11:13:20Z
dc.date.issued	2021-10-05
dc.identifier.citation	BMJ: British Medical Journal, 2021, 375, pp. n2183-n2183
dc.identifier.issn	0959-535X
dc.identifier.issn	1756-1833
dc.identifier.uri	http://hdl.handle.net/10453/153432
dc.description.abstract	Objective To update a previous individual participant data meta-analysis and determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9), the most commonly used depression screening tool in general practice, for detecting major depression overall and by study or participant subgroups. Design Systematic review and individual participant data meta-analysis. Data sources Medline, Medline In-Process, and Other Non-Indexed Citations via Ovid, PsycINFO, Web of Science searched through 9 May 2018. Review methods Eligible studies administered the PHQ-9 and classified current major depression status using a validated semistructured diagnostic interview (designed for clinician administration), fully structured interview (designed for lay administration), or the Mini International Neuropsychiatric Interview (MINI; a brief interview designed for lay administration). A bivariate random effects meta-analytic model was used to obtain point and interval estimates of pooled PHQ-9 sensitivity and specificity at cut-off values 5-15, separately, among studies that used semistructured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual), fully structured interviews (eg, Composite International Diagnostic Interview), and the MINI. Meta-regression was used to investigate whether PHQ-9 accuracy correlated with reference standard categories and participant characteristics. Results Data from 44 503 total participants (27 146 additional from the update) were obtained from 100 of 127 eligible studies (42 additional studies; 79% eligible studies; 86% eligible participants). Among studies with a semistructured interview reference standard, pooled PHQ-9 sensitivity and specificity (95% confidence interval) at the standard cut-off value of ≥10, which maximised combined sensitivity and specificity, were 0.85 (0.79 to 0.89) and 0.85 (0.82 to 0.87), respectively. Specificity was similar across reference standards, but sensitivity in studies with semistructured interviews was 7-24% (median 21%) higher than with fully structured reference standards and 2-14% (median 11%) higher than with the MINI across cut-off values. Across reference standards and cut-off values, specificity was 0-10% (median 3%) higher for men and 0-12 (median 5%) higher for people aged 60 or older. Conclusions Researchers and clinicians could use results to determine outcomes, such as total number of positive screens and false positive screens, at different PHQ-9 cut-off values for different clinical settings using the knowledge translation tool at www.depressionscreening100.com/phq. Study registration PROSPERO CRD42014010673.
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ Publishing Group
dc.relation.ispartof	BMJ: British Medical Journal
dc.relation.isbasedon	10.1136/bmj.n2183
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services
dc.subject.classification	General & Internal Medicine
dc.subject.mesh	Adult
dc.subject.mesh	Age Factors
dc.subject.mesh	Depressive Disorder, Major
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Middle Aged
dc.subject.mesh	Patient Health Questionnaire
dc.subject.mesh	Psychiatric Status Rating Scales
dc.subject.mesh	Reference Standards
dc.subject.mesh	ROC Curve
dc.subject.mesh	Sex Factors
dc.subject.mesh	Adult
dc.subject.mesh	Age Factors
dc.subject.mesh	Depressive Disorder, Major
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Middle Aged
dc.subject.mesh	Patient Health Questionnaire
dc.subject.mesh	Psychiatric Status Rating Scales
dc.subject.mesh	ROC Curve
dc.subject.mesh	Reference Standards
dc.subject.mesh	Sex Factors
dc.subject.mesh	Humans
dc.subject.mesh	ROC Curve
dc.subject.mesh	Depressive Disorder, Major
dc.subject.mesh	Psychiatric Status Rating Scales
dc.subject.mesh	Age Factors
dc.subject.mesh	Sex Factors
dc.subject.mesh	Reference Standards
dc.subject.mesh	Adult
dc.subject.mesh	Middle Aged
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Patient Health Questionnaire
dc.title	Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression: updated systematic review and individual participant data meta-analysis.
dc.type	Journal Article
utslib.citation.volume	375
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2022-01-21T11:13:19Z
pubs.publication-status	Published
pubs.volume	375

Abstract:

Objective To update a previous individual participant data meta-analysis and determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9), the most commonly used depression screening tool in general practice, for detecting major depression overall and by study or participant subgroups. Design Systematic review and individual participant data meta-analysis. Data sources Medline, Medline In-Process, and Other Non-Indexed Citations via Ovid, PsycINFO, Web of Science searched through 9 May 2018. Review methods Eligible studies administered the PHQ-9 and classified current major depression status using a validated semistructured diagnostic interview (designed for clinician administration), fully structured interview (designed for lay administration), or the Mini International Neuropsychiatric Interview (MINI; a brief interview designed for lay administration). A bivariate random effects meta-analytic model was used to obtain point and interval estimates of pooled PHQ-9 sensitivity and specificity at cut-off values 5-15, separately, among studies that used semistructured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual), fully structured interviews (eg, Composite International Diagnostic Interview), and the MINI. Meta-regression was used to investigate whether PHQ-9 accuracy correlated with reference standard categories and participant characteristics. Results Data from 44 503 total participants (27 146 additional from the update) were obtained from 100 of 127 eligible studies (42 additional studies; 79% eligible studies; 86% eligible participants). Among studies with a semistructured interview reference standard, pooled PHQ-9 sensitivity and specificity (95% confidence interval) at the standard cut-off value of ≥10, which maximised combined sensitivity and specificity, were 0.85 (0.79 to 0.89) and 0.85 (0.82 to 0.87), respectively. Specificity was similar across reference standards, but sensitivity in studies with semistructured interviews was 7-24% (median 21%) higher than with fully structured reference standards and 2-14% (median 11%) higher than with the MINI across cut-off values. Across reference standards and cut-off values, specificity was 0-10% (median 3%) higher for men and 0-12 (median 5%) higher for people aged 60 or older. Conclusions Researchers and clinicians could use results to determine outcomes, such as total number of positive screens and false positive screens, at different PHQ-9 cut-off values for different clinical settings using the knowledge translation tool at www.depressionscreening100.com/phq. Study registration PROSPERO CRD42014010673.

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http://hdl.handle.net/10453/153432