Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Apr 9:365:l1476.
doi: 10.1136/bmj.l1476.

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

Brooke Levis  1 , Andrea Benedetti  2 , Brett D Thombs  3 ; DEPRESsion Screening Data (DEPRESSD) Collaboration
Collaborators, Affiliations
Meta-Analysis

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

Brooke Levis et al. BMJ. .

Erratum in

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.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICJME uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work other than that described above; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years with the following exceptions: NJ and SP received a grant, outside the submitted work, from the University of Calgary Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer; Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain; JCNC is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD, and Pfizer and has received sponsorships and honorariums for giving lectures and providing consultancy, and her affiliated institution has received research grants from these companies; UH was an advisory board member for Lundbeck and Servier, a consultant for Bayer Pharma, and a speaker for Roche Pharma and Servier and has received personal fees from Janssen, all outside the submitted work; MI has received a grant from Novartis Pharma and personal fees from Meiji, Mochida, Takeda, Novartis, Yoshitomi, Pfizer, Eisai, Otsuka, MSD, Technomics, and Sumitomo Dainippon, all outside of the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Nomograms of positive (top) and negative (bottom) predictive values for cut-off score 10 of the Patient Health Questionnaire-9 (PHQ-9) for major depression prevalence values of 5-25% for each reference standard category (semistructured diagnostic interviews, fully structured diagnostic interviews, and Mini International Neuropsychiatric Interview (MINI))
See this image and copyright information in PMC

References

    1. Thombs BD, Ziegelstein RC. Does depression screening improve depression outcomes in primary care? BMJ 2014;348:g1253. 10.1136/bmj.g1253 - DOI - PubMed
    1. Thombs BD, Coyne JC, Cuijpers P, et al. Rethinking recommendations for screening for depression in primary care. CMAJ 2012;184:413-8. 10.1503/cmaj.111035 - DOI - PMC - PubMed
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-13. 10.1046/j.1525-1497.2001.016009606.x - DOI - PMC - PubMed
    1. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 2002;32:1-7 10.3928/0048-5713-20020901-06. - DOI
    1. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999;282:1737-44. 10.1001/jama.282.18.1737 - DOI - PubMed

Publication types