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Meta-Analysis
. 2020 Jun;50(8):1368-1380.
doi: 10.1017/S0033291719001314. Epub 2019 Jul 12.

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

Yin Wu  1   2   3 , Brooke Levis  1   3 , Kira E Riehm  1 , Nazanin Saadat  1 , Alexander W Levis  1 , Marleine Azar  1 , Danielle B Rice  1   4 , Jill Boruff  5 , Pim Cuijpers  6 , Simon Gilbody  7 , John P A Ioannidis  8 , Lorie A Kloda  9 , Dean McMillan  7 , Scott B Patten  10   11 , Ian Shrier  1   3 , Roy C Ziegelstein  12 , Dickens H Akena  13 , Bruce Arroll  14 , Liat Ayalon  15 , Hamid R Baradaran  16   17 , Murray Baron  1   18 , Charles H Bombardier  19 , Peter Butterworth  20   21 , Gregory Carter  22 , Marcos H Chagas  23 , Juliana C N Chan  24   25   26 , Rushina Cholera  27 , Yeates Conwell  28 , Janneke M de Man-van Ginkel  29 , Jesse R Fann  30 , Felix H Fischer  31 , Daniel Fung  32   33   34   35 , Bizu Gelaye  36 , Felicity Goodyear-Smith  14 , Catherine G Greeno  37 , Brian J Hall  38   39 , Patricia A Harrison  40 , Martin Härter  41 , Ulrich Hegerl  42 , Leanne Hides  43 , Stevan E Hobfoll  44 , Marie Hudson  1   18 , Thomas Hyphantis  45 , Masatoshi Inagaki  46 , Nathalie Jetté  10   11   47 , Mohammad E Khamseh  16 , Kim M Kiely  48   49 , Yunxin Kwan  50 , Femke Lamers  51 , Shen-Ing Liu  35   52   53   54 , Manote Lotrakul  55 , Sonia R Loureiro  23 , Bernd Löwe  56 , Anthony McGuire  57 , Sherina Mohd-Sidik  58 , Tiago N Munhoz  59 , Kumiko Muramatsu  60 , Flávia L Osório  23   61 , Vikram Patel  62   63 , Brian W Pence  64 , Philippe Persoons  65   66 , Angelo Picardi  67 , Katrin Reuter  68 , Alasdair G Rooney  69 , Iná S Santos  59 , Juwita Shaaban  70 , Abbey Sidebottom  71 , Adam Simning  28 , Lesley Stafford  72   73 , Sharon Sung  32   35 , Pei Lin Lynnette Tan  50 , Alyna Turner  74   75 , Henk C van Weert  76 , Jennifer White  77 , Mary A Whooley  78   79   80 , Kirsty Winkley  81 , Mitsuhiko Yamada  82 , Andrea Benedetti  3   18   83 , Brett D Thombs  1   2   3   4   18   84
Affiliations
Meta-Analysis

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

Yin Wu et al. Psychol Med. 2020 Jun.

Erratum in

  • Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis - ERRATUM.
    Wu Y, Levis B, Riehm KE, Saadat N, Levis AW, Azar M, Rice DB, Boruff J, Cuijpers P, Gilbody S, Ioannidis JPA, Kloda LA, McMillan D, Patten SB, Shrier I, Ziegelstein RC, Akena DH, Arroll B, Ayalon L, Baradaran HR, Baron M, Bombardier CH, Butterworth P, Carter G, Chagas MH, Chan JCN, Cholera R, Conwell Y, de Manvan Ginkel JM, Fann JR, Fischer FH, Fung D, Gelaye B, Goodyear-Smith F, Greeno CG, Hall BJ, Harrison PA, Härter M, Hegerl U, Hides L, Hobfoll SE, Hudson M, Hyphantis T, Inagaki M, Jetté N, Khamseh ME, Kiely KM, Kwan Y, Lamers F, Liu SI, Lotrakul M, Loureiro SR, Löwe B, McGuire A, Mohd-Sidik S, Munhoz TN, Muramatsu K, Osório FL, Patel V, Pence BW, Persoons P, Picardi A, Reuter K, Rooney AG, Santos IS, Shaaban J, Sidebottom A, Simning A, Stafford L, Sung S, Tan PLL, Turner A, van Weert HC, White J, Whooley MA, Winkley K, Yamada M, Benedetti A, Thombs BD. Wu Y, et al. Psychol Med. 2020 Dec;50(16):2816. doi: 10.1017/S0033291719002137. Epub 2019 Aug 19. Psychol Med. 2020. PMID: 31423953 No abstract available.

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.

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Conflict of interest statement

Conflict of Interest.

Drs. Jetté and Patten declare that they 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. Dr. Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr. Hegerl declares that within the last three years, he was an advisory board member for Lundbeck and Servier; a consultant for Bayer Pharma; a speaker for Roche Pharma and Servier; and received personal fees from Janssen, all outside the submitted work. Dr. Inagaki declares that he 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. All authors declare no other relationships or activities that could appear to have influenced the submitted work. No funder had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Figures

Fig 1
Fig 1
(a) ROC curves for PHQ-8 and PHQ-9 among studies that used a semi-structured reference standard. (b) ROC curves for PHQ-8 and PHQ-9 among studies that used a fully structured reference standard (MINI excluded). (c) ROC curves for PHQ-8 and PHQ-9 among studies that used the MINI reference standard
Fig 2
Fig 2
Forest plots of the difference in sensitivity and specificity estimates at cutoff 10 between PHQ-8 and PHQ-9 among all studiesa (N Studies = 54b; N Participants = 16,742; N major depression = 2,097)c a τ2 for the difference of sensitivity and specificity were both <0·001. b The reference numbers refer to Supplementary Material References. c Amoozegar, 2017 [1] and Lambert, 2015 [13] were unpublished at the time of the electronic database search then subsequently published.
See this image and copyright information in PMC

References

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