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

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.

The Impact of the COVID-19 Pandemic on the Mental Health of Healthcare Workers in Italy: Analyzing the Role of Individual and Workplace-Level Factors in the Reopening Phase After Lockdown

“…Even when applying the same cut-offs adopted in Spain, we still found lower, although closer, estimates (22.3% of the HCWs screening positive at the PHQ-9 and 45.74% at the GHQ-12). Scores of 15 or greater on the PHQ-9 have high specificity, though low sensitivity, for major depressive disorder (sensitivity: 0.56, specificity: 0.96, PPV: 51%) ( 21 , 45 ). Similarly, scores ≥ 4 at the GHQ-12 using the bimodal scoring method indicate the likely presence of clinically significant psychological distress ( 24 ).…”

Sample size and precision of estimates in studies of depression screening tool accuracy: A meta‐research review of studies published in 2018–2021

“…Meta‐analyses of individual participant data, which combine datasets from primary studies, can assess all cut‐offs for all participants and, therefore, provide a solution to selective reporting (Levis et al., 2019). Large individual meta‐analyses of individual participant data have been conducted with some of the most commonly used depression screening tools, such as the EPDS (Levis, Negeri et al., 2020), the Hospital Anxiety and Depression Scale – Depression subscale (Wu et al., 2021), and the Patient Health Questionnaire‐2 and ‐9 (Levis et al., 2019; Levis, Sun et al, 2020; Negeri et al., 2021).…”

A Pilot Study to Evaluate the Efficacy of Self-Attachment to Treat Chronic Anxiety and/or Depression in Iranian Women

“…They have been developed in the UK for Improving Access to Psychological Therapies (IAPT) services, which provide evidence-based psychological therapies to people with anxiety disorders and depression. Their reliability and validity have been shown in [ 52 , 53 ] respectively; see also [ 54 ]. GAD-7 has seven questions related to anxiety symptoms experienced in the previous two weeks with a Likert scale 0–3 and scores as follows: 0–4 minimal anxiety, 5–9 mild anxiety, 10–14 moderate anxiety, 15–21 severe anxiety.…”