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

Published online by Cambridge University Press:  12 July 2019

Yin Wu
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada Department of Psychiatry, McGill University, Montréal, Québec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
Brooke Levis
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
Kira E. Riehm
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
Nazanin Saadat
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
Alexander W. Levis
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
Marleine Azar
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
Danielle B. Rice
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada Department of Psychology, McGill University, Montréal, Québec, Canada
Jill Boruff
Affiliation:
Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
Pim Cuijpers
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
Simon Gilbody
Affiliation:
Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK
John P.A. Ioannidis
Affiliation:
Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, California, USA
Lorie A. Kloda
Affiliation:
Library, Concordia University, Montréal, Québec, Canada
Dean McMillan
Affiliation:
Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK
Scott B. Patten
Affiliation:
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
Ian Shrier
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
Roy C. Ziegelstein
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Dickens H. Akena
Affiliation:
Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
Bruce Arroll
Affiliation:
Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
Liat Ayalon
Affiliation:
Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
Hamid R. Baradaran
Affiliation:
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
Murray Baron
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada Department of Medicine, McGill University, Montréal, Québec, Canada
Charles H. Bombardier
Affiliation:
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
Peter Butterworth
Affiliation:
Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
Gregory Carter
Affiliation:
Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia
Marcos H. Chagas
Affiliation:
Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
Juliana C. N. Chan
Affiliation:
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China
Rushina Cholera
Affiliation:
Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
Yeates Conwell
Affiliation:
Department of Psychiatry, University of Rochester Medical Center, New York, USA
Janneke M. de Man-van Ginkel
Affiliation:
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
Jesse R. Fann
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
Felix H. Fischer
Affiliation:
Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Berlin, Germany
Daniel Fung
Affiliation:
Department of Child & Adolescent Psychiatry, Institute of Mental Health, Singapore, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
Bizu Gelaye
Affiliation:
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
Felicity Goodyear-Smith
Affiliation:
Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
Catherine G. Greeno
Affiliation:
School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Brian J. Hall
Affiliation:
Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau Special Administrative Region, China Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Patricia A. Harrison
Affiliation:
City of Minneapolis Health Department, Minneapolis, Minnesota, USA
Martin Härter
Affiliation:
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Ulrich Hegerl
Affiliation:
Depression Research Center of the German Depression Foundation and Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
Leanne Hides
Affiliation:
School of Psychology, University of Queensland, Brisbane, Queensland, Australia
Stevan E. Hobfoll
Affiliation:
STAR-Stress, Anxiety & Resilience Consultants, Chicago, Illinois, USA
Marie Hudson
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada Department of Medicine, McGill University, Montréal, Québec, Canada
Thomas Hyphantis
Affiliation:
Department of Psychiatry, University of Ioannina, Ioannina, Greece
Masatoshi Inagaki
Affiliation:
Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan
Nathalie Jetté
Affiliation:
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Mohammad E. Khamseh
Affiliation:
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
Kim M. Kiely
Affiliation:
School of Psychology, University of New South Wales, Sydney, Australia Neuroscience Research Australia, Sydney, Australia
Yunxin Kwan
Affiliation:
Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore, Singapore
Femke Lamers
Affiliation:
Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
Shen-Ing Liu
Affiliation:
Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan Department of Medicine, Mackay Medical College, Taipei, Taiwan
Manote Lotrakul
Affiliation:
Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Sonia R. Loureiro
Affiliation:
Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
Bernd Löwe
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Anthony McGuire
Affiliation:
Department of Nursing, St. Joseph's College, Standish, Maine, USA
Sherina Mohd-Sidik
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Cancer Resource & Education Centre, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Tiago N. Munhoz
Affiliation:
Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
Kumiko Muramatsu
Affiliation:
Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan
Flávia L. Osório
Affiliation:
Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil
Vikram Patel
Affiliation:
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
Brian W. Pence
Affiliation:
Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
Philippe Persoons
Affiliation:
Department of Adult Psychiatry, University Hospitals Leuven, Leuven, Belgium Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
Angelo Picardi
Affiliation:
Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
Katrin Reuter
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
Alasdair G. Rooney
Affiliation:
Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, Scotland, UK
Iná S. Santos
Affiliation:
Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
Juwita Shaaban
Affiliation:
Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
Abbey Sidebottom
Affiliation:
Allina Health, Minneapolis, Minnesota, USA
Adam Simning
Affiliation:
Department of Psychiatry, University of Rochester Medical Center, New York, USA
Lesley Stafford
Affiliation:
Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Melbourne, Australia Melbourne School of Psychological Sciences, University of Melbourne, Australia
Sharon Sung
Affiliation:
Department of Child & Adolescent Psychiatry, Institute of Mental Health, Singapore, Singapore Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
Pei Lin Lynnette Tan
Affiliation:
Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore, Singapore
Alyna Turner
Affiliation:
School of Medicine and Public Health, University of Newcastle, New South Wales, Newcastle, Australia IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
Henk C. van Weert
Affiliation:
Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
Jennifer White
Affiliation:
Monash University, Melbourne, Australia
Mary A. Whooley
Affiliation:
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA Department of Medicine, Veterans Affairs Medical Center, San Francisco, California, USA Department of Medicine, University of California San Francisco, San Francisco, California, USA
Kirsty Winkley
Affiliation:
Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
Mitsuhiko Yamada
Affiliation:
Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ogawa-Higashi, Kodaira, Tokyo, Japan
Andrea Benedetti
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada Department of Medicine, McGill University, Montréal, Québec, Canada Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada
Brett D. Thombs
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada Department of Psychiatry, McGill University, Montréal, Québec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada Department of Psychology, McGill University, Montréal, Québec, Canada Department of Medicine, McGill University, Montréal, Québec, Canada Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada
Corresponding

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2019

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