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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
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6 2020
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Source: Psychol Med. 50(8):1368-1380
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Details:
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Alternative Title:Psychol Med
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Description: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 (2,097 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.
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Pubmed ID:31298180
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Pubmed Central ID:PMC6954991
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