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

Details

• Alternative Title:
  Psychol Med
• Personal Author:
  Wu, Yin ; Levis, Brooke ; Riehm, Kira E. ; Saadat, Nazanin ; Levis, Alexander W. ; Azar, Marleine ; Rice, Danielle B. ; Boruff, Jill ; Cuijpers, Pim ; Gilbody, Simon ; Ioannidis, John P.A. ; Kloda, Lorie A. ; McMillan, Dean ; Patten, Scott B. ; Shrier, Ian ; Ziegelstein, Roy C. ; Akena, Dickens H. ; Arroll, Bruce ; Ayalon, Liat ; Baradaran, Hamid R. ; Baron, Murray ; Bombardier, Charles H. ; Butterworth, Peter ; Carter, Gregory ; Chagas, Marcos H. ; Chan, Juliana C. N. ; Cholera, Rushina ; Conwell, Yeates ; de Man-van Ginkel, Janneke M. ; Fann, Jesse R. ; Fischer, Felix H. ; Fung, Daniel ; Gelaye, Bizu ; Goodyear-Smith, Felicity ; Greeno, Catherine G. ; Hall, Brian J. ; Harrison, Patricia A. ; Härter, Martin ; Hegerl, Ulrich ; Hides, Leanne ; Hobfoll, Stevan E. ; Hudson, Marie ; Hyphantis, Thomas ; Inagaki, Masatoshi ; Jetté, Nathalie ; Khamseh, Mohammad E. ; Kiely, Kim M. ; Kwan, Yunxin ; Lamers, Femke ; Liu, Shen-Ing ; Lotrakul, Manote ; Loureiro, Sonia R. ; Löwe, Bernd ; McGuire, Anthony ; Mohd-Sidik, Sherina ; Munhoz, Tiago N. ; Muramatsu, Kumiko ; Osório, Flávia L. ; Patel, Vikram ; Pence, Brian W. ; Persoons, Philippe ; Picardi, Angelo ; Reuter, Katrin ; Rooney, Alasdair G. ; Santos, Iná S. ; Shaaban, Juwita ; Sidebottom, Abbey ; Simning, Adam ; Stafford, Lesley ; Sung, Sharon ; Lynnette Tan, Pei Lin ; Turner, Alyna ; van Weert, Henk C. ; White, Jennifer ; Whooley, Mary A. ; Winkley, Kirsty ; Yamada, Mitsuhiko ; Benedetti, Andrea ; Thombs, Brett D.
• 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.
  
  
• Subjects:
  Depressive Disorder, Major Female Humans Interviews As Topic Male Mass Screening Middle Aged Patient Health Questionnaire Sensitivity And Specificity
• Source:
  Psychol Med. 50(8):1368-1380
• Pubmed ID:
  31298180
• Pubmed Central ID:
  PMC6954991
• Document Type:
  Journal Article
• Funding:
  R36 HS018246/HS/AHRQ HHSUnited States/ ; R34 MH072925/MH/NIMH NIH HHSUnited States/ ; R01 MH069666/MH/NIMH NIH HHSUnited States/ ; R01 MH073687/MH/NIMH NIH HHSUnited States/ ; TL1 RR024135/RR/NCRR NIH HHSUnited States/ ; MR/J000914/1/MRC_/Medical Research CouncilUnited Kingdom/ ; F30 MH096664/MH/NIMH NIH HHSUnited States/ ; RP-PG-0606-1142/DH_/Department of HealthUnited Kingdom/ ; MRF_C0396/MRF/MRFUnited Kingdom/ ; FRN 83518/CIHRCanada/ ; R49CE002093/ACL/ACL HHSUnited States/ ; R01 HL079235/HL/NHLBI NIH HHSUnited States/ ; R49 CE002093/CE/NCIPC CDC HHSUnited States/ ; R34 MH084673/MH/NIMH NIH HHSUnited States/ ; P30 DK050456/DK/NIDDK NIH HHSUnited States/ ; T37 MD001449/MD/NIMHD NIH HHSUnited States/ ; T32 GM007356/GM/NIGMS NIH HHSUnited States/ ; K02 MH065919/MH/NIMH NIH HHSUnited States/ ; R24 MH071604/MH/NIMH NIH HHSUnited States/
• Volume:
  50
• Issue:
  8
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:1ccbcb3bc062599e3079328df0acb737978612b684c9ff88540da09d8bdf66c0
• Download URL:
  https://stacks.cdc.gov/view/cdc/84248/cdc_84248_DS1.pdf
• File Type:
  [PDF - 718.21 KB ]