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.
| Original language | English |
|---|---|
| Pages (from-to) | 1368-1380 |
| Number of pages | 13 |
| Journal | Psychological Medicine |
| Volume | 50 |
| Issue number | 8 |
| Early online date | 12 Jul 2019 |
| DOIs | |
| Publication status | Published - Jun 2020 |
Keywords
- Depression
- diagnostic accuracy
- individual participant data meta-analysis
- meta-analysis
- PHQ-8
- PHQ-9
- screening
- systematic review
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In: Psychological Medicine, Vol. 50, No. 8, 06.2020, p. 1368-1380.
Research output: Contribution to journal › Review article › peer-review
TY - JOUR
T1 - Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9
T2 - a systematic review and individual participant data meta-analysis
AU - Wu, Yin
AU - Levis, Brooke
AU - Riehm, Kira E
AU - Saadat, Nazanin
AU - Levis, Alexander W
AU - Azar, Marleine
AU - Rice, Danielle B
AU - Boruff, Jill
AU - Cuijpers, Pim
AU - Gilbody, Simon
AU - Ioannidis, John P A
AU - Kloda, Lorie A
AU - McMillan, Dean
AU - Patten, Scott B
AU - Shrier, Ian
AU - Ziegelstein, Roy C
AU - Akena, Dickens H
AU - Arroll, Bruce
AU - Ayalon, Liat
AU - Baradaran, Hamid R
AU - Baron, Murray
AU - Bombardier, Charles H
AU - Butterworth, Peter
AU - Carter, Gregory
AU - Chagas, Marcos H
AU - Chan, Juliana C N
AU - Cholera, Rushina
AU - Conwell, Yeates
AU - de Man-van Ginkel, Janneke M
AU - Fann, Jesse R
AU - Fischer, Felix H
AU - Fung, Daniel
AU - Gelaye, Bizu
AU - Goodyear-Smith, Felicity
AU - Greeno, Catherine G
AU - Hall, Brian J
AU - Harrison, Patricia A
AU - Härter, Martin
AU - Hegerl, Ulrich
AU - Hides, Leanne
AU - Hobfoll, Stevan E
AU - Hudson, Marie
AU - Hyphantis, Thomas
AU - Inagaki, M D
AU - Jetté, Nathalie
AU - Khamseh, Mohammad E
AU - Kiely, Kim M
AU - Kwan, Yunxin
AU - Lamers, Femke
AU - Liu, Shen-Ing
AU - Lotrakul, Manote
AU - Loureiro, Sonia R
AU - Löwe, Bernd
AU - McGuire, Anthony
AU - Mohd-Sidik, Sherina
AU - Munhoz, Tiago N
AU - Muramatsu, Kumiko
AU - Osório, Flávia L
AU - Patel, Vikram
AU - Pence, Brian W
AU - Persoons, Philippe
AU - Picardi, Angelo
AU - Reuter, Katrin
AU - Rooney, Alasdair G
AU - Santos, Iná S
AU - Shaaban, Juwita
AU - Sidebottom, Abbey
AU - Simning, Adam
AU - Stafford, M D
AU - Sung, Sharon
AU - Tan, Pei Lin Lynnette
AU - Turner, Alyna
AU - van Weert, Henk C
AU - White, Jennifer
AU - Whooley, Mary A
AU - Winkley, Kirsty
AU - Yamada, Mitsuhiko
AU - Benedetti, Andrea
AU - Thombs, Brett D
N1 - Funding Information: Acknowledgements. This study was funded by the Canadian Institutes of Funding Information: Health Research (KRS-134297; PCG-155468). Dr Wu was supported by an Utting Postdoctoral Fellowship from the Jewish General Hospital, Montreal, Quebec. Drs Benedetti and Thombs were supported by Fonds de recherche du Québec – Santé (FRQS) researcher salary awards. Ms. Levis was supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship doctoral award. Ms. Riehm and Ms. Saadat were supported by CIHR Frederick Banting and Charles Best Canadian Graduate Scholarships – Master’s Awards. Mr. Levis and Ms. Azar were supported by FRQS Masters Training Awards. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. Collection of data for the study by Arroll et al. was supported by a project grant from the Health Research Council of New Zealand. Data collection for the study by Ayalon et al. was supported from a grant from Lundbeck International. The primary study by Khamseh et al. was supported by a grant (M-288) from Tehran University of Medical Sciences. The primary study by Bombardier et al. was supported by the Department of Education, National Institute on Disability and Rehabilitation Research, Spinal Cord Injury Model Systems: University of Washington (grant no. H133N060033), Baylor College of Medicine (grant no. H133N060003), and University of Michigan (grant no. H133N060032). Dr Butterworth was supported by Australian Research Council Future Fellowship FT130101444. Dr Cholera was supported by a United States National Institute of Mental Health (NIMH) grant (5F30MH096664), and the United States National Institutes of Health (NIH) Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Heart, Blood, and Lung Institute, and the NIH Office of Research for Women’s Health through the Fogarty Global Health Fellows Program Consortium (1R25TW00934001) and the American Recovery and Reinvestment Act. Dr Conwell received support from NIMH (R24MH071604) and the Centers for Disease Control and Prevention (R49 CE002093). The primary studies by Amoozegar and by Fiest et al. were funded by the Alberta Health Services, the University of Calgary Faculty of Medicine, and the Hotchkiss Brain Institute. The primary study by Fischer et al. was funded by the German Federal Ministry of Education and Research (01GY1150). Dr Fischler was supported by a grant from the Belgian Ministry of Public Health and Social Affairs and a restricted grant from Pfizer Belgium. Data for the primary study by Gelaye et al. was supported by grant from the NIH (T37 MD001449). Collection of data for the primary study by Gjerdingen et al. was supported by grants from the NIMH (R34 MH072925, K02 MH65919, P30 DK50456). The primary study by Eack et al. was funded by the NIMH (R24 MH56858). Collection of data provided by Drs Härter and Reuter was supported by the Federal Ministry of Education and Research (grants No. 01 GD 9802/4 and 01 GD 0101) and by the Federation of German Pension Insurance Institute. Collection of data for the primary study by Hobfoll et al. was made possible in part from grants from NIMH (RO1 MH073687) and the Ohio Board of Regents. Dr Hall received support from a grant awarded by the Research and Development Administration Office, University of Macau (MYRG2015-00109-FSS). The primary study by Hides et al. was funded by the Perpetual Trustees, Flora and Frank Leith Charitable Trust, Jack Brockhoff Foundation, Grosvenor Settlement, Sunshine Foundation and Danks Trust. The primary study by Henkel et al. was funded by the German Ministry of Research and Education. Data for the study by Razykov et al. was collected by the Canadian Scleroderma Research Group, which was funded by the CIHR (FRN 83518), the Scleroderma Society of Canada, the Scleroderma Society of Ontario, the Scleroderma Society of Saskatchewan, Sclérodermie Québec, the Cure Scleroderma Foundation, Inova Diagnostics Inc., Euroimmun, FRQS, the Canadian Arthritis Network, and the Lady Davis Institute of Medical Research of the Jewish General Hospital, Montreal, QC. Dr Hudson was supported by a FRQS Senior Investigator Award. Collection of data for the primary study by Hyphantis et al. was supported by grant from the National Strategic Reference Framework, European Union, and the Greek Ministry of Education, Lifelong Learning and Religious Affairs (ARISTEIA-ABREVIATE, 1259). The primary study by Inagaki et al. was supported by the Ministry of Health, Labour and Welfare, Japan. Dr Jetté was supported by a Canada Research Chair in Neurological Health Services Research. Collection of data for the primary study by Kiely et al. was supported by National Health and Medical Research Council (grant number 1002160) and Safe Work Australia. Dr Kiely was supported by funding from an Australian National Health and Medical Research Council fellowship (grant number 1088313). The primary study by Lamers et al. was funded by the Netherlands Organisation for Health Research and development (grant number 945-03-047). The primary study by Liu et al. was funded by a grant from the National Health Research Institute, Republic of China (NHRI-EX97-9706PI). The primary study by Lotrakul et al. was supported by the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (grant number 49086). Dr Bernd Löwe received research grants from Pfizer, Germany, and from the medical faculty of the University of Heidelberg, Germany (project 121/2000) for the study by Gräfe et al. The primary study by Mohd-Sidik et al. was funded under the Research University Grant Scheme from Universiti Putra Malaysia, Malaysia and the Postgraduate Research Student Support Accounts of the University of Auckland, New Zealand. The primary study by Santos et al. was funded by the National Program for Centers of Excellence (PRONEX/FAPERGS/CNPq, Brazil). The primary study by Muramatsu et al. was supported by an educational grant from Pfizer US Pharmaceutical Inc. Collection of primary data for the study by Dr Pence was provided by NIMH (R34MH084673). The primary studies by Osório et al. were funded by Reitoria de Pesquisa da Universidade de São Paulo (grant number 09.1.01689.17.7) and Banco Santander (grant number 10.1.01232.17.9). Dr Osório was supported by Productivity Grants (PQ-CNPq-2 -number 301321/2016-7). The primary study by Picardi et al. was supported by funds for current research from the Italian Ministry of Health. Dr Persoons was supported by a grant from the Belgian Ministry of Public Health and Social Affairs and a restricted grant from Pfizer Belgium. Dr Shaaban was supported by funding from Universiti Sains Malaysia. The primary study by Rooney et al. was funded by the United Kingdom National Health Service Lothian Neuro-Oncology Endowment Fund. The primary study by Sidebottom et al. was funded by a grant from the United States Department of Health and Human Services, Health Resources and Services Administration (grant number R40MC07840). Simning et al.’s research was supported in part by grants from the NIH (T32 GM07356), Agency for Healthcare Research and Quality (R36 HS018246), NIMH (R24 MH071604), and the National Center for Research Resources (TL1 RR024135). Dr Stafford received PhD scholarship funding from the University of Melbourne. Collection of data for the studies by Turner et al. were funded by a bequest from Jennie Thomas through the Hunter Medical Research Institute. Collection of data for the primary study by Williams et al. was supported by a NIMH grant to Dr Marsh (RO1-MH069666). The primary study by Thombs et al. was done with data from the Heart and Soul Study (PI Mary Whooley). The Heart and Soul Study was funded by the Department of Veterans Epidemiology Merit Review Program, the Department of Veterans Affairs Health Services Research and Development service, the National Heart Lung and Blood Institute (R01 HL079235), the American Federation for Aging Research, the Robert Wood Johnson Foundation, and the Ischemia Research and Education Foundation. Dr Thombs was supported by an Investigator Award from the Arthritis Society. The primary study by Twist et al. was funded by the UK National Institute for Health Research under its Programme Grants for Applied Research Programme (grant reference number RP-PG-0606-1142). The study by Wittkampf et al. was funded by The Netherlands Organization for Health Research and Development (ZonMw) Mental Health Program (nos. 100.003.005 and 100.002.021) and the Academic Medical Center/University of Amsterdam. Collection of data for the primary study by Zhang et al. was supported by the European Foundation for Study of Diabetes, the Chinese Diabetes Society, Lilly Foundation, Asia Diabetes Foundation and Liao Wun Yuk Diabetes Memorial Fund. No other authors reported funding for primary studies or for their work on the present study. Publisher Copyright: Copyright © Cambridge University Press 2019.
PY - 2020/6
Y1 - 2020/6
N2 - 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.
AB - 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.
KW - Depression
KW - diagnostic accuracy
KW - individual participant data meta-analysis
KW - meta-analysis
KW - PHQ-8
KW - PHQ-9
KW - screening
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85069052660&partnerID=8YFLogxK
U2 - 10.1017/S0033291719001314
DO - 10.1017/S0033291719001314
M3 - Review article
C2 - 31298180
SN - 0033-2917
VL - 50
SP - 1368
EP - 1380
JO - Psychological Medicine
JF - Psychological Medicine
IS - 8
ER -