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

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.

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Item Type:	Article
Authors/Creators:	This paper has 79 authors. You can scroll the list below to see them all or them all. Wu, Yin Levis, Brooke Riehm, Kira E Saadat, Nazanin Levis, Alexander W Azar, Marleine Rice, Danielle B Boruff, Jill Cuijpers, Pim Gilbody, Simon https://orcid.org/0000-0002-8236-6983 Ioannidis, John P A Kloda, Lorie A McMillan, Dean https://orcid.org/0000-0002-2901-8410 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, M D 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, M D Sung, Sharon Tan, Pei Lin Lynnette Turner, Alyna van Weert, Henk C White, Jennifer Whooley, Mary A Winkley, Kirsty Yamada, Mitsuhiko Benedetti, Andrea Thombs, Brett D
Copyright, Publisher and Additional Information:	© Cambridge University Press 2019. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.
Dates:	Published (online): 12 July 2019 Accepted: 14 May 2019
Institution:	The University of York
Academic Units:	The University of York > Faculty of Sciences (York) > Hull York Medical School (York)
Depositing User:	Pure (York)
Date Deposited:	23 Jul 2019 13:10
Last Modified:	16 Oct 2024 15:52
Published Version:	https://doi.org/10.1017/S0033291719001314
Status:	Published online
Refereed:	Yes
Identification Number:	10.1017/S0033291719001314
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:148897

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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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