Laura Manea1, Simon Gilbody1, Catherine Hewitt2, Alice North2, Faye Plummer2, Rachel Richardson2, Brett D Thombs3, Bethany Williams2, Dean McMillan4. 1. Hull York Medical School and Department of Health Sciences, University of York, United Kingdom. 2. Department of Health Sciences, University of York, United Kingdom. 3. Hull York Medical School and Department of Health Sciences, University of York, United Kingdom; Department of Health Sciences, University of York, United Kingdom. 4. Hull York Medical School and Department of Health Sciences, University of York, United Kingdom. Electronic address: dean.mcmillan@york.ac.uk.
Abstract
BACKGROUND: There is interest in the use of very brief instruments to identify depression because of the advantages they offer in busy clinical settings. The PHQ-2, consisting of two questions relating to core symptoms of depression (low mood and loss of interest or pleasure), is one such instrument. METHOD: A systematic review was conducted to identify studies that had assessed the diagnostic performance of the PHQ-2 to detect major depression. Embase, MEDLINE, PsychINFO and grey literature databases were searched. Reference lists of included studies and previous relevant reviews were also examined. Studies were included that used the standard scoring system of the PHQ-2, assessed its performance against a gold-standard diagnostic interview and reported data on its performance at the recommended (≥3) or an alternative cut-off point (≥2). After assessing heterogeneity, where appropriate, data from studies were combined using bivariate diagnostic meta-analysis to derive sensitivity, specificity, likelihood ratios and diagnostic odds ratios. RESULTS: 21 studies met inclusion criteria totalling N=11,175 people out of which 1529 had major depressive disorder according to a gold standard. 19 of the 21 included studies reported data for a cut-off point of ≥3. Pooled sensitivity was 0.76 (95% CI =0.68-0.82), pooled specificity was 0.87 (95% CI =0.82-0.90). However there was substantial heterogeneity at this cut-off (I(2)=81.8%). 17 studies reported data on the performance of the measure at cut-off point ≥2. Heterogeneity was I(2)=43.2% pooled sensitivity at this cut-off point was 0.91 (95% CI =0.85-0.94), and pooled specificity was 0.70 (95% CI =0.64-0.76). CONCLUSION: The generally lower sensitivity of the PHQ-2 at cut-off ≥3 than the original validation study (0.83) suggests that ≥2 may be preferable if clinicians want to ensure that few cases of depression are missed. However, in situations in which the prevalence of depression is low, this may result in an unacceptably high false-positive rate because of the associated modest specificity. These results, however, need to be interpreted with caution given the possibility of selectively reported cut-offs.
BACKGROUND: There is interest in the use of very brief instruments to identify depression because of the advantages they offer in busy clinical settings. The PHQ-2, consisting of two questions relating to core symptoms of depression (low mood and loss of interest or pleasure), is one such instrument. METHOD: A systematic review was conducted to identify studies that had assessed the diagnostic performance of the PHQ-2 to detect major depression. Embase, MEDLINE, PsychINFO and grey literature databases were searched. Reference lists of included studies and previous relevant reviews were also examined. Studies were included that used the standard scoring system of the PHQ-2, assessed its performance against a gold-standard diagnostic interview and reported data on its performance at the recommended (≥3) or an alternative cut-off point (≥2). After assessing heterogeneity, where appropriate, data from studies were combined using bivariate diagnostic meta-analysis to derive sensitivity, specificity, likelihood ratios and diagnostic odds ratios. RESULTS: 21 studies met inclusion criteria totalling N=11,175 people out of which 1529 had major depressive disorder according to a gold standard. 19 of the 21 included studies reported data for a cut-off point of ≥3. Pooled sensitivity was 0.76 (95% CI =0.68-0.82), pooled specificity was 0.87 (95% CI =0.82-0.90). However there was substantial heterogeneity at this cut-off (I(2)=81.8%). 17 studies reported data on the performance of the measure at cut-off point ≥2. Heterogeneity was I(2)=43.2% pooled sensitivity at this cut-off point was 0.91 (95% CI =0.85-0.94), and pooled specificity was 0.70 (95% CI =0.64-0.76). CONCLUSION: The generally lower sensitivity of the PHQ-2 at cut-off ≥3 than the original validation study (0.83) suggests that ≥2 may be preferable if clinicians want to ensure that few cases of depression are missed. However, in situations in which the prevalence of depression is low, this may result in an unacceptably high false-positive rate because of the associated modest specificity. These results, however, need to be interpreted with caution given the possibility of selectively reported cut-offs.
Authors: Sanjay Basu; Bruce E Landon; John W Williams; Asaf Bitton; Zirui Song; Russell S Phillips Journal: J Gen Intern Med Date: 2017-12 Impact factor: 5.128
Authors: Miyabi Ishihara; Daphna Harel; Brooke Levis; Alexander W Levis; Kira E Riehm; Nazanin Saadat; Marleine Azar; Danielle B Rice; Tatiana A Sanchez; Matthew J Chiovitti; Pim Cuijpers; Simon Gilbody; John P A Ioannidis; Lorie A Kloda; Dean McMillan; Scott B Patten; Ian Shrier; Bruce Arroll; Charles H Bombardier; Peter Butterworth; Gregory Carter; Kerrie Clover; Yeates Conwell; Felicity Goodyear-Smith; Catherine G Greeno; John Hambridge; Patricia A Harrison; Marie Hudson; Nathalie Jetté; Kim M Kiely; Anthony McGuire; Brian W Pence; Alasdair G Rooney; Abbey Sidebottom; Adam Simning; Alyna Turner; Jennifer White; Mary A Whooley; Kirsty Winkley; Andrea Benedetti; Brett D Thombs Journal: Depress Anxiety Date: 2018-09-20 Impact factor: 8.128
Authors: Yin Wu; Brooke Levis; John P A Ioannidis; Andrea Benedetti; Brett D Thombs Journal: Psychother Psychosom Date: 2020-08-19 Impact factor: 17.659
Authors: Jennifer Ferrar; Gareth J Griffith; Caroline Skirrow; Nathan Cashdollar; Nick Taptiklis; James Dobson; Fiona Cree; Francesca K Cormack; Jennifer H Barnett; Marcus R Munafò Journal: J Med Internet Res Date: 2021-06-18 Impact factor: 5.428