Yin Wu1,2,3, Brooke Levis1,3, Kira E Riehm1, Nazanin Saadat1, Alexander W Levis1, Marleine Azar1, Danielle B Rice1,4, Jill Boruff5, Pim Cuijpers6, Simon Gilbody7, John P A Ioannidis8, Lorie A Kloda9, Dean McMillan7, Scott B Patten10,11, Ian Shrier1,3, Roy C Ziegelstein12, Dickens H Akena13, Bruce Arroll14, Liat Ayalon15, Hamid R Baradaran16,17, Murray Baron1,18, Charles H Bombardier19, Peter Butterworth20,21, Gregory Carter22, Marcos H Chagas23, Juliana C N Chan24,25,26, Rushina Cholera27, Yeates Conwell28, Janneke M de Man-van Ginkel29, Jesse R Fann30, Felix H Fischer31, Daniel Fung32,33,34,35, Bizu Gelaye36, Felicity Goodyear-Smith14, Catherine G Greeno37, Brian J Hall38,39, Patricia A Harrison40, Martin Härter41, Ulrich Hegerl42, Leanne Hides43, Stevan E Hobfoll44, Marie Hudson1,18, Thomas Hyphantis45, Masatoshi Inagaki46, Nathalie Jetté10,11,47, Mohammad E Khamseh16, Kim M Kiely48,49, Yunxin Kwan50, Femke Lamers51, Shen-Ing Liu35,52,53,54, Manote Lotrakul55, Sonia R Loureiro23, Bernd Löwe56, Anthony McGuire57, Sherina Mohd-Sidik58, Tiago N Munhoz59, Kumiko Muramatsu60, Flávia L Osório23,61, Vikram Patel62,63, Brian W Pence64, Philippe Persoons65,66, Angelo Picardi67, Katrin Reuter68, Alasdair G Rooney69, Iná S Santos59, Juwita Shaaban70, Abbey Sidebottom71, Adam Simning28, Lesley Stafford72,73, Sharon Sung32,35, Pei Lin Lynnette Tan50, Alyna Turner74,75, Henk C van Weert76, Jennifer White77, Mary A Whooley78,79,80, Kirsty Winkley81, Mitsuhiko Yamada82, Andrea Benedetti3,18,83, Brett D Thombs1,2,3,4,18,84. 1. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. 2. Department of Psychiatry, McGill University, Montréal, Québec, Canada. 3. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada. 4. Department of Psychology, McGill University, Montréal, Québec, Canada. 5. Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada. 6. Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands. 7. Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK. 8. Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, California, USA. 9. Library, Concordia University, Montréal, Québec, Canada. 10. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 11. Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada. 12. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 13. Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda. 14. Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand. 15. Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel. 16. Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran. 17. Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK. 18. Department of Medicine, McGill University, Montréal, Québec, Canada. 19. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA. 20. Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia. 21. Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia. 22. Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia. 23. Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. 24. Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China. 25. Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China. 26. Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China. 27. Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. 28. Department of Psychiatry, University of Rochester Medical Center, New York, USA. 29. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. 30. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA. 31. Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany. 32. Department of Child & Adolescent Psychiatry, Institute of Mental Health, Singapore, Singapore. 33. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 34. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. 35. Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore. 36. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA. 37. School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 38. Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau Special Administrative Region, China. 39. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 40. City of Minneapolis Health Department, Minneapolis, Minnesota, USA. 41. Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 42. Depression Research Center of the German Depression Foundation and Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany. 43. School of Psychology, University of Queensland, Brisbane, Queensland, Australia. 44. STAR-Stress, Anxiety & Resilience Consultants, Chicago, Illinois, USA. 45. Department of Psychiatry, University of Ioannina, Ioannina, Greece. 46. Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan. 47. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 48. School of Psychology, University of New South Wales, Sydney, Australia. 49. Neuroscience Research Australia, Sydney, Australia. 50. Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore, Singapore. 51. Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. 52. Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan. 53. Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan. 54. Department of Medicine, Mackay Medical College, Taipei, Taiwan. 55. Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 56. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 57. Department of Nursing, St. Joseph's College, Standish, Maine, USA. 58. Department of Psychiatry, Faculty of Medicine and Health Sciences, Cancer Resource & Education Centre, Universiti Putra Malaysia, Serdang, Selangor, Malaysia. 59. Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil. 60. Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan. 61. National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil. 62. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. 63. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. 64. Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 65. Department of Adult Psychiatry, University Hospitals Leuven, Leuven, Belgium. 66. Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium. 67. Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy. 68. Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany. 69. Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, Scotland, UK. 70. Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia. 71. Allina Health, Minneapolis, Minnesota, USA. 72. Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Melbourne, Australia. 73. Melbourne School of Psychological Sciences, University of Melbourne, Australia. 74. School of Medicine and Public Health, University of Newcastle, New South Wales, Newcastle, Australia. 75. IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia. 76. Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands. 77. Monash University, Melbourne, Australia. 78. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA. 79. Department of Medicine, Veterans Affairs Medical Center, San Francisco, California, USA. 80. Department of Medicine, University of California San Francisco, San Francisco, California, USA. 81. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK. 82. Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ogawa-Higashi, Kodaira, Tokyo, Japan. 83. Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada. 84. Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada.
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.
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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