Chen He1,2, Brooke Levis1,2, Kira E Riehm1, Nazanin Saadat1, Alexander W Levis1,2, Marleine Azar1,2, Danielle B Rice1,3, Ankur Krishnan1, Yin Wu1,2,4, Ying Sun1, Mahrukh Imran1, Jill Boruff5, Pim Cuijpers6, Simon Gilbody7, John P A Ioannidis8, Lorie A Kloda9, Dean McMillan7, Scott B Patten10,11, Ian Shrier1,2, Roy C Ziegelstein12, Dickens H Akena13, Bruce Arroll14, Liat Ayalon15, Hamid R Baradaran16,17, Murray Baron1,18, Anna Beraldi19, Charles H Bombardier20, Peter Butterworth21,22, Gregory Carter23, Marcos Hortes Nisihara Chagas24, Juliana C N Chan24,25,26, Rushina Cholera27, Kerrie Clover23,28, Yeates Conwell29, Janneke M de Man-van Ginkel30, Jesse R Fann31, Felix H Fischer32, Daniel Fung33,34,35,36, Bizu Gelaye37, Felicity Goodyear-Smith14, Catherine G Greeno38, Brian J Hall39,40, Patricia A Harrison41, Martin Härter42, Ulrich Hegerl43, Leanne Hides44, Stevan E Hobfoll45, Marie Hudson1,18, Thomas N Hyphantis46, Masatoshi Inagaki47, Khalida Ismail48, Nathalie Jetté10,11,49, Mohammad E Khamseh16, Kim M Kiely50,51, Yunxin Kwan52, Femke Lamers53, Shen-Ing Liu36,54,55,56, Manote Lotrakul57, Sonia R Loureiro49, Bernd Löwe58, Laura Marsh59, Anthony McGuire60, Sherina Mohd-Sidik61, Tiago N Munhoz62, Kumiko Muramatsu63, Flávia L Osório49,64, Vikram Patel65,66, Brian W Pence67, Philippe Persoons68,69, Angelo Picardi70, Katrin Reuter71, Alasdair G Rooney72, Iná S da Silva Dos Santos62, Juwita Shaaban73, Abbey Sidebottom74, Adam Simning29, Lesley Stafford75,76, Sharon Sung33,36, Pei Lin Lynnette Tan52, Alyna Turner77,78, Henk C P M van Weert79, Jennifer White80, Mary A Whooley81,82,83, Kirsty Winkley84, Mitsuhiko Yamada85, Brett D Thombs86,87,88,89,90,91, Andrea Benedetti2,18,92. 1. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. 2. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada. 3. Department of Psychology, McGill University, Montréal, Québec, Canada. 4. Department of Psychiatry, McGill University, Montréal, Québec, Canada. 5. Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, Québec, 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, United Kingdom. 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 and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom. 18. Department of Medicine, McGill University, Montréal, Québec, Canada. 19. Kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Lehrkrankenhaus der Technischen Universität München, Munich, Germany. 20. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA. 21. Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia. 22. Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia. 23. Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, New South Wales, Australia. 24. Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 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. Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, New South Wales, Australia. 29. Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA. 30. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 31. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA. 32. Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany. 33. Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore, Singapore. 34. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 35. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. 36. Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore. 37. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. 38. School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 39. Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau SAR, China. 40. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 41. City of Minneapolis Health Department, Minneapolis, Minnesota, USA. 42. Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 43. Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-Universität Frankfurt, German Depression Foundation, Frankfurt, Germany. 44. School of Psychology, University of Queensland, Brisbane, Queensland, Australia. 45. STAR-Stress, Anxiety and Resilience Consultants, Chicago, Illinois, USA. 46. Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece. 47. Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan. 48. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, London, United Kingdom. 49. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 50. School of Psychology, University of New South Wales, Sydney, New South Wales, Australia. 51. Neuroscience Research Australia, Sydney, New South Wales, Australia. 52. Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore, Singapore. 53. Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands. 54. Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan. 55. Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan. 56. Department of Medicine, Mackay Medical College, Taipei, Taiwan. 57. Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 58. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 59. Baylor College of Medicine Houston and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA. 60. Department of Nursing, St. Joseph's College, Standish, Maine, USA. 61. Cancer Resource and Education Centre, and Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia. 62. Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil. 63. Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan. 64. National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil. 65. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. 66. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. 67. Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 68. Department of Adult Psychiatry, University Hospitals Leuven, Leuven, Belgium. 69. Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium. 70. Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy. 71. Practice for Psychotherapy and Psycho-Oncology, Freiburg, Germany. 72. Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, United Kingdom. 73. Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia. 74. Allina Health, Minneapolis, Minnesota, USA. 75. Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, Australia. 76. Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia. 77. School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia. 78. IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia. 79. Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands. 80. Monash University, Melbourne, Victoria, Australia. 81. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA. 82. Department of Medicine, Veterans Affairs Medical Center, San Francisco, California, USA. 83. Department of Medicine, University of California San Francisco, San Francisco, California, USA. 84. Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom. 85. Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan. 86. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada, brett.thombs@mcgill.ca. 87. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada, brett.thombs@mcgill.ca. 88. Department of Psychology, McGill University, Montréal, Québec, Canada, brett.thombs@mcgill.ca. 89. Department of Psychiatry, McGill University, Montréal, Québec, Canada, brett.thombs@mcgill.ca. 90. Department of Medicine, McGill University, Montréal, Québec, Canada, brett.thombs@mcgill.ca. 91. Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada, brett.thombs@mcgill.ca. 92. Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada.
Abstract
BACKGROUND: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. OBJECTIVE: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. METHODS: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. RESULTS: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88). CONCLUSIONS: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.
BACKGROUND: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. OBJECTIVE: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. METHODS: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. RESULTS: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88). CONCLUSIONS: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.
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